By Godwin Akpan, Uyo
Over the years, there have been serious concerns over the ills associated with the importation of syringes and needles into Nigeria.
Syringes and needles are essential medical products used for the administration of drugs parentally (intravenous, intramuscular, subcutaneous).
The concern has been that, besides the negative impact importation holds on the economy of the nation, most of these imported syringes and needles are already used equipment, hence, exposing the country to great risk of blood-borne diseases.
In Nigeria, it is estimated that the requirement of syringe and needle in the country is two billion units per annum. Out of this requirement, data shows that an estimated over one billion units per annum of syringes and needles are imported into the country, exposing the country to health hazards and loss of huge foreign exchange.
According to National Agency for Food and Drugs Administration and Control (NAFDAC), 70 per cent of medicine and medical equipment consumed in Nigeria is imported from South-East Asia, mainly China and India.
NAFDAC admits that part of the reason substandard medical products are imported is because of the compromise by some of her Clean Report of Inspection and Analysis (CRIA) Agents who conduct pre-shipment inspection and analysis of all NAFDAC regulated products exported from China and India into Nigeria.
The Agency also blames the fact that they were removed from the Port from 2011 through 2018. According to the Director General – DG of NAFDAC, Prof Mojisola Adeyeye, “During that time, cabals were formed. And you know you cannot remove cabals overnight. Removing such cabal from the port is not easy. And you think things will work well with them there? Certainly no. Not immediately”.
Senate to the rescue
Worried about the development, the Nigerian Senate on Thursday, February 11, 2021, raised alarm that majority of the syringes and needles imported into the country are substandard and unsterile.
They noted that these syringes imported from the Asian countries are used and rewashed and thereafter shifted into the country mainly through the boarders that are almost non-functional.
In a motion titled “The need to regulate the manufacturing, importation, and use of Syringes and needles to protect the lives and safety of Nigerians as well as the economy of the country” and sponsored by Senator Ibrahim Oloriegbe, APC, Kwara Central and co-sponsored by Senator Suleiman Umar, APC, Kwara North, Senate moved to take a holistic probe into the state of manufacturing, importation, and policy guideline for syringe and needles in Nigeria.
Health, economic implications
The Senate observed that the use of syringes and needles if not sterilized and of the right quality, could cause disease and even death to the patient. Hence, instead of being a life-saving instrument, it becomes a danger to the patient.
This observation is in line with the position of the World Health Organization (WHO). According to WHO, “Blood-borne diseases such as hepatitis B, hepatitis C and HIV/AIDS can be transmitted through unsafe injection practices, including overuse and more dangerously reuse of injection equipment.”
WHO says unsafe injections can also cause abscesses, septicaemia and nerve damage. They note that less frequently, haemorrhagic fevers and malaria can also be transmitted. Sadly, many become infected every year due to unsafe injection practices.
WHO mathematical modelling based study published in 2014, estimated the annual global burden of HBV, HCV and HIV as follows:
For Hepatitis B virus: 1.67 million HBV infections are associated with unsafe injections, Hepatitis C virus: 315,120 cases of HCV infections are linked with unsafe injections, HIV: 33,877 HIV infections are caused by unsafe injections. WHO adds: “These viruses can remain dormant in the body for a long time before the first symptoms start to appear. Thus unsafe injections can lead to a silent epidemic that occurs many years after the original unsafe injections which caused the infections.”
What is more, a study published in 2004 calculated the Disability-Adjusted Life Years (DALYs) in 2000-2030 for infections caused by unsafe injections in the year 2000. In 2000, contaminated injections caused an estimated 21 million HBV infections, two million HCV infections and 260,000 HIV infections, accounting for 32%, 40% and 5% of new infections respectively for a total burden of 9,177, 679 DALYs between 2000 and 2030. Experts have noted that the sad narrative will hamper Nigeria from attaining the Sustainable Development Goals -SDG on Good Health (SDG 3).
