As big pharma exits Nigeria, asthma patients face spiralling costs

Ibadan, Nigeria — When Gloria Mofifoluwa’s friend informed her in March that the price of inhalers had risen in Nigeria, she did not think much about it.

The following week, when she went out in Ibadan city to replace her old Ventolin inhaler, the asthma sufferer was shocked to see that many pharmacies were out of stock and the only place it was available sold it for 7,500 naira ($5) – more than double the 2,800 naira ($1.86) she had paid months before.

This price jump – which followed the departure from Nigeria of a major health pharmaceutical – was a shock for the 24-year-old undergraduate student who earns a bit of money designing clothes. And the ripple effects were even worse.

Last month, while alone in her room at the university hostel and consumed by thoughts of her economic challenges, Mofifoluwa started hyperventilating and struggled to catch her breath.

Her roommate was away and there was no one to take her to hospital. All she had on her was an Aeroline inhaler, which she explained does not work as fast for her as the Ventolin she now struggles to get.

“I was just scared because not only was I alone in my room, I was also on my floor [and without the medicine I most needed],” she told Al Jazeera, adding that all she could do was pray until she fell asleep, hoping she would regain her strength by the time she woke up.

The pharmaceutical scarcity and rising prices causing stress for asthma sufferers like Mofifoluwa cap off a chain of events that began in May 2023, when Bola Tinubu was elected president.

During his inauguration ceremony, Tinubu announced the removal of a fuel subsidy, which resulted in an unprecedented increase in petrol prices. This also affected the cost of various goods and services and contributed to an inflation rate of above 27 percent. The cumulative economic effects have been harsh, especially for the vulnerable – including students and low-income earners.

The hardships worsened as the president’s monetary policies pushed the naira to an all-time low against the United States dollar, further leading to a downward trend as manufacturers struggled to meet production targets.

Amid the downturn – which included exchange rate volatility, declining revenues and a general worsening of the investment climate in Nigeria – a significant number of businesses including international pharmaceuticals exited the country.

GSK exit

Among those that left was British company GlaxoSmithKline (GSK), which ceased direct business in Nigeria in August 2023 and transitioned to a third-party distribution model. The company had operated in the Nigerian market since 1972.

“We believe the move to a third-party distribution model, a strategy we’ve successfully implemented in other markets, will enable more sustainable access to our medicines and vaccines for patients in Nigeria in line with our global strategy,” said GSK spokesperson Dan Smith.

However, Nigerian doctors and patients Al Jazeera spoke to said GSK’s departure has contributed to rising prices and increased the scarcity of some medicines. As a major supplier of inhalers – including the type Mofifoluwa depended on – the company’s exit has not been good news for asthma patients.

According to the World Health Organization (WHO), asthma cannot be cured but common treatments like the usage of inhalers which deliver medication to the lungs allow patients to live normal, active lives.

The global health body recommends that people with asthma get access to proper healthcare, but in developing countries like Nigeria, the situation is complicated. This has been worsened by the exit of companies like GSK.

While asthma inhalers were easily available and more affordable when the company was around, many now find the medication is out of reach. Despite there being alternative options, Nigeria relies largely on imported medicines, meaning high operational costs get added to the price tag for consumers.

For the average patient, an inhaler lasts about two months, depending on usage, which makes it a pricey regular cost in a country where the minimum monthly wage is 30,000 naira (about $20).

Like Mofifoluwa, 21-year-old Joseph Biyi also struggles with asthma. The library, archival and information science student was diagnosed in the middle of last year, and has since been confronted with the rising prices of inhalers.

The first time he bought a Ventolin inhaler, it sold at 3,500 naira ($2.30) but by his next visit to the pharmacy this year, the price had jumped to 7,500 naira ($5).

While Biyi has his parents to help him with money for inhalers, especially since the prices have skyrocketed, he said he now also forgoes some essential items, like groceries, to save the extra money for medicine, “just to avoid risk”.

High asthma rates

The Nigerian Thoracic Society says that, as of 2019, 15 million Nigerians were asthmatics while a nationwide study put the number at 13 million – one of the highest rates in Africa. With less than accurate data in Nigeria, because those in rural areas have limited access to quality healthcare or medical tracking, the number could be even higher.

On World Asthma Day in 2023, the president of the Nigerian Society of Asthmatics, University College Hospital (UCH) Branch, Professor Olusoji Ige, said more than 10 million Nigerians have asthma and about three-quarters of them risked dying due to poor asthma control.

