This
89th National Conference of the Pharmaceutical Society of Nigeria
(PSN) is happening at a most critical time in the nation with the Nigerian
economy in a recession characterized by the decline in the official naira
exchange rate by more than 55% over the last one year. In the parallel market,
we see an even more significant decline in the exchange rate at more than 90%
over the same period. While the government would wish otherwise, the fact is
that most Nigerians and their business unless they are well connected, they
cannot source foreign exchange for their business in the official market. For
the Nigerian pharmaceutical industry that is virtually import-dependent from
raw materials to finished products, negative exchange rate movement at the
quantum we have seen has meant skyrocketing prices for pharmaceutical products
for those who could source forex. It has also meant reduced capacity
utilization for the pharmaceutical companies who are unable to source foreign
exchange for their raw materials. On the demand side, it implies expensive
medicines for the Nigerian people, far above their means and the
rationalization or the contraction of demand from retail to wholesale and the
factory gates. Indeed, the Pharmaceutical Society of Nigeria (PSN) has issued a
rallying cry to the government for some form of preferential treatment for
pharmaceutical imports given public health implications. The challenge however
for the Nigerian state is that it has to contend with other diverse priority
and preferential sectors such as petrol imports and cannot satisfy their forex
demand at current prices. I believe as argued in my earlier economic papers
titled “ Government must let markets work” published in leading Nigerian
newspapers that markets are the most efficient ways to allocate and price
scarce resources. Attempts to undo the market, even with patriotic intentions,
as we have seen with petroleum product markets create price distortions;
dis-incentivize private provision to complement public supply, that which is
critical in a period of fiscal constraints. It creates a parallel, rent seeking
market for the privileged few to make undeserved profits. The government must
stay committed to flexible, market-driven exchange rate policy, ensure
effective co-ordination of fiscal and monetary policies and deploy political
sagacity in the Niger Delta, to contain militancy and get oil production to
recover back to 2 million barrels a day from current 1.4million barrels. At
current oil prices of fifty dollars over the coming period, in addition to a
market driven exchange rate that eliminates speculation premium and distortion,
we should see private capital flows of forex returning. This along with higher
government revenue at fifty-dollar oil price and increased oil production
should improve foreign exchange supply and ultimately help the naira with the
wide positive spirals across the economy.
The
current situation however calls for a deeper reflection on how we would build
and develop a pharmaceutical industry that is increasingly less import
dependent, and by so doing can absorb the shocks of foreign exchange
volatility, which is inevitable in the boom, and bursts of global economic
cycles. In discussing the pharmaceutical industry contribution to national
development, this paper would be more forward looking on contemporary industry
and practice issues while recognizing where the industry is coming from. How do
we build a pharmaceutical industry that is competitive, at least in some areas
of the pharma industry value chain; and become a critical local player in
addressing the health needs of our people while also dominating the exports
market in the West Africa? Professor
Charles Soludo in his lecture titled “Can Nigeria Manufacturing and
Pharmaceutical Industry Compete” at the Nigeria Association of Industrial
Pharmacists Conference six years ago, in September 2001 x-rayed these issues.
