Verity Bowman

Across Nigeria, flames are consuming towering piles of seized drugs – but not cannabis or heroin.

Hidden in warehouses are millions of doses of counterfeit and substandard medicines, now being burned in highly visible operations that have become the hallmark of an intensifying government crackdown.

In one of the largest raids, officials in Lagos seized 10 million doses of fake and banned drugs in February.

“What we seized from that warehouse alone could kill three million Nigerians if it reached the markets,” said Martins Iluyomade, director of investigations at Nigeria’s National Agency for Food and Drug Administration and Control.

Such raids – and the resulting bonfires – are being repeated nationwide as authorities target a trade blamed for thousands of deaths.

The approach, experts say, could offer a blueprint for other developing countries grappling with the global crisis of falsified and substandard medicines.

“Nigeria is regarded as a model for the global south,” said Dr Harparkash Kaur, director of the London School of Hygiene and Tropical Medicine’s bioanalytical facility and lead investigator into the university’s drug quality project. “Their regulator has been doing a brilliant job… they’ve gone from strength to strength.”

In the last year alone, NAFDAC has conducted six large-scale raids of open-air markets, seizing millions of doses.

Counterfeit medicines are deliberately and fraudulently mislabelled in terms of identity or source, while substandard medicines are genuine products that fail to meet quality or specification standards, often due to poor manufacturing or degradation.

Their deadly impact has been felt across the developing world: substandard cough medicines have killed hundreds of children in recent years; falsified cancer drugs have left patients receiving treatments with little or no active ingredient; and poor-quality antimalarials continue to drive preventable deaths and fuel drug resistance across parts of Africa and Asia.

In Nigeria’s open air markets, more than 30 per cent of drugs are counterfeit or substandard, according to estimates last year from the NAFDAC.

Most Nigerians obtain their medicines not from licenced pharmacies but from these informal sellers – small roadside shops, market stalls, and street vendors who stock essential drugs. In rural areas, where pharmacies are scarce or non-existent, these informal traders are often the only source of medicines available.

“It’s an informal supply system, and they sell essential items: painkillers, antimalarials, and sometimes antibiotics, which they shouldn’t really be selling,” said Prof Gernot Klantschnig, from the University of Bristol’s School for Policy Studies.

Counterfeit and substandard antimalarials alone are estimated to kill around 12,300 people in Nigeria each year, according to a study by researchers at the University of North Carolina.

But the true impact of the trade remains unclear, as no figures include deaths linked to falsified or poor-quality antibiotics, cancer drugs, and other essential medicines, all of which have been detected in the country.

NAFDAC, established in the early 2000s, is Nigeria’s answer to the problem, responsible for ensuring the safety, quality, and efficacy of food, drugs, cosmetics, and other controlled products.

The agency tests medicines in laboratories, inspects manufacturing facilities, monitors ports of entry, and runs public awareness campaigns urging consumers to check for NAFDAC registration numbers on packaging.

It also works alongside the police, the Nigerian Army, and the Pharmacists Council of Nigeria to investigate and dismantle illegal supply networks.

The agency rose to international prominence in the early 2000s under Dora Akunyili, a pharmacist who transformed it from a largely ineffective bureaucracy into one of Africa’s most respected regulatory bodies. During her tenure, the proportion of counterfeit drugs in circulation dropped from an estimated 60 per cent to around 16 per cent.

“It has become a very prominent actor in debates about drug quality and also food quality, not just medicines, in Nigeria,” said Prof Gernot. “It’s a highly visible agency: people are generally aware that when buying medicines, they should check for a NAFDAC registration number, and if it’s not there, that’s a red flag.”

One of NAFDAC’s most innovative public awareness tools is its mobile authentication service, which allows anyone with a mobile phone to verify whether a medicine is genuine by scratching a code on the packaging and sending it via SMS.

The agency has also conducted nationwide campaigns warning consumers about the dangers of purchasing medicines from street hawkers, broadcasting these messages across television and radio in multiple languages to reach rural communities.

Last year, NAFDAC also intensified legal enforcement against counterfeit pharmaceuticals across the country in a series of raids. All ended in dramatic bonfires.

In March 2025, over 100 containers of fake drugs were destroyed after raids in the cities of Onitsha and Aba in the country’s southeast. In July, authorities seized 25 containers of unregistered imports at Apapa Port, Nigeria’s largest and busiest port, followed by another 16 containers at Port Harcourt in the Niger Delta region in August.

In the February raid, eight truckloads of various medicines were taken from the warehouse in Lagos. The drugs are thought to be worth £1.5m in total, including anti-malarials and injections for cerebral malaria, antibiotics, and banned pain medications.

