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INTERVIEW WITH MR TUNDE BALOGUN – PRODUCT MANAGER, ANTI – MALARIALS
By Chukwuma Muanya – (As Published in Guardian Newspaper, April 23, 2015)
Why the huge interest in malaria by Fidson?
MALARIA is serious public health concern in Nigeria now and it has always being. Estimates show us that everybody remains at risk even today in Nigeria because it is an endemic problem. It is a vector borne disease and the vector is everywhere with us. So it remains a huge public health challenge for us. As a responsible indigenous pharmaceutical company, we therefore have to play a major role in fighting malaria. We just have to be at the vanguard of that fight as a pharmaceutical industry.
Where do you come in now as a company?
Our primary responsibility is to ensure the provision and distribution of high quality anti-malarials at cost effective prices. We are aware that there is a direct link between poverty and incidence of malaria therefore cost of therapy must be affordable for patients to reduce the economic burden of malaria on them.
Already many of such people perhaps they live on daily basis, that means their earning is on daily basis and once malaria reduces their capacity to generate income on a particular day it also means that the funds to access medical care, to treat themselves is also becomes unavailable for such category of patients. So this is the major role that we play.
Another role we play is to ensure increased advocacy on behalf of the low-income earners, on behalf of indigent people we are always talking about malaria prevention and control and increase awareness. To that extent we are engaged in nationwide talks at various fora. We have representatives scattered all over the country to the remotest areas and every now and then engage in talks with pregnant women in schools so that everybody is aware. Malaria is a very preventable disease. All it takes is we prevent a vector bite and therefore malaria burden goes down. If people are aware, how do we reduce the chance of that vector bite? It is a major war against malaria. How do we do that? There should be improved sanitation. Do not allow manmade water bodies to be formed. In other words gutters that pass through residential areas should be allowed to flow, address over population in certain centres and improve nutrition so that people eat the right and balance diet to boost their immune levels. All these are what we put in our awareness campaigns and from time to time at occasion like World Malaria Day for instance go out via Non-Governmental Organisations (NGOs) give back to the society and those that need insecticide treated nets we give for free. Some of our representatives are involved in health campaigns and free medical screening. We give out drugs to these NGOs to support them and to improve the fight against malaria. These are situations whyere Fidson plays a very prominent role.
How does Fidson go about addressing the issue of malaria resistance and the burden on the socio economic situation of the country? Do you have specific products or programmes?
Firstly, Fidson has potent antimalarials to fight malaria. We have an intravenous artemisinin based product. The frequency of dosage is very convenient for patients, it is just once a day. If the frequency is too high they may also discourage patient from complying with prescriptions and invariably resistance would rise. With that we have been able to address frequency of dosage and compliance of patients to doctors prescriptions. We also have the oral ACT, Artemed ACT, is very convenient for patients. They just take it one tablet twice a day for three days. We just recently relaunched our Artemed ACT into the market because of the burden of malaria. We introduced it to ensure that people will continue to have access to high quality, cost effective antimalarials. We are always engaging doctors, pharmacists and their associations such as the Nigerian Medical Association (NMA), the Association of General and Private Medical Practitioners of Nigeria (AGPMPN), the Pharmaceutical Society of Nigeria (PSN) and so on. We have strong alliances with them, some of them are also engaged in our research. We also partner with them, support them to ensure that we can develop products locally for our people.
Has Fidson done any clinical trials on its anti-malarials in Nigeria?
At the moment there is a research work that is on going which I cannot disclose in details for now. Again what we are looking at is to improve the quality of our products, to ensure that we can enhance compliance of patients to prescriptions. For instance instead of giving twice a day can we get a once a day molecule, instead of giving for three days can we get a once and for all regimen. This is the focus of our research currently.
Another major issue in the fight against malaria is the faking of products. Have they attempted faking your products and how are you addressing the issue of faking of products? Also, NAFDAC gave a deadline for companies to comply with its anti-faking device of scratch and text. In terms of faking of drugs, what are you doing and what have been the challenges?
We acknowledge the serious threat that unscrupulous people pose by attempting to counterfeit various brands of antimalarials. We have complied with regulatory guidelines that require that all antimalarials in Nigerian markets should have scratch codes through which customers can verify the authenticity of the product they are buying. We are glad that even though these bad elements try to counterfeit our brands, the scratch code has been helpful in preventing them from succeeding. Both Emal® and Arthemed® antimalarials have the scratch code.