The summary of Professor Soludo’s argument, which I extend further, are as
follows
a) The pharmaceutical industry
competitiveness cannot be divorced from the competitiveness of the overall
manufacturing sector and the Nigerian economy. Nigeria has consistently ranked
near the bottom on international competitiveness ratings such as the recent World Bank’s Ease Doing Business
(released last month) where Nigeria ranked 169th out of 190 countries, the
World Economic Forum’s Global Competitiveness Index (GCI) also released last
month where Nigeria dropped 3 places to 127th out of 138 countries and was only
better than countries like Serria Leone and Malawi, Mo Ibrahim’s Africa governance index (36th
out of 54 countries), Transparency International’s corruption perception index (136th)
, UN’s Human Development Index , Failed State Index where Nigeria is in the top
15 of the most fragile states in the world . The competitiveness issues where
Nigeria has consistently scored low include infrastructure, access to finance,
security, corruption and governance, quality of education, skilled manpower and
labour productivity. This low competitiveness prevents Nigeria from benefiting
from the “flying geese” economic theory model that says that when labour cost
increases in developed markets, old technologies, factories and production
moves from developed countries to lesser-developed countries with cheaper
labour cost. China and Japan benefitted from these model as factories moved
production from the US and Europe to China. You will recall that this is one
the electoral campaign issues of Mr. Donald Trump in the current American
elections incidentally holding today, the opening day of the 89th PSN
conference. It should normally have been expected that as China gets more
prosperous with wages and labour cost increasing, that global factories and
production will then also move to Africa especially Nigeria, given our huge
population. This is however unlikely to happen as we do not have the basics in
place, like infrastructure, governance, transparency and regulation, skilled
and vocational workforce to harness this economic dynamic. The extension of
this argument is that while we have seen global pharmaceuticals in a flying
geese from Europe (Beechams and Wellcomes in the UK) to Asia (in the Ranbaxys
in India), unless we deploy the right economic and governance actions, we may
not see the pharmaceutical geese flying from Asia to Africa or Nigeria. The
geese may be stuck in Asia, in India and China for a long time to come. This is
essentially what we have today with the Nigeria pharmaceutical industry with
Western multi-nationals dominating advance medicines category and the Indian
and Chinese companies dominating the manufacturing of basic medicines , leaving
our local players to be largely importers of finished products or raw materials.
What must we do to make the
pharmaceutical industry geese fly to Nigeria in Africa from India and China in
Asia?
a) Nigeria must develop and adopt a formal
comprehensive “National Strategy and Plan of Action for Pharmaceutical
Manufacturing”. While researching this paper, I was shocked to see that right
under our eyes, some smart African countries like Ethiopia have developed such
framework and implementing such , essentially leaving Nigeria behind. The
following recommendations on the issues, which the National Strategy and Plan
of Action for Pharmaceutical Manufacturing must address, is largely adapted
from the Ethiopian framework.
1. Improvement
of access to medicines through quality local production and implementation of
the Good Manufacturing Plan Road Map. Nigeria now has four local companies
certified as compliant with WHO Good Manufacturing Standard. We congratulate
them on the achievement. We however need to make such standards the norm and
not the exception. A formal public and private, inter-sectorial partnership,
involving the Federal Ministry of Health, Federal Ministry of Trade and
Industry, NAFDAC, PGMAN and the PSN need to be deployed to make this happen.
Ladies
and Gentlemen, I will like you to specially notice the role of bodies outside
the health sector like the Federal Ministry of Trade and Industry in this task.
This is because the issues that we face and we seek to tackle while they are
health sector issues, they are also larger national economic and development
issues for which we will need to deploy cross-ministerial lobbies from Finance,
Budget and Planning, Health, Trade and Industry including the support of
multi-lateral agencies. This is indeed the model that has been deployed in
Ethiopian Plan of Action.
2. Secondly,
we must strengthen the National Medicine Regulatory System. We must
continue to strengthen efforts and capacity to eradicate fake drugs and
medicine in the pharmaceutical supply chain.
3. Thirdly,
we must create incentives to move our local companies progressively along the
pharmaceutical industry value chain from importation of finished products to
local manufacturing. We must drive import substitution more aggressively.
Government must deploy incentives that moves local players increasingly from
importation and distribution of finished pharmaceutical products (Level 1 of
the pharmaceutical value chain) to
packaging and labeling of imported bulk finished products (Level 2) and then to real product
manufacturing which is the manufacturing of finished products from imported
active pharmaceutical ingredients (APIs)LEVEL 3, and then to local Active Pharmaceutical
Ingredient manufacturing in Nigeria at Level 4) and ultimately Research and
Development of new chemical or biological entities( Level 5) .
An
empirical audit of the distribution of local players in the pharmaceutical
industry value chain will suggest that most of our local play is largely
between Levels 1 and 3 with about 90% of local players largely in the
importation and distribution of finished pharmaceutical products in Level 1 and
just about 10% of local players in packaging and labeling and product
manufacturing according UNIDO Pharmaceutical Sector report on Nigeria in 2011.
