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How COVID-19 Has Slowed Nigeria’s Access to MedicineNigeria, a country with both bustling cities and green plains stretching for miles, has earned the nickname “Giant of Africa.” Although Nigeria isn’t the largest country in Africa, it has the largest population with 206 million people calling it home. Even though the population in Nigeria has grown in 2020 by 2.58%, the country still has a high mortality rate and life expectancy of 54 years. Nigeria has one of the biggest HIV pandemics as well as a high risk for malaria. Access to medicine and vaccines have always been limited in Nigeria; however, COVID-19 has exacerbated the issues facing Nigeria’s healthcare system. The COVID-19 pandemic has increased restrictions on international trade, which has greatly impacted Nigeria’s pharmaceutical needs for people with pre-existing conditions, particularly those with HIV/AIDS or malaria. As 70% of Nigeria’s medical products are shipped from China and India, COVID-19 has interrupted an important part of Nigeria’s basic health needs.

Healthcare in Nigeria

Nigeria has always had trouble accessing medication as the country has a great dependency on imported products. According to Medrxiv, a server for health sciences, in 2013, only 25% of kids under the age of 2 had been vaccinated. In an attempt to secure a more efficient healthcare system, Nigeria began to manufacture its own pharmaceuticals but lately, production has been on a decline due to high prices, poor quality and a shortfall in access to medicine. Nigeria has 115 pharmaceutical manufacturers but they mainly rely on large imports from neighboring countries.

Before the virus swept across Nigeria, the country only had 350 ventilators and beds for the entire population. In April 2020, Nigeria obtained 100 more ventilators. But, what has actually been done to improve Nigeria’s basic health needs?

Changing Nigeria’s Healthcare

In 2018, four policy documents were presented to Nigeria by the Federal Minister of Health. The four policies acknowledge Nigerians need for access to medication and control of narcotics.

  1. The National Policy for Controlled Medicines — This policy, with support from the United Nations Office on Drugs and Crime (UNODC) and the European Union (EU), aims to improve healthcare services in Nigeria. By properly training healthcare professionals, narcotics can be safely monitored for medical and scientific use while avoiding abuse. The policy ensures that Nigeria will have better access to medication so citizens do not have to silently suffer. In 2012, as reported by The Global Access to Pain Relief Initiative, Nigeria only used 0.01% of narcotics to manage pain. The UNODC states, “This was largely attributed to limited or poor quantification of annual estimates, inadequate and irregular release of funds for procurement, limited knowledge and poor attitude, or issues of fear and stigma among many healthcare workers and the general populace.”
  2. National Guidelines for Quantification of Narcotic Medicines — This policy is continuous of Nigeria’s efforts to have access to “narcotic medicines.” It is a way to know how much medicine is required to fulfill Nigeria’s basic health needs. By creating a standardized system, Nigeria can estimate which and how many narcotics are needed for the country.
  3. National Guidelines for the Estimation of Psychotropic Substances and Precursors — This policy regulates “psychotropic substances,” such as alcohol, caffeine and marijuana. These drugs, according to the UNODC, can be used for “pain management including treatment of neuropathic pain and in the management of obstetric emergencies including hemorrhage, thus critical in reducing maternal deaths.” The policy verifies that these substances are and will be used for legal use only.
  4. National Minimum Standards of Drug Dependence — In the past, Nigeria treated addiction as a psychiatric condition or mental illness. Although Nigeria does not have the data to see how many people in the country have a drug dependency, treatments of addiction are changing. The policy’s goal is to have adequate care such as “counseling, vocational and occupational rehabilitation” available across Nigeria.

According to a 2020 Statista analysis, the budget for Nigeria’s healthcare is expected to increase, eventually reaching 1477 billion Nigerian naira by 2021. This can create more opportunities for Nigeria’s healthcare system, increase access to medicine and fulfill Nigeria’s basic health needs.

– Jessica LaVopa
Photo: Flickr

most effective drug for preventing maternal death
Each year, more than 300,000 women die in childbirth. The top three causes of global maternal deaths are severe bleeding, infections and high blood pressure at the time of birth. Often, pregnant women in developing countries are faced with an impossible decision: seek affordable care from untrained/unlicensed midwives or enter hospitals without being able to pay for modern treatment. It is extremely unlikely that women in this situation will receive the most effective drug for preventing maternal death.

