Interviewed by Marilynn Larkin

Dora Akunyili, PhD, is Director General of Nigeria’s National Agency for Food and Drug Administration and Control. Her efforts to purge Nigeria of counterfeit drugs has led to world-wide acclaim. She has been profiled in Time, Newsweek, and other national and international media. Prof. Akunyili recently received a Human Rights Award in London for her heroic stand against Africa’s counterfeit drug makers. Prof. Akunyili is presenting a keynote address, Combating Counterfeit Drugs, at an SBS special event for conference participants and the general public. The event, Global Health Forum: Impact of Globalization on Drugs and Diseases, will take place on Tuesday, September 19th, at 4 pm.

What is your main message for drug-discovery professionals regarding their role in global health?

DA: I’m happy that new drugs are being developed. But I must also sound a note of caution. We know that many of the old drugs—for example, chroloquine for malaria—are no longer working because we’ve been using them for a long time, and resistant strains have evolved. But a large part of why we have antimicrobial resistance is because so many of the older drugs were counterfeited by criminals, and people have been taking drugs that either don’t have active ingredients at all, or they have a little bit of active ingredients, or somebody’s product has been copied and the activity can never be the same as the original drug. So I’m also happy that drug manufacturers are now recognizing that drug counterfeiting is a reality, that it’s destroying our health, and that we all should fight together because we’re working against an international criminal network. We can’t control it without international cooperation.

What role would drug companies play in this kind of cooperation?

DA: It’s time for drug companies to cooperate with regulators instead of shutting them out. In some parts of the world, such as Africa, drug companies try to prevent food and drug regulators from telling the world that a particular drug has a counterfeit because they are afraid that this will adversely affect sales of their genuine product. And so there has been pressure to hide the problem.

What about the recent WHO meeting that was convened to address the counterfeit drug problem?

DA: I was among the participants in the World Health Organization meeting convened in February 2006 in Rome, Italy, to address the “silent epidemic” of counterfeit drugs. It was noted there, as elsewhere, that trade in counterfeit drugs is extremely lucrative, thus making it attractive to criminal networks. A report released by the Center for Medicines in the Public Interest, in the United States, projected counterfeit drug sales to reach $75 billion in 2010, a 92 % increase from 2005. In my country, before we took action, about 80% of drugs were counterfeit.

To help counteract the problem, participants agreed to establish an international task force. This was a good beginning, but I said that we need to move quickly from a task force to a convention, so that we have something solid on ground. That’s because, despite our efforts, the counterfeiters are not getting ready to leave the scene. They’ve enjoyed this business for more than three decades. We have conventions for hard drugs and for chemicals, and yet drug counterfeiting has nothing. The problem can’t be compared to malaria or HIV, because malaria can be prevented and HIV can be avoided. It cannot be compared to hard drugs, because hard drugs like cocaine are taken out of choice, and by those who can afford it. So we need a convention where we all—governments, NGOS, industry, academia—contribute and work together on this platform.

Tell us a bit about the work you’ve done in Nigeria.

DA: I’ve worked hard to confiscate counterfeit medicines that purport to treat everything from malaria to tuberculosis to HIV/AIDS. All the antibiotics and antivirals we have for treating these diseases have counterfeits. If you take an antibiotic that has no active ingredient at all, you will continue to be sick. But if you take an antibiotic that has small doses of active ingredients, you create resistance. So when you eventually get a full dose of the real drug, it can’t cure you. What’s more, when a bug becomes resistant to antibiotic A, and that bug is transmitted to another person, then that person also has a resistant strain. And this resistant strain can travel anywhere. People forget that resistant strains have no boundaries—and resistant strains do not need visas to travel from country to country. This is what happened with chloroquine-resistant malaria. The drug companies are looking at new molecules, but they’ve forgotten that drugs we’re seizing in NAFDAC have little or no active ingredients. Resistance is a problem; people are not addressing it, and so we are spreading resistance from country to country.

SBS is inviting members of the US general public, students of public health, other public health officials to its Global Health Forum. What are your messages for them?

DA: Americans should be more vigilant when buying drugs, making sure to purchase them only in authorized outlets, not via the Internet. The Internet is supporting counterfeiting, even when the vendors and purchasers don’t realize it. When buying drugs, look carefully at the package of the medication. A counterfeit package may have a slightly different shape or color, or the way the numbers are written may be somewhat different. Counterfeiters rarely succeed in making exact copies. Take the old package and pills and compare them with what you’re buying. It sounds a bit childish, but it’s very important to put them side by side.

Let’s talk a bit about you. Did you always want to work in medicine and pharmacology?

DA: No. I had a problem as a child, in that I was an all-rounder. I could do any aspect of science. So when I was taking my examination to go to a university, I applied for engineering, mathematics, medicine, and pharmacy, knowing that I would probably get accepted to all of them. I really wanted to go into mathematics, but my mother was against that because she thought all mathematicians were crazy. Eventually, I settled for pharmacy because I had a childhood friend who was studying pharmacy. But then people started asking why I was studying pharmacy and not medicine? The pressure became too much, and so I went to the president of the university, who gave me a letter of introduction to a professor at the school of medicine. He was impressed, and told me to come on Friday of that week.

Until this day, I cannot tell you why I did not go back. I continued with pharmacy, and I look back now and say ‘ok, why did I do that?’ And it was because in pharmacy, you have mathematics and chemistry—my two favorite subjects—and so that led me to do what I enjoy. Somewhere at the back of my mind I regretted not going into medicine, but I stopped regretting it when I got this job offer. If I had done medicine, I would not be in this job. And so I believe everything has actually been fashioned by the invisible hand of God, even when you don’t understand why.

Did you have a mentor? Or have you been on your own in taking this important, but obviously perilous path?

DA: I adored my Dad. He was one of the most intelligent human beings I’ve ever known. He was brilliant, had wonderful public relations skills, and even though he was a rich man, he had sympathy for the poor. I adored him and he was inspiring. Outside of my Dad, I didn’t really have another role model unless it’s Mother Teresa. She cut across nations, cut across color, cut across religion. She was respected by every head of state. I work so much to be like her—to not only attain a level where everybody will be happy, but where they will feel the impact of the good that can help me to make it to heaven.

You have been in your current position since 2001. You have risked your life to make an impact against counterfeit drugs. Do you have any plans to retire?

DA: No. I don’t know. Although I love my work, the problem is with my family. They are constantly under tension, and it’s not good for their health. The stress they’re going through I compare to stress that children and parents go through when they are living in a war zone. They’re living every day wondering if something will happen to me, and I don’t blame them when they say, “enough of this.” They said it when I was shot in 2003, and I told them that if I quit because I was shot, that would be victory for drug counterfeiters, and all that we have done will come to nothing.

I have the support of Nigeria’s President and of the Nigerian people. Even though I am a Christian, people pray for me in churches and mosques all over the country. This support encourages me to continue. I also do not want to dash people’s hopes. For me too, quitting amounts to failure. And I know that If I die in this job, I will be dying for a right cause.