To encourage local manufacturing, government must deploy incentives that
encourage importers to become local producers through the right discriminatory
tariffs and tax policies. The current ECOWAS unified tariff model where tariffs
on imported finished pharmaceutical products are lower than pharmaceutical raw
materials for local manufacturing therefore needs to be reviewed. It delivers exactly the opposite of this
policy objective. It dis-incentivize local manufacturing while encouraging
importation of finished products. It kills local jobs in the Nigerian
pharmaceutical manufacturing industry while creating jobs in in China and
India.
Other
incentives will include the encouragement of pooled procurement of raw
materials to get scale and cost benefits for local manufacturers, a firm formal
policy to patronize local players and local products by government, where there
are local manufacturing capacities, where prices are competitive and there is
adequate compliance to Good Manufacturing Standards. Similar policies are being
implemented called “Local Content” policy in the oil industry to encourage
local players. Federal, States and local governments should implement such
“local content” policy in their procurement of drugs and medicaments.
4. Fourthly,
we must develop our human resources and local technical capacity through
relevant education and training. We must build a stronger
university-industry partnership to promote technology innovation,
entrepreneurship, supply chain and regulatory management to support the
progressive movement of the local pharmaceutical industry to higher levels of the
value chain.
5. Fifthly,
we must develop geographic clusters for the production of active pharmaceutical
ingredients (APIs). In locations around Lagos, Onitsha and Kano where the
pharmaceutical forward supply chain is well-developed, deliberate pharmaceutical
industry clusters or industrial parks could be developed that bring local
players and their value chain suppliers together with adequate and shared
infrastructure for good pharmaceutical manufacturing and distribution.
Industrial clusters development in a country with constrained resources allows
resources to be concentrated in fewer geographic locations at levels above the
minimum effective threshold, that support industrial development rather than
scattering them uncoordinatedly and ineffectively across the country. Can we
for example plan a pharmaceutical cluster at the Lekki Free Zone around the
petrochemical refineries coming on stream and build geographic, and value chain
complementarities to support the manufacturing of Active Pharmaceutical Ingredients?
(Igwillo, 2016)
6. Lastly,
we must develop a national system to coordinate health technology research
across our universities and research institutes working closely with industry.
While
addressing the above issues, we must continue to put pressure on government to
deal with all the issues constraining our broader national development, such as
infrastructure, ease of doing business, quality of education, labour
productivity and skilled work force, security, governance and the cankerworm of
corruption. These issues, as earlier discussed provide the macro context to
support the implementation of the National Strategy and Plan of Action for
Pharmaceutical Manufacturing”. They are the macro level issues that have made
the manufacturing geese unable to fly to Africa from Asia as it flew from
Europe to Asia. We should therefore commend the government for its latest move
to deal with corruption in the Nigerian judiciary even if by extra-ordinary
means. A corrupt judiciary is dangerous for business. A corrupt judiciary means
contracts cannot be enforced. A corrupt judiciary means there will be no
remedies for the breach of business contracts. It means a rule of the jungle, a
state of anarchy, a business market in which there are no rights, rules or
remedies. In such situations, business
and markets will malfunction or absolutely collapse to the detriment of
national development.
Lessons from India and Brazil:
Ensuring a non-stunted development of the Nigerian local pharmaceutical
manufacturing base.
Mr.
President, distinguished fellows, ladies and gentlemen, the evolution of the
pharmaceutical industries in Brazil and India can teach us important lessons in
how to ensure that the growth of the Nigerian pharmaceutical industry does not
become stunted. Today, the world
recognize India as an emerging power in the
manufacture and export of generic medicines but little is heard of the
Brazilian pharmaceutical industry. This
is despite the fact that both countries had similar growth ambition and similar
opportunities of the relaxed intellectual property right protection environment
in the pre-TRIPS era of the international pharmaceutical market. TRIPS is the
World Trade Organization (WTO) Trade-Related Aspects of Intellectual Property
Rights Agreement (TRIPS) which sets the minimum standards for the protection of
intellectual property, including patents for pharmaceuticals. Guennif and
Ramani (2010) in their seminal work titled “Catching up in pharmaceuticals: a
comparative study of India and Brazil have identified the following factors for
the strong growth trajectory of the local Indian pharmaceutical industry
compared to the stunted growth of the pharmaceutical industry in Brazil.