Mrs Tinubu, the Matron of the University of Ibadan’s Asthmatic Club who prefers to be identified only by her surname, said there are several factors responsible for asthma. However, she noted that the ill-equipped healthcare system worsens the condition over time.

Due to the poor state of the public healthcare system in Nigeria, after diagnosis, most people take charge of getting their medication themselves.

Meanwhile, in Ibadan, some enterprising young Nigerians have been trying to help fill the health gaps that exist.

Temitope Omosebi, a postgraduate psychology student, told Al Jazeera that after having an encounter with an asthma sufferer in 2023, he understood the full gravity of the condition and wanted to do something to help.

That’s when he launched the #AttackAgainstAsthma campaign at the University of Ibadan, to help at least some patients get access to interventions. The campaign helps provide various types of inhalers, including Sivobutamol, Aeroline, Ventolin and Fortide, to those who need them. Last year alone, 40 inhalers were distributed and this year, an additional 60 were disbursed for free; all were procured with funds from Omosebi himself.

“The campaign is important as it addresses self-care medication for asthmatic patients which has become highly costly in the recent time,” Omosebi said. “Our focus is specifically on varsity students – and on individuals in low socioeconomic communities hopefully soon – because of the known financial challenges among these groups of people.

“In Nigeria, the government isn’t doing anything it’s meant to do,” he added,

‘All inhalers are expensive’

Olabitan Odunola, a doctor and the lead at The Health City, a tech-enabled platform that focuses on preventive services and education, bemoaned the scarcity and cost of GSK products since the company exited the Nigerian market.

She said that especially for asthmatic patients who depended on GSK’s inhalers, the new circumstances are disturbing and even alternative medicines are out of reach for most patients.

“Across the board, all the inhalers are expensive,” Odunola said.

Patients have switched to alternatives like Longlife Pharmaceuticals which mostly sells Aeroline inhalers, to find relief. There are also other options like Symbicort inhalers, manufactured by AstraZeneca, and Fortide inhalers, distributed by Pakistani pharmaceutical company Getz Pharma. While all are recognised and available, they are also largely unaffordable.

Odunola said the limited access to these preventers could worsen healthcare outcomes for asthmatics. Since the condition is long-term, she also feared that it could lead to more deaths, especially in instances when someone has an asthmatic attack.

The poverty rate in Nigeria, according to the World Bank, was estimated at 38.9 percent in 2023, and considering the relatively high prices of inhalers, patients may even resort to unproven asthmatic treatments out of desperation, experts fear.

There is a correlation between limited access to quality healthcare services and the number of asthmatic patients in Nigeria, said Bello Wada, a physician and the current public health rirector of the State Ministry of Health in Kano.

“This leads to delayed diagnosis, inadequate treatment and poor management of asthma, exacerbating the condition and increasing the number of patients,” he said.

Wada also pointed out that GSK leaving Nigeria further puts those who have been diagnosed at a disadvantage, as inaccessibly priced inhalers could lead to increased morbidity and mortality rates.

Finding solutions

In January, the value of drugs imported into Nigeria was estimated at 900 billion naira ($606m), showing a high dependency on imported medicines.

In February, the federal government announced a $240m investment in the local manufacturing of pharmaceuticals, but while this is yet to materialise, Wada wants the government to do more to address the situation.

“They need to implement policies to make essential medicines more affordable, increase funding for healthcare infrastructure and personnel, develop programmes to improve access to quality healthcare services, especially for vulnerable populations, and also engage with international organisations to secure donations or discounted prices for essential medicines,” he stressed.

Nigeria’s Coordinating Minister of Health and Social Welfare, Professor Muhammad Pate, met with representatives and chief executive officers of pharmaceutical companies in Nigeria last year and said the government is concerned about the high cost of medicines and finding solutions to the crisis.

“The Federal Ministry of Health & Social Welfare, @Fmohnigeria, is working towards policy actions that may address the high prices of medicines especially for the most vulnerable Nigerians,” he said on the social platform X in November.

Until that happens, to help her asthma and manage costs, Mofifoluwa said she will continue to use Aeroline, which at 6,500 naira ($4.30) is slightly cheaper than Ventolin. Even though it does not work as well for her, she feels the lower price makes a difference and allows her supplies to last longer.

“I normally don’t use Aeroline because Ventolin works faster. I had to start buying because it’s less costly,” she told Al Jazeera. “But I still have to manage when I buy it and use it based on calculation [and only when necessary].

“During examinations period, I consume a lot because anxiety and stress are all over me,” she added.

Now, with the high cost of essential medicine she needs, school is not the only thing adding to her stress.