President Bola Tinubu’s move to check the unprecedented increase in prices of medicines in the country through an executive order to introduce zero tariffs, excise duties and Value Added Tax (VAT) on imported pharmaceutical inputs is commendable. That is the immediate antidote to the undesirable and dangerous situation in which Nigerians have found themselves.
Before the President’s intervention, some stakeholders had started warning against national health crisis being precipitated by the hike in the prices of drugs, urging the Federal Government to return to the pre-2015 era of zero duty on importation of medicines. Indeed, life is becoming increasingly unlivable in Nigeria, particularly with the prices of medicines generally, and the essential over-the-counter drugs in particular, that have shot up by more than 200 per cent. It is worrisome that, like most foodstuffs and essential commodities in the Nigerian market, the prices of most medicaments and other essential pharmaceutical products, including those for hypertension and diabetes, have gone out of reach of the poor.
Apart from the fact that the essential drugs have become very expensive, they are also not available in most pharmacies and chemists. A market survey conducted by some pharmaceutical organisations recently showed scarcity and astronomical increase in prices of commonly used drugs such as Amlodipine, Meropenam injection, Omeprazole, Tetanus serum (ATS), and Vitamin B complex injection. The prices of hypertension and diabetes drugs have increased so much that most patients are discontinuing their medication. Some patients on insulin and Glibenclamide, who had been spending N14, 000 over the last 16 years to refill their medication, are now spending N29,800, which is twice the old price to do the same thing.
Similarly, the prices of some anti-malarial drugs have increased by 11 per cent to around 23 per cent between November 2023 and April 2024. In November last year, a 120mg Artesunate injection was sold for N2,500, while the 60mg injection was sold for N1, 800. The price of Coartem 80/480mg, which used to be around N3,300, has gone up to N4, 000. Amatem Soft Gel was sold for N2,500 but is now being sold for N3,000 – a 20 per cent increase. Lonart 80/480mg sold for N2,850 in the past but now sells for N3,500, representing 22 per cent increase.
The skyrocketing prices can be attributed to a combination of factors, including the fall in the value of the naira, unstable foreign exchange rates, reliance on imported active pharmaceutical ingredients, and the 20 per cent duty on drug importation. Because the naira has weakened very much against the Dollar, the expenses incurred in procuring these essential medical supplies have risen, consequently driving up the overall prices of medicines in Nigeria. The tragedy is that Nigeria’s pharmaceutical companies, who rely heavily on imported materials for manufacturing medicines, are producing at exorbitant costs. This creates a ripple effect, forcing manufacturers to increase the prices of medicines to cover their higher operational costs. Following the announcement of the exit of GlaxoSmithKline (GSK) from the Nigerian pharmaceutical market, there has been a notable surge in the prices of medications produced by the company. This has led to an unprecedented increase in drug prices in the Nigerian pharmaceutical industry.
Health is wealth. Commonsense teaches us that inability to access essential drugs in a country will lead to many untimely deaths. Moreover, when drug shortage consistently occurs, pharmaceutical and medicine shops are flooded with adulterated drugs and medical doctors may resort to suboptimal treatments that are less effective and increase the risk of antimicrobial resistance. Researchers warned that shortage of essential drugs, such as antifungal products, can lead to sporadic epidemic outbreaks. The sudden ban on essential drugs can have a widespread negative impact on healthcare delivery.
To address the high cost of medicines in Nigeria, some stakeholders advised that the 20 per cent duty imposed on drugs should be removed. Experts specifically urged the government to lift the ban on importation of essential medicines and pharmaceutical products such as antibiotics for fighting bacterial infections (levofloxacin tablets, ofloxacin tablets, tetracycline HCL capsules, doxycycline HCI capsules, penicillins, amoxicillin, and sampicillin + cloxacillin capsules, erythromycin tablets, chloramphenicol, and ciprofloxacin infusions); antifungals for mycotic infections e.g. athlete’s foot (clotrimazole tablets, fluconazole capsules); anti-hypertensives/anti-angina drugs (amiloride HCL 5mg + 50mg, amlodipine tablets, methyldopa 250 tablets, lisinopril tablets); anti-ulcer agents for treatment of ulcer in GERD (omeprazole, esomeprazole tablets, cimetidine tablets 200 mg, misoprostol tablets); analgesics/anti-inflammatory and antipyretic agents (paracetamol-containing tablets, capsules and syrups, diclofenac sodium/potassium tablets); anti-diabetic agents for treatment of diabetic patients (metformin tablets); cough preparations (all cough preparation syrups, liquids, and tablets); antihistamines for treatment of allergic rhinitis and other allergic reactions (diphenhydramine HCI syrup); benzodiazepines for reducing anxiety, seizures, relaxing muscles, and inducing sleep (diazepam, nitrazepam, bromazepam); vitamins/trace elements (vitamin C, yeast, etc.); corticosteroids for lessening swelling, redness, itching, and asthma (prednisolone); bronchodilators that relax and widen airways e.g., asthma; eye and ear drops (chloramphenicol eye drops, neomycin plus dexamethasone eye drops) and liquid mouthwashes and disinfectants.
The Coordinating Minister of Health and Social Welfare, Muhammad Ali Pate, who announced the Federal Government’s intervention, said the executive order was aimed at revitalising the Nigerian health sector and increase local production of healthcare products. Specifically, the order introduces zero tariffs, excise duties and VAT on specified machinery, equipment and raw materials, with a view to reducing production costs and enhancing local manufacturers’ competitiveness. The specified items include Active Pharmaceutical Ingredients (APIs), excipients, other essential raw materials required for manufacturing of crucial health products like drugs, syringes and needles, Long-lasting Insecticidal Nets (LLINs) and Rapid Diagnostic Kits.
In 2013, Nigeria agreed with other ECOWAS countries that drug importation into the sub-region should attract zero duty. Nigeria and other countries in the region adhered to this agreement until the coming of former President Muhammadu Buhari-led administration in 2015, when the Federal Ministry of Finance, under the watch of Kemi Adeosun, imposed a 20 per cent duty on drug importation, a decision that elicited several protests. The question is: if all ECOWAS countries are operating a zero-tax regime plus lower port charges on drug importation, why should Nigeria impose tariffs on drug importation?
In the past, there were about 100 drugs manufacturing companies in Nigeria. Today, 25 per cent of them have shut down operations due to harsh economic conditions and unavailability of foreign exchange. This means that about 80 per cent of unmet medicament needs in Nigeria are imported. In fact, all the drugs manufacturing companies in Nigeria produce less than 20 per cent of our national needs. So, why should the government impose prohibitive tariffs on the importation of these unmet medicaments?
It is cheerful news that President Tinubu is already taking measures to ensure that Nigerians do not die untimely because of their inability to purchase or access medicines needed to take care of their health challenges. We urge the Federal Government to ensure that the Order is carried out timely and with utmost sense of responsibility by relevant officials for the objectives to be achieved.