a) A
consistent, long commitment and execution by the Indian government of an import
substitution model, relative discriminatory tariffs that incentivize local
production compared to a vacillating commitment of generations of Brazilian
governments to import substitution policy. Guennif and Ramani identified
the presence of two powerful opposing lobbies in Brazil of local manufacturers
pushing import substitution agenda and a counter powerful lobby that pushed for
open and unrestrained market for drug importation, actively supported by the
multi-national companies (MNC) and the Washington multi-lateral agencies with
the argument that unrestrained market will attract more Foreign Direct
Investments. India put up a more united
front and selectively implemented the advice of the Washington consensus and
the MNCs. Guerniff and Ramani (2010) and Nassif (2007) concluded that the
vacillating commitment and the poor implementation of import substitution
policy by the Brazilian governments had been disastrous for the Brazilian
pharmaceutical industry.
b) Role
of local players and their different perceptions of opportunities. Whereas
Indian local players saw the pre-TRIPS relaxed Intellectual property
environment as an opportunity for duplicative imitation of western medicines
and mobilize in series of Schumpeterian innovation, competing among themselves
to exploit it for their local huge market and then for export, the Brazilian
local players preferred importation of bulk drugs and raw materials. The
Brazilian local pharmaceutical firms copying the multi-nationals in fact spent
more on commercialization and marketing of products rather than investments in
local manufacturing.
Our
local pharmaceutical industry in Nigeria seem to be following the glide path of
a Brazil rather than an India. We seem to be unable to build a consensus even
among ourselves in the Pharmaceutical Society, that for the long term good of
the industry and for the creation of local jobs, we should be united in
supporting an import substitution policy that encourage local manufacturing. It
is important to emphasize that import substitution policy does not mean a
discrimination against everything imported. A country like Nigeria with limited
local capacity for production and manufacturing of medicines will in-fact
damage public good and health care with such blanket discrimination against all
drug imports. The critical issue is to collaborate and identify the categories
and products where there are local capacity and implement progressive and
gradual import-substitution policy in these areas, with clear set goals and
timelines, and leave the rest for inevitable and necessary importation. The
local manufacturers must also produce to global standards and deliver prices
that are competitive. Import
substitution should never become a policy to promote and protect local
production inefficiency, which will be at the detriment of the consumer and
public good.
Pharmaceutical care: A Nigeria socio
economic context:
Now
that we have addressed the pharmaceutical manufacturing issues, let us now
address the delivery of pharmaceutical care. Pharmacists globally led by the
International Pharmaceutical Federation (FIP) and with the endorsement and
adoption by the Pharmaceutical Society of Nigeria have embraced the concept of
pharmaceutical care, which is defined by the University Of Oklahoma College Of
Pharmacy as the “responsible provision of drug therapy for the purpose of
achieving definite outcomes that improves the patient’s quality of life. These
outcomes are cure of a disease; elimination or reduction of patient's
symptomatology; arresting or slowing of disease process and the prevention of
disease or symptomatology. Pharmaceutical care involves the process through
which a pharmacist cooperates with a patient and other professionals in
designing, implementing, and monitoring a therapeutic plan that will produce
specific therapeutic outcomes for the patient. Pharmaceutical care is provided
for the direct benefit of the patient, and the pharmacist is responsible
directly to the patient for the quality of that care. The fundamental relationship
in pharmaceutical care is a mutually beneficial exchange in which the patient
grants authority to the provider, and the provider gives competence and
commitment (accept responsibility) to the patient.”