Deaths from infections can easily be prevented through good hygiene practices by the patient and the medical staff attending to her. As for high blood pressure, the most fundamental precautionary measure is to educate the public on adolescent pregnancies, as this is often associated with maternal mortality from high blood pressure. Severe bleeding in childbirth can kill a healthy woman within several hours if proper attention and care are not given to her by her caretakers.

Often there are complications, such as bleeding, that require costly surgical operations or blood transfusions. If the mother is unable to afford the operation, she may not survive the excessive bleeding. In Sierra Leone, many people know at least one woman who has either died in childbirth or lost a fetus due to complications. Maternal care is the comprehensive indicator of the overall development of a country; the healthcare system for maternal health reflects the level of education, infrastructure and transparency of a nation.

Well educated nations with high literacy rates can still experience a shortage of qualified medical workers. Why? They are not properly paid or paid at all. The few qualified or highly educated emigrate for better opportunities and salaries. This resulting brain drain further exacerbates the crisis of maternal mortality. Prior to childbirth, there is also a delay in pregnant women seeking proper treatment. This delay can be attributed to a lack of confidence in the competence of the local healthcare facilities.

Thanks to U.N. funding, clinics in every nation are sponsored to employ local medical staff, which not only provides them with a salary, but with training as well. In addition to improved services, many patients benefit the from donation and careful administration of drugs. Among the most notable is tranexamic acid. Also known as TXA, this drug helps to control bleeding for trauma patients. It helps to stabilize a clot at the site of bleeding by preventing it from dissolving during formation. It has proven to be the most effective drug for preventing maternal death.

TXA works by preventing the conversion of plasminogen to plasmin; this promotes the accumulation of fibrin to form a complex known as the fibrin degradation products. It should be noted that TXA is not an alternative for blood transfusion; it is merely an important addition to this treatment. In addition to trauma patients, TXA has also proven effective in treating combat casualties. It has also been proven to be safe for patients.

In April 2017, the WHO launched a clinical trial dubbed the World Maternal Antifibrinolytic Trial. It consisted of 20,000 women from 21 countries who were diagnosed with postpartum hemorrhage (PPH). It was a randomized, double-blind trial with placebos for some of the participants. The organization wanted to see if bleeding persisted 30 minutes after the first dosage, and if it restarted within 24 hours. If bleeding did persist, it determined if a second dose was necessary.

What they found was that TXA reduced deaths in the trial, and it was evident that early treatment maximized the benefit. It was the most effective drug for preventing maternal death. In their words, “safe, effective and affordable PPH treatments are critical to saving the lives of pregnant women globally, and the findings of this trial have important implications for the delivery of high-quality maternity care.”

– Awad Bin-Jawed

Photo: Flickr

Antibiotic
As stated by Marc-Alain Widdowson and colleagues from The Journal of Infectious Diseases, the rotavirus was first recognized by Ruth Bishop and associates in 1973. Within a 10-15-year span of the virus’s recognition, the rotavirus came to exist as the most widely accepted reason for extreme loose bowels in youths worldwide and diarrheal death in developing nations. However, according to Mathuram Santosham of the Impatient Optimist, 93 countries now have rotavirus antibiotic access in their governmental immunization programs.

Rotavirus Vaccine Program

Widdowson and colleagues state that studies have demonstrated that essential characteristic rotavirus contamination provides security against resulting contamination and severe infection, animating endeavors to grow live constricted oral rotavirus antibodies that would reenact this defensive impact. At the point when antibodies at long last showed up not too far off, PATH, an international health organization, propelled the Rotavirus Vaccine Program to guarantee that each kid approached assurance alongside other contributors to the cause. Here is how the universal rift in rotavirus antibiotic access is declining:

South Asia

In 2016, India was the leading South Asian nation to bring rotavirus immunizations into its open program, utilizing a staged approach to end the universal rift in rotavirus antibiotic access.

The Middle East

After a year, Pakistan took action accordingly. Once these projects scale up, the antibody should grasp more than 30 million youngsters annually. Progressively, Afghanistan, Bangladesh and Nepal also intend to utilize Gavi support to present the antibody in 2018.

Conforming to Widdowson’s statement in The Journal of Infectious Diseases, rotavirus immunization advancement endeavors have concentrated on live oral antibodies, and at an exhibit, two items are industrially accessible all around: Rotarix (GlaxoSmithKline Biologicals) and RotaTeq (Merck).

Africa

Concerning the genesis of the rotavirus vaccinations, Santosham states that African nations have been in the front line of rotavirus immunization presentation since it started in South Africa in 2009.