Mr Iluyomade, who warned the seized goods “could kill three million Nigerians if it reached the markets”, said the preliminary findings suggested an international criminal syndicate was behind the huge operation.

“These groups obtain samples of original products, replicate them abroad with near-perfect precision, and reintroduce them into Nigeria’s supply chain,” he said. “This is organised crime with both local and foreign collaborators.”

Nigeria imports around 70 per cent of its medicines from India, China, Pakistan, Egypt and Indonesia, and research from the Economic Community of West African States found that India and China are also the biggest sources of illicit medical products entering the region.

“When it comes to falsified or substandard pharmaceuticals, these patterns often mirror the legal trade. So it’s not surprising that poor-quality medicines may also originate from major production hubs like India or China,” said Prof Gernot.

Among the medicines seized in recent raids are counterfeit antimalarials and antibiotics – the drugs most commonly falsified across West Africa – as well as fake hypertension and diabetes medications, expired vaccines, and unregistered versions of oxytocin, used to induce labour.

Authorities also discovered large quantities of Analgin, a painkiller banned in Nigeria for over 15 years, alongside codeine-based cough syrups, tramadol, and falsified versions of cancer drugs Avastin and Tecentriq.

NAFDAC officials warned that counterfeit injectable antimalarials used in emergency cases such as cerebral malaria were “virtually indistinguishable from the real thing – even product owners sometimes struggle to tell the difference.”

Dr Kaur said falsified antimalarials often lack the active ingredient needed to effectively kill the parasite, while improper dosing may eliminate initial parasites but leave some behind due to insufficient drug levels

“Anything of poor quality will undermine the patient’s health and can lead to drug resistance. Resistance develops when the parasite doesn’t fully die and continues to multiply,” she said.

Substandard antibiotics carry similar risks: partially treated bacterial infections can breed resistant strains that spread through communities, rendering entire classes of drugs ineffective.

For patients taking fake cancer medicines such as Avastin or Tecentriq, which can cost thousands of pounds per dose via official supply chains, the stakes are even higher.

A falsified version may contain no active ingredient at all, leaving a tumour untreated while the patient and their doctors believe the therapy is ongoing.

And for medicines like oxytocin, used to manage bleeding after childbirth, a substandard product can be the difference between life and death within minutes.

There is also a broader regional risk: drugs entering the continent through Nigeria can easily move through interconnected supply chains and spread across West Africa.

“West African markets are closely linked,” said Prof Gernot. “A large volume of drugs comes through Lagos, and from there they are distributed to neighbouring countries like Benin, and further afield to Ghana and others in the region. That means if there are concerns in Nigeria, they can have wider regional implications.”

Yet the crackdown is far from straightforward. For millions of Nigerians – particularly the rural poor – these same informal markets are not just a convenience but a lifeline, providing access to essential medicines that would otherwise be unaffordable or entirely out of reach.

Licenced pharmacies, where they exist, are often seen as expensive and intimidating, and many Nigerians prefer buying from a familiar trader in their neighbourhood.

“Some people simply can’t afford higher-quality or properly regulated medicines, so they may still turn to cheaper, lower-quality alternatives,” said Prof Gernot.

He warned that closing these markets without providing an affordable alternative does not make fake drugs disappear, but simply pushes the trade underground, where it becomes harder to monitor and control.

Weak legal deterrents also constrain the agency: under current Nigerian law, those convicted of selling fake drugs face a maximum fine of just ₦500,000 – around £270 – an amount critics describe as laughable compared to the profits counterfeiters make, with some cases stuck in courts for over a decade without resolution.

But even taken alongside its limitations, experts argue that Nigeria’s experience with NAFDAC offers valuable lessons for countries across the developing world still struggling to regulate their pharmaceutical markets.

Its multi-pronged approach – combining public awareness campaigns, market surveillance, port inspections, and visible enforcement – has helped reshape public behaviour and strengthen trust in regulation.

Regional bodies are already taking note: the African Medicines Agency, established to coordinate drug regulation across the continent, has looked to Nigeria’s model as a template for building capacity in systems where oversight remains weak or fragmented.

Yet beyond the spectacle of the bonfires – the flames, the smoke, the millions of doses reduced to ash – the deeper problem persists.

Informal markets exist because Nigeria’s health system has never fully met the needs of its 220 million people, and for millions of the poorest Nigerians, they remain the only place to turn when someone is sick, according to Professor Gernot.

He asked: “Where will people go who need those drugs, or who at least want access to them?”

It is a question Nigeria has not yet answered. And until it does, the bonfires will keep burning, and the trade will keep finding a way through.

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