We
commend pharmacists in Nigeria for the adoption of this much-needed
patient-centred rather than drug-centred paradigm in pharmacy practice. You
will notice however that the definition of pharmaceutical care given above is
not situated in any specific socio-economic context. That definition is a western
and prosperous society definition of pharmaceutical care that assumes that the
patient can afford the medicines, will fully comply with their prescriptions
because they can afford them; and all that is left is for the pharmacist to
work with the patient closely to ensure that specific therapeutic outcome is
achieved. In reality, this would not work exactly like that, here in Nigeria
and in the third world given endemic poverty and acute socio-economic
inequalities that fundamentally constrains access to health care for the mass
of our people. The genuine execution of the concept pharmaceutical care must
therefore be situated in its broader socio-economic context and reality in
Nigeria. Nigeria has one of the highest socio-economic inequalities in the world
with a gini coefficient of 0.48 making it the 152nd worst unequal country in
the world out of 189 countries in income distribution. It should be noted that
social inequalities has progressively worsened in Nigeria with the top 30% of
the population controlling more than 80% of income while the rest of the
population sank deeper into unemployment, underemployment, poverty and misery.
Nigeria is rated as having the third highest concentration of poorest people in
the world according to the World Bank President, Jim Yong Kim in 2014. The
Nigerian middle class is no longer rising due to rising unemployment or
underemployment. 2% of customers control 90% of bank deposits in Nigeria
according to the Nigeria Deposit Insurance Corporation, a proxy for extreme
income concentration and inequality in Nigeria. When society gets more unfair,
with widespread sea of poverty surrounding islands of excessive wealth, genuine
pharmaceutical care can only become a mirage for the mass of people who cannot
afford medicines.
The
prosperity of many community pharmacists is tied to the prosperity of their
communities. If society continues to get
more unfair, only pharmacy shops in Maitama in Abuja, Victoria Island in Lagos
and Olu Obasanjo way in Port Harcourt will make it and be prosperous. The
prosperity of many of our community pharmacies is therefore tied to the
prospect of a fairer society.
Pharmacists and the Pharmaceutical Society of Nigeria can therefore not
be socially cocooned from the larger society and social injustice issues. It is
time to have a PSN that is more concerned about society than the pecuniary
interest of its members. It is time to
have a PSN that is less insular but have a stronger external orientation to
society as its primary stakeholder.
We
have made very significant progress in the PSN in this regards especially under
our current e leadership. More however still needs to be done to move from the
success achieved in commanding a new prestige for pharmacy to becoming a
champion of enabling access to genuine pharmaceutical and healthcare for the
mass of our people; to align with broader civil society movements to fight
endemic poverty, to push for a fairer society and lesser social inequities
without which genuine pharmaceutical care will be impossible in Nigeria. It is in our greatest interest to do so as
pharmacists for our prosperity is tied to the prosperity of our communities.
Pharmaceutical care, digital
technology and the pharmaceutical industry:
Mr.
President, distinguished fellow, ladies and gentlemen, let us now discuss
another critical subject, the subject of digital technology and how it is
disrupting many industries, in which the pharmaceutical industry will not be an
exception. It is very good to note that current President of the Pharmaceutical
Society of Nigeria, President Ahmed Yakassai leveraged and continue to leverage
the social media for his presidential campaign. The social media is becoming
the primary information and engagement media for many customers, even on their
health needs. Patients post online and in real-time, their experience of
medicines, they go to Wikipedia to search for pharmacological informations on
medicines even before they approach the health professional. The new and
emerging patient in the modern world of digital media is becoming more informed
on medicines, pharmacology and toxicology. When she visits the pharmacy or
medical clinic, she has questions already and clarifications to ask the
pharmacist and may even be aware of options to her prescriptions based on on-line
conversations with other patients. The pharmacy profession needs to re-invent
itself for this new digital world in which medical information is no longer an
exclusive privilege of the health professional. The new generations of patients
emerging will put health professionals on their toes to raise their game, to
raise their knowledge, to be a several steps higher than their patient, to
provide advisory and consulting services to informed patients rather than just
act as mere dispensers of medicines. New access models such as remote
consulting of the health professional will emerge, geographic boundaries of the
neigbourhood pharmacy may become irrelevant if an Abuja patient can leverage
the power of the internet to remotely access their pharmacist who is based in
Lagos. There will be disruption in distribution channels and service models of
health and pharmaceutical services. It does look to me from my distant
observation of the pharmaceutical society that we are still so much bogged down
with old analogue practice issues that we pay little attention to how the
future of pharmacy practice will change with digital technology. It will create
new opportunities for some, while it will leave others behind.
