Dora Nkem Akunyili is the director general of Nigeria's National Agency for Food and Drug Administration and Control (NAFDAC). Since being appointed in 2001, Dr. Akunyili has led an aggressive and widely successful effort to crack down on counterfeit and substandard pharmaceutical drugs in that country. She is widely recognized as one of Africa's foremost health reformers. In 2003, Transparency International awarded her one of its International Integrity Awards, and in 2005, Time magazine named her one of its eighteen "global health heroes."

On April 14, 2008, Dr. Akunyili delivered a lecture at AEI. In the first installment of a new series of AEI.org Exclusive Interviews, Christy Hall Robinson asks Dr. Akunyili about her experience as director general of NAFDAC.

NAFDAC Director General Dora Akunyili

I became aware in the 1990s. When my younger sister died in 1988 from fake insulin, it was not clear to us why she died. We didn't know that it could be fake; we were simply confused. But in the 1990s, people started whispering about it. It was not spoken about out loud. It was being discussed privately in Nigeria and not publicly. I knew about it then, and by 2001, when I was given the opportunity to head Nigerian food and drug, I felt I got an opportunity to work on this and save other families from suffering that my family went through with the death of my sister.

How did you get started on the path to becoming director general of NAFDAC?

It's a very interesting story. I was working for Petroleum Special Trust Fund (PTF) as a zonal secretary. I went to London for treatment. I was given 17,000 pounds--12,000 pounds for surgery and 5,000 pounds for tests, medications, and follow-up. When I finished my tests, it turned out that the diagnosis that was made in Nigeria was wrong, and I did not need surgery. And I told the consultant I needed to be refunded the 12,000 pounds to return to my organization since I didn't have the surgery. He was surprised because when Nigerians go on treatment they inflate bills. I figured I would return it because the money was not my own. My strong Christian ethic does not allow me to take what is not my own. I returned it to the chief executive of PTF, and he wrote that he never knew that there were Nigerians with integrity.

One day, one of President [Olusegun] Obasanjo's friends came to visit PTF. He was told, "Oh, this is the lady who returned 12,000 pounds." He said, "Go on, give me your CV. My friend wants somebody that will clean up NAFDAC." And his friend was the former president Obasanjo. Two weeks after that, the president called me on the phone, and he asked me why I returned the 12,000 pounds. I told him because it was not mine. I would never have taken it. He made up his mind to give me the job. And when my name was announced, people kicked against it. I was not a politician, and I'm a woman. In the end, the president insisted that he wanted me to do the job. And that trust and confidence of the president has actually permeated to all Nigerians. And that's how I landed on the job. I was given this job because of my integrity, and I have to maintain that integrity.

Once you became director general, where did you start in trying to eradicate counterfeit drugs?

We started with a public enlightenment campaign. We realized that the first step in solving a problem is to sit down and accept that there is a problem; to tell people that there is a problem so that people will stop being deceived; to sensitize people to be vigilant about what they buy, what they use, and what they eat. And concurrently we were doing staff training and retraining, staff empowerment, modernization of our registration processes and laboratories, and putting up offices in every state. And we moved on to trying to find out where the fake drugs are coming from. Well, they are coming from India and China. What do we do to stop them? We put in place independent analysts in these countries to recertify the drugs before they are imported into Nigeria. We insist on pre-shipment information before drugs are accepted in Nigeria. Above all, we don't register any drug except if that product is freely used in the country of production.

We also have a strategy of mopping up what is already in circulation--true, sustained, systematic surveillance and testing and retesting what we had already registered. We have closed down three big drug markets, we've closed down shops, and we have also confiscated drugs from hawkers. And in the process of mopping up what was already in circulation, we found that some people when we find fake drugs in their shops, they give us fake receipts, and that's made it impossible for us to trace who imported it, who produced it. So we put up a guideline that if such receipts were ever given by any shop, everything in that shop would be evacuated and destroyed. That is how we were able to find the thirty Indian and Chinese companies and one Pakistani company that we banned from importing drugs into Nigeria. We've also strengthened our registration processes. We give NAFDAC numbers to every product. On drugs, there is always a number affixed for each product. People started faking our NAFDAC number, and now we have decided to add a serialized hologram as an additional mechanism.

We are not just working to protect Nigerians. It's also a responsibility for us to protect other countries in sub-Saharan Africa. These countries, most of them are poor. They don't have the capacity to help themselves. And more importantly, the criminals being chased out of Nigeria were relocating to these countries. In 2005, we instituted the West African Drug Regulatory Authorities Network as a platform for interacting and exchanging strategies. And it's working. East African countries are joining us. The level of incidence of fake drugs is coming down drastically, though we are not relaxing because we know these criminals are not relaxing. We always want to be ahead of them.

How have Nigerians responded to your efforts?

Nigerians have given us unprecedented good will and support. People pray for us in mosques and churches. Even though I am a Christian, Muslims pray for me. The support and good will of Nigerians is very encouraging. And, in fact, we have so much public support that even if there is any politician that doesn't want to support us, the politician would not be able to voice it. But very importantly, the political class is supporting us. The public is supporting us. And all of the press are in the vanguard of the fight. So that makes the drug counterfeiters in the minority. And it's a problem when they are in the minority. And now there is so much awareness that even illiterates have to look for people to read and tell them whether a product is registered by NAFDAC or not.

Do you see your model in Nigeria for eliminating counterfeit drugs as one that could be adopted successfully by other countries?

Yes. Our model has already been adopted by other countries in sub-Saharan Africa. And it's working.