The COVID-19 Crisis Upends Africa’s Crucial Drug Supplies
Containing COVID-19 is urgent. But while all eyes are on that health crisis, the toll of leaving chronic illnesses untreated across Africa may prove even more deadly, says Danjuma Adda, CEO of the Center for Initiative and Development (CFID)/ Chagro-Care Trust (CCT) in Nigeria. He explains why medical professionals, governments, NGOs, and drug manufacturers must collaborate to ensure patients are able to access the critical care and medications they need, now and in the future.
My phone rang several times; I could not answer due to the protective equipment I was wearing to draw blood from a patient. When it rang again and I picked up. It was Gabriel and he sounded desperate. “My drugs have finished. I went to the hospital, but they could not give me any! I visited your office, but met the doors locked with an inscription, ‘Closed due to the Coronavirus pandemic'. What do I do?” Welcome to the world of Gabriel Emmanuel, a chronic hepatitis C patient in Jalingo, Nigeria.
I listen to similar lamentations every day from around the country. Patients suffering from hepatitis and other chronic infections are running out of their medicines, cannot get their diagnostics done, or have to miss scheduled hospital appointments due to the stay-at-home or social distancing measures put in place to counter the coronavirus pandemic. In most parts of Nigeria, we do not have the technology to provide telemedicine or eHealth.
Around the world, viral hepatitis claims 1.34 million lives annually. It has infected over 16 million Nigerians, and kills more of us than HIV and malaria. Symptoms can take a decade to appear, as they did for Gabriel, who is 34 and recently married. His eyes turned yellow, his head hurt, his stomach bloated. Doctors told him he had cirrhosis and needed Direct Acting Antivirals (DAAs), the drugs that cure Hepatitis C. At the pharmacy, he learned that the drugs would cost him $890 for generics for a six-month treatment. That is more than he earns in a year. Like most Nigerians, he has no health insurance so he went to the bank for a loan to pay for the first three months. In late March, he borrowed enough from friends for the remaining three months, but hospitals, pharmacies and CFID-Taraba, an NGO that helps provide access to treatment, all told him the same story—NO supplies due to the COVID-19 lockdown. In Nigeria, the government funds shipments of essential drugs and medical supplies. A large share of them are manufactured in India using active pharmaceutical ingredients from China. Supplies sometimes ran short even before the COVID-19 pandemic struck. But the current disruptions in manufacturing, trade and transport will leave patients like Gabriel with stark choices. Without the rest of his medication, the virus could develop resistance. He would have to start treatment all over again, move to another regimen he cannot afford, or live with a disease that will kill him. Gabriel’s plight offers one glimpse of what is happening all over Nigeria, and across Africa, to millions living with chronic hepatitis, HIV/AIDS, Tuberculosis, cancer, diabetes, high blood pressure and neglected tropical diseases.
Not only are essential commodities like drugs now often unavailable or priced completely out of reach, but travel bans and lockdowns have made it hard for many to even seek treatment. If they manage to get to a clinic or hospital, patients may still not get the care and attention they need from medical workers focused on COVID.
Broken medical supply chains and lockdowns have already proved deadly. In Uganda, where private transport was banned and where ambulances are scarce, seven women who went into in labor reportedly died trying to walk to the hospital. And in places like Kano City, Nigeria, where COVID-19 is yet to make inroads, corpses are literally appearing in the street. Medical experts suspect that as many as 600 people may have died there over a period of one week, possibly from an outbreak of meningitis. Whatever the cause of these deaths in Kano, the reality is that the medical world was too busy to detect and treat the victims. The question that comes to mind is how many other patients in need of critical medical care are not getting it? How many cannot visit the hospitals or receive treatment that could save their lives?
These losses may be dwarfed by those in the future, if strained health care systems like that in Nigeria give way under the burden of this pandemic. The World Health Organization (WHO) has warned that deaths from malaria in sub-Saharan Africa could double if the coronavirus pandemic interferes with the distribution of bed nets and medicines. Ninety three percent of malaria cases world-wide are in Africa and two-thirds of those who die are children under five. WHO officials have also warned that if vaccination programs against measles and polio are disrupted, these entirely preventable diseases could come roaring back.
Containing COVID-19 is urgent. But while all eyes are on this battle, other vicious and insidious diseases deserve attention too.
Governments, international organizations and donors, and drug manufacturers, need better coordination, monitoring, and flexibility to get drugs shipped quickly where they are needed most. Patients should receive enough medicine so that they do not need to keep returning to clinics during this pandemic. Medical personnel need to be able to step in and perform new tasks. In the longer term, governments must invest in local clinics so they can care for patients with serious illnesses and provide back-up in a crisis. And of course, patients should not have to bankrupt themselves borrow from friends to get live-saving medicines. They need health insurance that covers drugs.
If we are not careful, hard fought advances against vaccine-preventable diseases, like polio, could be lost. Antibiotic resistant strains of infectious diseases could pose new threats. And right now, people who cannot get essential medical care or buy the drugs they need, people like Gabriel, could become uncounted casualties in this war.
In addition to leading CFID/CCT, an NGO and patient group that works to improve access to quality health care for patients across Africa, Danjuma Adda is a 2020 New Voices Fellow at the Aspen Institute, and part of the Aspen Ideas: Health community.
The views and opinions of the author are his own and do not necessarily reflect those of The Aspen Institute.