Mr.
President, distinguished fellows, ladies and gentlemen. Let me jolt you a
little bit. Imagine if the two biggest successful
e –commerce on line retail platforms in Nigeria that have disrupted fashion
retailing, imagine if they go into pharmaceutical on-line retailing. These
on-line retailers have become the
biggest retailers of fashion products in Nigeria, driving out many expensive
retail shops that used to be located on Allen Avenue and Awolowo road in Ikoyi
in Lagos. They are taking business even from the informal fashion product
traders in Tejuosho and Balogun markets, as their e commerce model delivers low
prices through scale and supplier aggregation model while also delivering
convenience for customers to shop without leaving their
homes.
On the global level, we see how Amzon.com has become the biggest book retailer
in the world through an e commerce model, driving incumbent book retailers to
the corner. Ladies and gentlemen, because pharmacy is a retail business, though
a specialized one, it will not be insulated from the disruptive trend going –on
in the digital space. If medicines are
sold as mere commodities in our pharmacies, like fashion and clothing items,
without any form of advisory service, we are creating a perfect condition for
disruption of retail pharmacy by scaled e commerce players.
We
must therefore not wait for the on-line retailers to disrupt us. We must
re-invent and disrupt ourselves before others disrupt us by accelerating our
appreciation and embracement of the new potentials of digital technology.
Conclusion:
Mr.
President, distinguished fellows, ladies and gentlemen, in concluding this
keynote address, let me say that this generation of pharmacists and
pharmaceutical industry managers face an historic task. This historic task is
how to take advantage of the current challenges of economic recession, scarcity
of forex for drugs and raw material importation, that threatens the survival of
the pharma industry, to reinvent the industry and build a strong local
manufacturing base for pharmaceutical products. It is no longer a task that can
be postponed for another generation.
Paraphrasing Okey Akpa, Chairman
of PGMAN in their presentation to the Nigerian Senate, that it is a question of
national security for a nation to have a minimum level of critical capacity to
produce the medicines it needs. There will always be global trade and relative
comparative advantages among nations for different products. However, to be
absolutely dependent on other countries, to produce very little, to bulk import
most medicines consumed, without a national structured articulated plan, with
specific goals and timelines to gradually replace a critical level of imports
by local manufacturing is tantamount to a pathological health crisis and
perpetual poor access to medicines.
The
pharmaceutical industry is unique. Its importance is far bigger than its
contribution to GDP. Nobel prize winner in economics, Joseph Stiglitz has
identified that GDP as a measure of economic performance, does not adequately
cover and measure real “well-being and the quality of life” of citizens of a
nation. The well-being of the people,
their quality of life and indeed their health are not necessarily the same
thing as production output and consumption data that conventional economics
measure in sizing the GDP. The
contribution of the pharmaceutical industry to citizen well-being and their
quality of life far exceeds what is captured by its size and share of national
GDP. We must therefore commission a new level of advocacy with government and
policy makers to appreciate better the pharmaceutical industry and urgently
address the disincentives to local pharmaceutical manufacturing because of its
importance to our citizen’s well-being. We must also become more visible in the
advocacy to improve the ease of doing business in Nigeria, to improve our
national competitiveness and create jobs for the mass of our youths. We must
become champions of a fairer society of shared prosperity, through our policy
lobby, for our collective prosperity is tied to the prosperity of our
communities and our neighborhoods. We must also reinvent pharmacy practice and
retail pharmacy to take advantage of digital technology, e commerce and remote
advisory services to deliver pharmaceutical care more efficiently and
innovatively.
Ladies
and gentlemen, the Pharmaceutical Society of Nigeria is about ninety years old
at this conference. The generations before us recognized their own place and
purpose in history and fulfilled their mission.
Let this generation too recognize its place and purpose in history and
fulfill its own mission.
Distinguished
fellows, ladies and gentlemen. Thank you for listening.
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Policies: Brazil and India in
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C.I ( 2016), Drug Research as a panacea for economic development, Businessday,
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