Nonetheless, the new monovalent immunizations functioned admirably in princely settings; these models were later found to manage the cost of practically zero assurance in kids from disparate countries, where mortality was most elevated.

However, Santosham informs that the WHO Regional Office for Africa has discovered that rotavirus-affirmed loose bowels hospitalizations in kids under five has declined by 33 percent. Advancement continues predominantly due to 33 African nations that place rotavirus in their domestic antibody plan, with numerous efforts bolstered from Gavi and the Vaccine Alliance; these organizations’ goal is to end the universal rift in rotavirus access.

Price Cuts and Improved Affordability

Santosham states that improvements and alternatives are growing, and with that improvement comes conceivably diminished costs to end the universal rift in rotavirus antibiotic access.

Price cuts are a major ordeal because in 2006 (when Rotarix and RotaTeq were authorized), Rotarix was roughly 132 times costly per portion than the least expensive customary EPI immunization; RotaTeq was 90 times more costly, according to Lizell B. Madsen and colleagues of the Bulletin of the World Health Organization.

As countries apply the rotavirus immunization, observation will be essential to gauge the effect of the program, either through expository examinations, case-control considers, antibody viability or by taking a gander at patterns in hospitalization. Once these factors are calculated, documented and improved, then fewer kids worldwide will suffer from rotavirus.

– Christopher Shipman

Photo: Flickr

Good News on Access to Hepatitis C CureMore than 300 million people worldwide are infected with Hepatitis C. With recent efforts to increase access to the Hepatitis C cure, elimination of the virus is now possible, according to the World Hepatitis Alliance.

Over the past two years, three million people around the world were treated for Hepatitis C. The biggest deterrent to access to the Hepatitis C cure was funding, with prices for the drug being as much as $1000 for one pill. Fortunately, though, Doctors Without Borders has made access to the drug treatment available at a much more affordable price.

Gilead Sciences released their cure for Hepatitis C, known as sofosbuvir, in 2013 at $1000 per pill. In 2015, Bristol-Myers Squibb released a similar treatment, known as daclatasvir, for $750. Recently, Doctors Without Borders was able to make generic forms of the drug available for as little as $1.40 per day, according to Reuters.

This is a major victory, as a large amount of the Hepatitis C population lives in low and middle-income countries. For them, a $1000 price tag is not affordable. The accomplishment means that more people will be able to access treatment.

The World Health Organization (WHO) has a goal of eliminating viral hepatitis by the year 2030. Because of the increased availability of the Hepatitis C cure, this can become a reality. However, the cure alone is not the only way for the virus to be eliminated.

There are key factors that WHO has outlined as steps necessary to eliminate Hepatitis C, but many countries have failed to implement them. These setbacks include a lack of political will and global funding mechanisms, poor data and surveillance, access to diagnostics and medicines and poor diagnosis rates, according to the World Hepatitis Alliance.

With that being said, there are currently nine countries on track to eliminate Hepatitis C by 2030, and three of them are developing countries. The countries are Australia, Brazil, Egypt, Georgia, Germany, Iceland, Japan, the Netherlands and Qatar.

Egypt has been innovative in implementing strategies that could eliminate the virus. So far, they have “pledged to test 30 million for hepatitis C by the end of 2018 by implementing mass screening initiatives (including assistance from the military), as well as mass-producing generic copies of DAA drugs for under U.S. $200 per 12-week course.”

By the same token, Brazil has “committed to gradually lift treatment restrictions in 2018, meaning that the country will be able to treat all people infected with hepatitis C.” In the past, the sickest patients have had priority for treatment.

When countries began to make the elimination of Hepatitis C a priority, the world will see results. Mongolia, Gambia and Bangladesh are among the countries that have begun to make progress towards getting on track to eliminate Hepatitis C. As more countries follow their lead, the goal of eradication will be reached sooner.

– Dezanii Lewis

Photo: Flickr

UNAIDS Wants Trade Agreements to Uphold Commitments to Public HealthWith the celebration of reaching 15 million people with HIV treatments and committing to end the AIDS epidemic, UNAIDS reminds countries that new trade agreements should not limit access to medicine.

At the 2011 Political Declaration on HIV/AIDS, governments reconfirmed their commitment to the use of existing flexibilities under the Trade-Related Aspects of Intellectual Property Rights (TRIPS). Specifically, governments reiterated their commitment to promoting access and trade of medicines and to ensure that intellectual property rights provisions in trade agreements do not undermine existing flexibilities.