The syringe manufacturing industry is a developing sector in Nigeria. The country has eight existing manufacturing factories which cut across the Nation.
There are two each in Calabar and Ilorin, one each in Kaduna, Port Harcourt, Kano and the recent among them, Jubilee Syringe Manufacturing Limited, JSM, reported to produce over 700,000 syringes daily and over 350 million syringes yearly.
According to Senator Oloriegbe, the sponsor of the motion, investment in the manufacturing of syringes and needles is estimated to be about N64 billion with a potential market value of about N100 billion that could be created locally, engaging about 3,000 Nigerians directly.
He adds: “Certified and approved local manufactures of syringe and needles in Nigeria by the National Agency for Food and Drug Administration Control have the capacity to produce 1.6 billion units per annum.
“In spite of this capacity, an estimated over 1 billion units per annum of syringe and needles are being imported into the country making the country to lose huge foreign exchange.”
This negative development has been noted by experts as having the potential to thwart Nigeria’s prospect of reaching the Sustainable Development Goals (8) which focuses on Good Job/Economic Growth.
Why importation continues
Experts have noted that importation of syringes into the country goes on unabated due to adverse government policies. They point out that duty on imported machinery to set up these units remain high, whereas import of finished syringes and needles is very cheap in the interest of consumer. As a result, most of the manufacturers are challenged in business.
This point is collaborated by Senator Oloriegbe. He notes that in spite of the introduction of 75 per cent import duties on imported syringes and needles, the Nigerian Customs department was not enforcing this.
He adds: “The Federal Ministry of Health does not have an effective policy on the procurement and utilization of syringe and needles by the federally-owned hospitals and agencies.” This means that even the Federal Government Hospitals still patronize imported syringes and needles.
Contacted, Director-General of NAFDAC, Prof. Adeyeye, gives a fresh perspective on the issue. She offers insight to the fact that why substandard syringes and needles are imported is because most of the exporting companies in China and India are known to present NAFDAC with ideal formulation (samples) to get approval but later shift in substandard or already used syringes with NAFDAC approved number.
Besides that, she notes that the neo-colonial mentality is another discouraging factor. She says most Nigerians have the wrong perception that anything imported is original hence in the process abandon the locally made syringes which may be of higher quality and safer than the ones imported. How then can this concern be addressed?
Experts have opined that Nigeria has the capacity to stand tall in the comity of Nations in the production of syringes since the raw materials for the manufacture of syringes are gotten from crude oil. They insist that Nigeria is one of the world’s leading oil-producing countries, hence it is expected that it is better positioned to be a major producer of syringes.
According to chairman of Jubilee Syringe Manufacturing Limited, Onur Kumral, to change the narrative, government must show substantial commitment in polices that will encourage patronage of syringes produced in Nigeria and also attract more investors in the country.
For the DG of NAFDAC, the solution lies in government not only discouraging importation of syringes and needles, but also taking practical steps to encourage companies who meet standard of production in Nigeria. Her reason? “We (NAFDAC) can easily deal with local manufacturers as compared to manufacturers in other countries.”
She assures that the agency at the post-marketing level surveillance has made provision to delist companies that import unsafe or substandard medical equipment.
However, the local manufacturers won’t have the privilege on a platter. Adeyeye notes, “NAFDAC is using international standard. We are answerable to WHO standard. We cannot allow substandard medical equipment, especially syringes and needles in the name of promoting local manufacturers. These companies should have innovative products. It must be standard. Their products must be science driven like what Jubilee Syringe has shown in the last few years.”
While expressing delight over the quality of syringes and needles so far produced in Nigeria, she advises: “It does not mean we will be perfect overnight. That is how China started and now they are leading the world market. We must not say we have not gotten much from Nigeria but we have to do more. We have to develop a different paradigm of thinking. If we keep the faith, we will succeed as a country and our syringe manufacturing companies will grow”.