How to ensure drug, medical supplies as COVID-19 locks down nations

The President of the Pharmaceutical Society of Nigeria (PSN), Mazi Sam Ohuabunwa, in this interview with CHUKWUMA MUANYA, recommends how the federal government can prevent a shortage of essential drugs and medical supplies, such as face masks, gloves, sanitisers, Personal Protective Equipment (PPE) and other medical supplies, as most countries enforce total lockdown due to COVID-19 pandemic.

What is your take on the current Global Shortages And Situation In Nigeria?
The world is already facing monumental shortages of medicines and particularly of medical supplies in North America, Europe, Asia and Africa primarily due to the lockdown of factories in China, the global epicentre of the COVID-19 health crisis. China has become the world’s manufacturing site due to its competitiveness and without anticipating this kind of phenomenon, most countries became over-dependent on China. 
 
However, many of the developed countries have residual manufacturing capacity they are activating to bridge the gap, yet shortages of PPE, facemasks and especially ventilators persist even in America, Canada and UK.

The US has also run out of hydroxychloroquine even for those who are on the drug for other ailments.
 
In Nigeria, we are facing a moving situation. Because of our over-dependence on the importation, we were hit directly by the shutdown in China and India. Indeed, many countries with export capacities are focusing first on their domestic needs. The local industry has scrambled to meet the needs of such things as hand sanitisers and hygiene products, though prices are rising purely due to market responses.

For items, such as face masks, goggles, professional protective equipment and respirators, we are facing a major challenge, though some relief may be coming from donations from China. 

Thirdly, we must deliberately expand local production capabilities for raw materials and finished pharmaceuticals and medical supplies. That is a medium to long-term measure to deal with this problem if it lasts longer than we estimated or to prepare for the next cycle. 

Fourthly, the federal government should mandate specific research efforts to produce local medicines that will be useful in this and future viral epidemics. We should, therefore, start preparing for the next epidemic today.

Again, the government should invest in conducting clinical trials on some of the locally identified candidates today, including Hydroxychloroquine. 

Could The CBN/Bankers Committee’s N100Billion be the solution? 
It certainly is the beginning of the solution. We have repeatedly drawn attention to the need to provide special funding for the pharmaceutical sector to enable it to expand capacity and capability to produce locally.

We have also complained of the inability of the private sector to invest in research and development with short-term funding from our commercial banks. So, it is very reassuring that the CBN has come to the conclusion that there is no other way to go than to develop our local capabilities to produce local raw materials, finished pharmaceutical products and medical supplies (surgical and protective equipment).

It has now been proven that lack of medicines is a national security issue. However, N100billion only will not do it, but it is a good start and that is why we have applauded the CBN governor and other members of the Bankers Committee for taking this initiative.

What is PSN doing to support the fight? 
We are doing quite a bit. First, we have raised awareness amongst all pharmacists.

Secondly, we are involved in raising awareness and promoting the adoption of preventive and protective measures in the communities.

Thirdly, we have pushed for increased supply of necessary medicines and protective equipment from the manufacturers and distributors.

Fourthly, we have issued professional advisory notes to our members not to hoard the products that are in high demand, such as facemasks, gloves, hand sanitisers and other hygiene products. We have set up surveillance and oversight committees to prevent profiteering.

Our members have embarked on massive production of hand sanitisers and disinfectants/ antiseptics and some of these are being donated to government agencies and distributed among the vulnerable communities. 

Do we have local capacity to meet our needs?
As previously indicated, we do not have the capacity to meet ALL of our drug needs at this time. We have full capacity to meet certain categories of drugs, such as analgesics (paracetamol and aspirin), nonsteroidal anti-inflammatory drugs (piroxicam, ibuprofen, naproxen, etc), vitamins and minerals, cough and cold preparations, infusions (dextrose, normal saline), anti-helminthics (pyrantrin, mebendaxole, albendazole, etc), antiseptic /disinfectants (NCP, Dettol, etc), common antibacterials and antibiotics (tetracycline, Ampicillin, co-trimaxaxole, etc) several antifungals- oral and topical (tioconazole, iconazole, etc) and a few more.
 
We have good capacity for anti-hypertensives and anti-diuretics (amlodipine, nifedepine, lysonipril, enalapril, prazosin/ hydrochorothiazide, amilochloride/ hydrchlorothiazide, etc)

Last year, the PSN organised a roundtable with all stakeholders in the pharmaceutical space and set targets for production of some raw materials and excipients in Nigeria by 2022. But with the planned dedicated investment, we can begin to bridge the gaps and meet the targets we have set.

Is their synergy with other healthcare professionals?
Yes! Just last week, the harmony committee set up by PSN and NMA submitted its report and implementation has started.

This week, we have empaneled a committee of NMA, PSN and the NANM (Nurses and Midwives) to monitor the development in the cOVID-19 pandemic and to liaise with other stakeholders to recommend concerted interventions.

Gradually, harmony is returning to the health sector and I must thank the NMA President, Dr. Francis Faduyile, and his current executive for fully supporting the paradigm shift and helping restore the team spirit among the healthcare professionals.

What is your take on US President Donald Trump’s assertion on the efficacy of Chloroquine? 
It is true that President Trump has been marketing Chloroquine (hydroxychloroquine) and maybe Azithromycin for treating the disease, but his position has not been supported by scientists. The best we hear is of in-vitro studies and some limited in-vivo studies with anecdotal reports.

Trump is very eager to get America back to business and so will clutch at ever straw. As scientists, we depend on verified data. So, we are waiting for confirmed clinical trials to substantiate this claim.

But the important thing is that there is an existing protocol for managing COVID-19 patients. So, we do not recommend indiscriminate self-medication.

The appropriate health care professionals will make the decision on which medicines or cocktails will be beneficial to each patient, depending on the severity of the disease or on the underlying disease condition of the patient.

It is certainly not helpful to self-medicate without medical advice. 

Should NAFDAC fast-track approvals?
Yes, NAFDAC is rightly accelerating approvals of products and items that will be helpful in dealing with the pandemic. But they are not approving any medicine or protocol for treating the disease that has not been scientifically proven.

They are also approving products for clinical trials, and that is exactly what they are supposed to do. It is only when those products are proven clinically effective and safe that they will allow for full product registration and use in Nigeria.
 
Of course, in certain critical situations, they may make exceptions to allow use of experimental medicines to save the lives of patients at high risk in the absence of any other existing therapy or approved medicines.

How do we containing the pandemic? 
The PSN suggests as follows:
1. Enforce the social distancing directive across the nation.

2. Possibly a full lockdown of the major city centres, starting with Lagos and Abuja.

3. Fully manning interstate borders and maintaining surveillance.

4. Providing more testing than is currently done.

5. Maintain nation-wide campaign to nooks and crannies of Nigeria to teach Nigerians on personal hygiene and social distancing.

6. Governments at all levels to invest in buying hand sanitisers and facemasks and distributing to their constituents, especially those with low income or no income at all. 

7. Remove duties and levies on all healthcare, pharmaceutical and medical supplies imports for the next three months to keep prices stable.

8. The Custom to be directed to give accelerated clearance of all pharmaceutical and healthcare imports currently lying in the ports so that the gaps can be minimised.