Besides drug treatment, there are so many other ways malaria is being tackle. Is there any other way Fidson is involved in eliminating malaria?
World Malaria Day is around the corner. The intention is laudable. In fact we must commend Nigeria and indeed the federal government in this regard because World Malaria Day started as an African event. Nigeria hosted pan African malaria summit in 2000 where 44 endemic countries in Africa where part of that summit in Abuja. Then African Malaria Day was borne the following year. Fortunately the WHO took it over to broaden the scope and then increase funding so that the fight against malaria will be more penetrating. So one of the things we are doing in occasion like this is to remain at the forefront and propagate the scourge of malaria, the burden, the economic loss. It is said for instance that the economic loss is in excess of $12 billion yearly in Africa. It is also said that about $5.1 billion is required yearly to fight malaria, to increase awareness. According to the World Malaria Report of 2014, which chronicled what happened in 2013, it is just about $3 million that was used by government bodies to fight malaria. So there is still a shortfall. So because that economic loss is huge because once people are not working because they are sick, the productivity drops, there is a challenge. So for us as a company and we know that malaria is preventable. Can we increase awareness on how to prevent malaria in the first place? Talk to people. There is a four-pronged approach. Firstly, we need to prevent the growth of the vector. Lets get rid of stagnant water bodies, let us address sanitation. Secondly, insecticide treated nets must be optimally used. This is another place where we are quite prominent because from time to time through NGOs we give out insecticide treated nets especially to the critical demographics that is the infants, children and pregnant women. The third approach is what we refer to as the intermittent preventive treatment to this critical demographics again that is the children and pregnant women. We also support such policies as well with our range of antimalarial. Fourthly is to ensure that there is always proper diagnosis so that there is the right treatment for the disease condition.
The theme of the World Malaria Day is "Invest in the future, defeat malaria." Are there plans by Fidson?
The theme has been on for the last three years now. We just have to defeat malaria.
Is it possible to defeat malaria?
Yes it is possible. The latest World Malaria Report shows that the incidence of malaria continues to go down in Africa. For instance the latest report says by the end of 2015 nine countries in Africa will be able to achieve 75 per cent reduction in cases of malaria. We are not there yet. Nigeria is not one of those countries. We have half of the malaria cases in Africa. The burden is still high on us in Nigeria. The government and other stakeholders are doing their bids. It is said that about 60 per cent of hospital visits is due to malaria, about 30 per cent of admissions is because of malaria. They tell us that 25 per cent of child mortality is as a result of malaria and infant mortality is even as high as 30 per cent and maternal mortality as high as 111 per cent. All these cases are going down fortunately. But if we put in absolute terms there is a lot to be done. As a company what we are doing is improving our product portfolio. Can we get a product that will increase the compliance of patients so that instead of twice a day it will be once a day. Can we get a product instead of three days or five day regimen, can we get a once for all regimen. So this is the thrust of our research that we are doing locally. These are the areas we are investing as a company.
In which area is Fidson investing to support the fight against malaria in line with the theme of World Malaria Day 2015?
As a leading indigenous pharmaceutical company, we are committed to improving patients' compliance to the dosing regimen of antimalarials. We know that when frequency of dosing is too high, patients tend to skip doses. This act usually increases the chance of the malaria parasite developing resistance to the drug in the long run. Currently, our flagship brands are easy to administer and comply with prescription. However, we are investing in the area of further improving compliance rate. We are working with researchers to develop antimalarials that could probably be dosed once and for all and the patient recovers. We do hope to succeed in our quest.
Emal injection is a third generation Artemisinin derivative, containing alpha- beta arteether. It is the first third-generation artemisinin injectable to be introduced in the Nigerian market.
Emal kills malaria parasite at the blood stage and is used to treat all forms of acute uncomplicated malaria, chloroquine resistant Plasmodium falciparum malaria, multidrug resistant malaria and cerebral malaria cases. It brings rapid relief from symptoms from the first day. Emal is administered intramuscularly once a day for 3 days. It is presented in 2mls for adults and 1ml for children.
Arthemed is a combination of artemether and lumefantrine; both blood schizonticides indicated for the treatment of Plasmodium falciparum or mixed infections including P. falciparum. It is an ACT, which is the international standard of care recommended by WHO for malaria therapy.
Arthemed is administered orally. It provides quick resolution of symptoms and prevention of disease progression in a cost-effective manner.