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Opinions of Tuesday, 20 October 2020

Columnist: Adekunle Yusuf

Corruption, drugs over-pricing hampering war against HIV

With the huge burden of having the second largest HIV epidemic in the world, Nigeria literally has its plate full in terms of public health challenges. Despite drops in prevalence in recent years, no fewer than 1.8 million people are living with HIV in the country, with UNAIDS estimating that around two-thirds of new HIV infections in West and Central Africa in 2019 occurred in Nigeria.

While many public health experts have applauded the considerable reduction in AIDS-related deaths in the country, reliable data showed that an estimated 45,000 people still died from AIDS-related illnesses in Nigeria in 2019, leaving the ambitious 90-90-90 goal a tough task in a country with one of the lowest levels of treatment coverage. This means all hands need to be on the deck at all levels of response to scale up testing, counseling, and treatment, especially the availability of antiretroviral treatment among population segments most affected by HIV in Nigeria.

Unfortunately, the goal of ramping up antiretroviral treatment may not be possible, despite local and international efforts geared towards ridding the country of the much-dreaded virus. According to the Civil Society Legislative Advocacy Centre (CISLAC) and Transparency International Nigeria, the goal to achieve total elimination of the virus from the country is increasingly thwarted by contractors who act as middlemen between antiretroviral drug manufacturers and the National Agency for the Control of AIDS (NACA).

Decrying the greedy role of middlemen, CISLAC, and TI said Nigeria loses about N8.5bn each time NACA procures antiretroviral drugs through private contractors. The two bodies said private contractors now act as saboteurs to the national aspiration to sustain free anti-retroviral drugs for people living with HIV/AIDS in the country. While addressing newsmen in Lagos recently, Auwal Musa Rafsanjani, executive director of CISLAC/TI, said the private contractors operate through a complex network that includes powerful insiders in government to defraud the country. To achieve their unwholesome mission, all the contractors do is to frustrate every effort by the government to procure antiretroviral drugs directly from original manufacturers, Rafsanjani said.

With middlemen’s activities, a product released at $7 by the manufacturers (including landing costs) always ends up costing as high as $13 when private contractors, who incur no other costs on the product, are involved – almost doubling the price. Inflated prices quoted by supplying contractors to render the supplies inadequate to eliminate the virus, he insisted.

“As the Nigerian government struggles to sustain the provision of free antiretroviral drugs as part of HIV programmes at health facilities in the country for an estimated 3.1 million people living with HIV/AIDS, this effort is mostly sabotaged by inflated prices quoted by supplying contractors, whose activities render the supplies inadequate to eliminate the high and sometimes inequitable economic burden of HIV/AIDS on households. This exorbitant prices quoted by existing contractors renders the government financially incapacitated to adequately provide for, and make anti-retroviral drugs accessible across health care facilities, which records resultant regular stock-out, health hazards, and relapse of illnesses.

“We observed the strong resistance by some contractors with support of some insiders to prevent NACA from buying HIV drugs directly from original manufacturers which allow Government to put more people on treatment. Giving the existing cost-efficient practice by the United States and Global Fund involving the direct purchase of the drugs from the manufacturers, we are worried by the ill-informed, pocket-serving and discrediting petitions by some vested interests, who have endlessly benefited from inflated prices of the drugs in the last five (5) years, to discourage the ongoing effort of NACA to directly source the drugs primarily for sustainability and wider coverage,” Rafsanjani said.

NACA DG Dr Gambo Aliyu last year unfolded plans to launch a $150 million HIV Trust Fund. The fund will provide the seed money that can “help Nigeria to cross the bridge when it gets there.” The trust fund is meant to prepare the country for the ultimate ownership, management, and funding of all activities geared towards the control of HIV/AIDS.

“The key thing is that if you can achieve three things: if you can get 90 per cent of people in society to undergo HIV test and get 90 per cent of those who know they have HIV to access treatment and get 90 per cent of those on treatment to take the treatment seriously and make sure it works very well in suppressing the virus in the blood. Once that is achieved, you are tending to what we call control of the epidemic. What happens after you control the epidemic is that you will be required to sustain it. And sustainability means you no longer have new cases of HIV or very few transmissions are taking place or very few people are dying because they are getting good treatment.

“But you still have one issue to deal with. That is, these guys that are taking the drugs must continue to take the drugs and continue to have their blood tested for the virus to see whether the virus is under check. So that will be the challenge for Nigeria because the funding we are getting from international donors will not be there forever. There is a level upon which the funders begin to divert resources to where the epidemic has not been controlled. Since your own has been controlled, they will want you to take the responsibility and taking that responsibility is where the issue lies. My goal in the next four years is to make sure that that sustainability path is created and actualised. And for this, we are looking at bringing in the private sector to participate in supporting HIV services in Nigeria,” Aliyu said.

While backing efforts to take ownership of the fight against the virus, CISLAC/TI expressed concerns over Nigeria’s continued dependence on foreign donors who fund the fight against HIV/AIDS in the country, including the purchase of anti-retroviral drugs. The funders could one day stop funding of the fight, thereby jeopardising the lives of over 3 million Nigerians living with the virus. “We are also concerned that over-reliance on donor funds in the fight against HIV in the country constitutes a dangerous trend to sustainability, hence the need for the government to take full ownership in the prevention and treatment of HIV in the country,” CISLAC/TI stated.

Rafsanjani, who commended NACA’s decision to start purchasing anti-retroviral drugs directly from the manufacturers at half the cost quoted by the private contractors, also stressed that the move will make it possible to have more drugs to achieve wider coverage even within available resources. “We acknowledge NACA’s plan to establish an HIV Trust Fund driven by the private sector to support existing efforts of the government; we observe that without current support by US and the Global Fund, it would cost Nigeria N50 billion to treat one million people living with HIV annually.”

As a longer sustainability plan, Adeshina Oke, a lawyer and board member of CISLAC, said pharmaceutical regulatory bodies like NAFDAC should begin to use their powers to encourage and empower local manufacturing of antiretroviral drugs. It is curious that a country blessed with many pharmaceutical companies is not yet producing antiretroviral drugs, he said. To redress this anomaly, Oke called for a review of heavy tax burden on the pharmaceutical sector to avert multiple taxations by local, state and federal governments as well as high tariffs on raw materials, packaging materials and other ancillary materials used to manufacture medicines.

“As we cannot depend on donors forever as a country, we must begin to look towards empowering our higher institutions for research purposes. These drugs could be a lot cheaper if they are manufactured here in Nigeria. Nigeria must empower her institutions so that they can be fit enough to uphold the country, should that day come and funding stops coming in for purchase of retroviral drugs. And the time to start preparing is now,” Oke said.

If these measures are implemented, the CISLAC board member said Nigeria will reap bountiful benefits in having a healthier citizenry, which he insisted every country needs to have a more productive economy.

“A sick country cannot have a good leadership; neither can it have a productive economy or citizenry. Hence, we must get read of anything capable of deteriorating our health as a nation,” he said.

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