Nigeria’s once-successful Public Health campaign against leprosy is now at risk due to over ten months delay in obtaining free Multi-Drug Therapy (MDT) medication from the World Health Organization (WHO). Bureaucratic obstacles, including delays in acquiring the Clean Report of Inspection and Analysis (CRIA) and other certificates, hinders treatment for over 3,000 patients, including 800 children. Nigeria’s progress so far in eradicating the disease is at risk as untreated cases strain healthcare systems and drives the spread of the disease. This has exacerbated physical infirmities, increased stigma, and infringed upon the Human Rights of those who are impacted.
In a statement during a conference in Abuja in December of last year, Mr. Peter Iorkighir Terver, President of Integration Dignity and Economic Advancement (IDEA-Nigeria), stated that the NAFDAC ruling had led to a crisis situation. He pointed out that the supply process for MDT, under WHO Purchase Order Number: 203416835, has been hampered by extra requirements from NAFDAC, including the Certificate of Pharmaceutical Product (CoPP) for Rifampicin, one of the medication combined in the MDT. The crisis has received international condemnation and exposes structural problems in Nigeria’s regulatory structure.
Challenges in MDT supply and NAFDAC authorization.
He lamented that the CRIA (Clean Report of Inspection and Analysis) results will expire by February 2025, and a crucial NAFDAC authorization will expire on December 31, 2024, possibly prolonging the drawn-out supply procedure. He urged for a waiver from NAFDAC in order to release and supply MDT as soon as possible. By eliminating needless obstacles to the distribution of donated medications, Nigeria may reaffirm its dedication to public health and the eradication of the disease. Despite calls from IDEA-Nigeria, advocates for those affected by leprosy, President Tinubu has not taken any action to alleviate the bottlenecks.
Multidrug therapy (MDT) has been the primary weapon in the fight against leprosy, effectively treating the illness and reducing its transmission. It comprises of three medications: dapsone, rifampicin, and clofazimine, which combine synergistically to destroy the causative pathogen, Mycobacterium leprae, and cure the patient. Early diagnosis and timely treatment guarantees a complete recovery and also prevents the onset of permanent impairments, particularly those caused by nerve damage. This initiative has been instrumental in global leprosy control efforts, significantly reducing the disease burden in many endemic regions, including Nigeria.
Impact of supply delay and dwindling medical expertise.
However, delays in the supply of the medication have deprived many patients from receiving treatment in a timely manner, increasing their chance of developing the disease and permanent disability. With immediate intervention still pending, delays have extended into 2025, leaving many patients untreated. This highlights the urgent need for increased emphasis and effort as it raises the risk of permanent disability and poses a threat to erode the previous achievement made in the eradication of the disease. In addition to the delay in Multi-Drug Therapy (MDT) medications, there is also dwindling leprosy expertise, making the situation a precarious one.
According to a 2023 Leprosy Review survey of health workers in 12 Local Government Areas (LGAs) across six states in Nigeria, only five MDT officers in the health facility reported having general knowledge of leprosy, out of 51 MDT officers interviewed from 37 health facilities covered in the study. The majority of healthcare facilities were unable to offer leprosy and disability treatments, despite being accessible to patients, having health workers ready to treat leprosy patients, and having the potential to offer MDT at no cost.
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This reveals a declining pattern in the Nigerian healthcare professionals capacity to provide leprosy control services. The Leprosy Mission Nigeria echoes similar sentiments and calls for innovative strategies and a larger scale-up of best practices’ application to end this stagnant trend and begin a genuine decline in the transmission of the disease. This factors, among others, combined to contributes to the emergence of the disease as a public health concern in recent years after Nigeria achieved the World Health Organization’s leprosy eradication target of less than 1 case per 10,000 population in 1998.