Fighting Fake Drugs

She injected her insulin as usual and it killed her. Vivian Edomobi, a graduate student, died of hyperglycemia at age 23 in 1987 from a spurious drug--the vial was a worthless fake. And hers was far from an isolated case. At the time, well over half of the pharmaceutical drugs offered on the huge Nigerian market were counterfeit. Uncounted thousands of people died every year after taking medicine that contained useless or harmful ingredients. But this death was special in one way. The victim's sister, British-educated pharmacist Dora Akunyili, lectured at one of Nigeria's leading medical schools. To her, this was an especially excruciating violation of a public trust.

Akunyili now is winning a holy war against the killers in a crusade that speaks to one of Africa's worst ills: endemic corruption. It's a problem long-recognized by Western authorities. When Paul Wolfowitz took up his new post as head of the World Bank this week, he announced plans to lead an immediate mission to Africa. "Corruption is the biggest threat to democracy since communism," he warned. But it is homegrown activists like Akunyili who, by revolutionizing a moribund drug-regulation agency, is forging a paradigm for how deeply corrupt societies such as Nigeria's can begin to turn around. Her success as leader of the National Agency for Food and Drug Administration and Control (NAFDAC) also bodes well for a national anti-corruption drive that this year has begun reeling in official after official--the centerpiece of President Olusegun Obasanjo's final two years in office.

Akunyili is a profile in personal courage. Arsonists torched her agency's offices and labs, and she herself narrowly survived three assassination attempts. Yet she fights on, leaving her fate to God. At the same time, her appointment to her post says volumes about her president's sincerity. An outsider to NAFDAC, she normally would have stood no chance of being named its director-general in 2000. But an anecdote about her filtered up to Obasanjo from her home in the eastern hinterlands. A government-run development fund she served sent her to London in 1999 to undergo an expensive operation. There, she learned the surgery wasn't needed, and asked the hospital to return a Nigerian government check for $20,000. "Aren't you a Nigerian?" a hospital staffer asked her--and proposed to keep a percentage and give her the rest in cash. Instead, she took all the money back to Nigeria and returned it. Not long afterward, Obasanjo personally phoned to summon her to the capital.

Akunyili turned first to her own staff of 3,000 pharmacists, technicians and enforcement officers scattered around the nation of 130 million people. Those who weren't totally demoralized were using their regulatory authority to extort bribes. "We were prisoners," said Ijeoma Chinaka, 41, a chief regulatory officer. Agents would seize whole containers of fake drugs only to see the drugs put back on the market after a VIP intervened on behalf of the importer. Akunyili weeded out incorrigible grafters and began to offer the rest incentives--foreign training, modern lab equipment, respect. Most stayed on. "When the leadership is dynamic, positive, the people can't help but shape up," says Okechukwu Ogbonna, deputy director of NAFDAC's testing labs in Kaduna. After the arsonists set them on fire last year, temporary quarters were established to house state-of-the-art testing gear. The attacks and nearly 100 public incinerations of seized drugs helped the vibrant Nigerian press spread word of the danger--and to encourage consumers to blow the whistle on wrongdoers.

After drug importers failed to bribe or intimidate Akunyili, kingpins in the drug trade allegedly tried to take her out. Her closest call came in December 2003, as she drove in a four-car convoy to her home village in eastern Nigeria. Six gunmen opened fire; a bullet pierced her headscarf and grazed her scalp. Police arrested--then allegedly executed--five of the attackers. The sixth spent a year on the run before turning himself in to federal authorities. He implicated Chief Francis Okoye, chairman of an association of medicine dealers who run the huge Onitsha open-air drug market in the east, and another leading dealer. Acting on his testimony, authorities arrested both businessmen. They deny the charges. "God indeed saved my life," Akunyili testified at a preliminary hearing in the case. A devout Roman Catholic, she says her proudest moment came when she learned that Pope John Paul II had offered prayers on her behalf.

In person, the reformer mixes steel with honey. At a stinking landfill outside Lagos where workers prepared to burn seized drugs several weeks ago, she barked orders like a drill sergeant. Every carton must be open in order to ensure that the operation is transparent, she insisted, and the team went back to work under a broiling sun.

Yet she misted up when asked, during a quiet moment in her office, about pressures on her family. A young son in boarding school once begged her not to visit because, frightened of the pharmaceutical barons, he had told friends she's his aunt. The crusader barely sees her husband, an emergency-room physician in the provinces. "It is too, too much, but I really don't have a choice," she says.

A secret weapon--other honest women--drives the agency's success, she says. Akunyili appoints only women to the most sensitive posts--clearing drug consignments in ports of entry and granting NAFDAC's approval for manufactures and importers to affix an agency registration number to a product. She says that women in general are less corruptible than men. While that point may be debatable, the Nigerian experience--corrupt military rule relieved only by 1999 democratic elections--unarguably supports it. President Obasanjo increasingly has put women in key posts--including, recently, the finance minister and a special advisor who works to ensure that government departments follow due process. "Our men have failed us," says Hauwa Keri, 50, who leads NAFDAC's registration lab in Lagos.

The rate of reform has been staggering. NAFDAC has convicted 31 people in drug counterfeiting cases; 40 cases are pending. It issues about 3,000 citations a year against manufacturers, and has blacklisted about 50 drug manufacturers and exporters in India, Pakistan and China. The incidence of fake drugs in the markets has dropped by 80 percent; in hospitals, kidney failures--often caused by bad medicine--are declining. West African countries have lifted a ban on drugs made in Nigeria. As a result of the cleanup, Nigerian drug manufacturers have stepped up their production, their stock prices have risen and multinational firms are prospecting. "The turnaround of NAFDAC is becoming an interesting case study in renowned business schools all over the world, on how a moribund establishment can be revived in a developing country," Health Minister Eyitabo Lambo told a fourth-anniversary gathering in Lagos.

Cleaning up Nigeria's endemic corruption remains a staggering challenge. Obasanjo's first act as president in 2000 was to establish a special corruption-busting commission; two years later he created another such agency specialized in money-laundering. Their main target has been ongoing corruption; too many former military leaders amassed enormous wealth to take them all on at once. However, Obasanjo has pressed for the return of billions of dollars looted from the national treasury and sent abroad by former military dictator Sani Abacha, who died in office in 1999. Earlier this year, one of Abacha's sons was arrested in Germany and extradited to Switzerland to face money-laundering charges.

Lately, these authorities have paraded top officials to court. In April, the Independent Corrupt Practices and other Related Offenses Commission charged the former senate president, former minister of education, four senators and a member of the House of Representatives with taking bribes in return for sweetening the budgets of government departments. The same month, the Economic and Financial Crimes Commission charged former Inspector-General of Police Tafa Balogun with stashing $100 million in government funds in personal companies and bank accounts. A judge set nearly impossible bail conditions, noting that the charges are serious, "particularly at this stage of our nation's fight against corruption and the desire to cleanse our nation's image internationally." These investigators also have been threatened. But Alhaji Ribadu, chairman of the money-laundering commission, told one Nigerian interviewer: "The funny thing I've realized in this country is that if you come out to say you are doing what is right, nobody will stand in your way ... If you insulate yourself from greed and other personal interests, nobody will disturb you." If NAFDAC's signal success is any indication, Nigerians may be more willing to stand and deliver than the world thinks.