TRIPS had to be reestablished with governments because as explained by UNAIDS Executive Director, Michel Sidibé, “We are entering a crucial phase of the AIDS response which will decide whether we end the epidemic as a public health threat by 2030. Anything that undermines that response must be avoided.”

Trade negotiators from 12 countries are working to conclude the Trans-Pacific Partnership Agreement (TPP). Under this text, there are reportedly provisions that go beyond what is required under the TRIPS Agreement.

With these “TRIPS-plus” provisions, generic competition could become more difficult. This would lead to higher drug prices. “Generic competition in the pharmaceutical industry, as well as the use of intellectual property flexibilities, have helped make prices for life-saving drugs much more affordable and enabled the unprecedented scale up of HIV treatment programmes.”

To achieve the elimination of AIDS by 2030, treatment drugs should not become more expensive. Instead, testing and medications should become more abundant and affordable to individuals.

The Fast Track Initiative not only wants to treat individuals who are infected with the virus but prevent the further spread of infection. With the combination of treatment and spreading awareness, this is how AIDS will be eliminated.

With this initiative, 28 million HIV infections will be avoided between 2015 and 2030. Twenty-one million AIDS-related deaths with be avoided during that same time period. A main point in this initiative is that the billions of dollars spent on HIV treatment will be made available to be spent on other areas of health care.

Early testing and treatment of HIV will save a generation that may not even be aware that they are infected. With many African countries being plagued by the spread of HIV, informing people about treatment and options is one of the best ways to end AIDS.

If the global Aids response is to attain the 90-90-90 treatment target by 2020 — 90 percent of people living with HIV knowing their status, 90 percent of people who know their status on treatment, and 90 percent attaining viral suppression — HIV treatment must be accessible and scale up must be financially sustainable.

Kerri Szulak

Sources: UNAIDS 1, UNAIDS 2
Photo: Flickr

Counterfeit_Medicine
With medicine progressing as rapidly as it is, people in the developing world are gaining access to the treatment of basic diseases. This has promoted growth and increased innovation but some issues have come up, one such issue being the production of counterfeit medicine. These are hitting the shelves and leading to the deaths of individuals who don’t know that they aren’t ingesting the proper medicine.

The American Journal of Tropical Medicine and Hygiene recently published a study identifying counterfeit malaria drugs as the cause of over 100,000 deaths in Africa in one year alone. More recently, in 2008, counterfeit teething medication was responsible for the death of 84 infants and toddlers whose parents were unaware that counterfeit drug makers had replaced a key chemical, propylene glycol, which is a medicinal solvent, with diethylene glycol, which is a solvent used in brake fluid. About 75 percent of the children who used this teething medication died. This was the breaking point for many individuals throughout Africa who were struggling to provide their families with the best medical care possible.

With the high cost of medications nowadays, it is no wonder that people would seek a cheaper option. However, there is often no way to tell if a medication is truly what it is advertised as or simply a placebo pill that will have no effect on any illness. Thankfully, innovator Bright Simons has developed a way for people to verify that the medicine they are purchasing is valid. Although it does have a few issues, it has proven to be very helpful so far.

Simons has developed a coding system called MPedigree, which allows customers to text a code that is printed on the label of their medication to a number and get an immediate response from the manufacturer that lets them know whether or not their medication is real. These labels are printed in China and India even though the system was developed in Ghana, as Ghana still faces issues with power outages and could, therefore, have unreliable printing sources. Today, the company has expanded to validate several goods from makeup to cables. Anything that is commonly counterfeited can be tracked using this system.

While the app has been successful so far, Simons ran into a few issues with counterfeiters copying numbers from genuine products and labeling fake products with the same number. Thankfully, this was caught and those who texted the code were notified of the counterfeit drugs in the system. After this point, HP agreed to take over the data portion of MPedigree and has saved Simons around $10 million, which he can now put toward funding other projects.

Medicine has created a world in which people no longer have to worry about death from drinking bad water or eating bad food. It has increased human lifespans drastically and will continue to do so as long as people are getting the right medicine for their ailments. By creating counterfeit drugs, people are essentially killing others by not giving them the medicine they need, and all for a small profit. This app, and the many that will come after it, will give people the opportunity to finally put their health in their own hands.

Sumita Tellakat

Sources: Bloomberg Businessweek, Mpedigree
Photo: Empire State Tribune