Codeine Syrup Ban: Pharmaceutical Company Suspends Staff

Hammed Shittu in Ilorin

A leading pharmaceutical company alleged to be one of the outfits mentioned in the BBC documentary video on codeine production and distribution, Bioraj Pharmaceutical Limited, Ilorin, at the weekend, disclosed that, the store man of the company that was shown in the video has been suspended from the company with immediate effect.

Already, the federal government has also banned the production and distribution of codeine products in the country with immediate effect.

The Managing Director, Bioraj Pharmaceuticals, Mr. Rahamon Bioku, who spoke with journalists in Ilorin, Kwara State capital, said the company had commenced a thorough investigation on the development and the ongoing investigation would reveal level of culpability of the staff.

Bioku, who said that the store man would be eventually sacked if found guilty, added that the staff does not have any control on sales and distribution of any of its NAFDAC approved 58 products.

The MD also said that the sales representative showed in the BBC documentary video had been suspended from the company since May 2016, adding that he was finally disengaged in August same year.

“Even when he was here with us, he was not allowed to handle cough syrup with codeine. Watching through the video clips, I saw in him a desperate marketer wanting to make big money from people he thought were big businessmen.

“Any representations made by the former sales representative and the store man shown in the video are not in line with the thinking, policy, ethical rules and regulations of Biorajpharmaceutical limited,” he said.

He said that the company had placed embargo on sales of Biolin cough syrup with codeine pending outcome of its investigation, adding that it would comply with federal government directive to ban further issuance of permits for importation of codeine phosphate as active pharmaceutical ingredient for cough syrup preparation to tame abuse of such drug products in the country.

Bioku, who said that the company had not sold codeine-containing preparation (cough) tounauthorised person or premises, added that its distributors and wholesalers were duly registered with Pharmacist Council of Nigeria.

“Biolin with codeine is not only registered, we comply with all rules and regulations guiding its importation, production and distribution. And none of our sales representatives has authority to take order or supply Biolin cough syrup with codeine to customers,” he said.

How Nigeria’s Start-Stop Immunisation Battle is Winning War to Eradicate Polio in Africa

The 50 million doses of polio vaccine stored in laboratory refrigerators all over Nigeria had a big weekend planned for them. If things had gone as intended, on Saturday morning, May 5, all of the little vials would have been trucked, flown, biked, walked around all 36 states of the nation – to be delivered to every single one of the 49,882,036 known Nigerian children under five years old. But, as things developed, an outbreak of circulating virus in one region of the country upended those plans for routine immunisation, replacing them for now with a crisis response in the affected area. The 50 million doses will instead remain on ice until sometime late in June.

That is the start-stop way polio surveillance and immunisation works—indeed, is supposed to work. And that’s what has allowed Nigeria to go a full 20 months without a single case of paralytic polio. If the country can make it to three years, plus a few extra months as an epidemiological cushion, it will be certified polio-free, which will also mean that the entire continent of Africa is clear of the disease. That will leave Afghanistan and Pakistan as the only nations on Earth where polio is endemic.

“Certification will be an achievement,” says Dr. Tunji Funsho, a former cardiologist who is now the chair of Rotary International’s Polio-Plus Committee in Nigeria. ”But we’re not in a hurry for that. We’re in a hurry to make sure no child is paralysed.”

Dr. Funsho would have been one of the ranking officials overseeing this weekend’s planned National Immunisation Day (NID), which actually would have spanned four days. NIDs are held twice a year in Nigeria, always from Saturday to Wednesday, to help ensure that field workers have two days to visit families when children are home from school. In addition to the semi-annual NIDs, a sub-NID covering nearly 23 million children is held annually in 13 northern states, which are considered high-risk areas.

The current NID was suspended when routine surveillance of sewage detected traces of live poliovirus in the northern states of Jigawa, Sokoto and Gombe, meaning somewhere in those states at least a few children were carrying the virus — perhaps asymptomatically. It had already passed through their bodies and into the environment. Bauchi State, which lies between Jigawaand Gombe, was also likely contaminated.

“When the geneticists sequenced the virus from Jigawa and Gombe they found they were identical,” says Dr. Mohammed Soghair, UNICEF’s polio field coordinator in Nigeria. “Somebody travelled from one state and shed the virus in the other, and that means it could have been shed in Bauchi too.”

In response, vaccine teams scrambled to the affected states to administer 2.4 million vaccine doses, hoping to cauterise the epidemiological wound before any cases of actual paralysis could turn up. Only when that situation is stabilised will the NID get underway.

In some ways, the weekend’s developments in Nigeria capture the devilishly tricky business of polio eradication overall. There are two types of vaccine used to prevent the disease: the oral polio vaccine (OPV) and the injected polio vaccine (IPV). OPV is easier and less expensive to administer and so that’s the kind that is used in mass-scale immunisations. The problem is, OPV uses a live, weakened form of the poliovirus to confer immunity, and on extremely rare occasions, that virus can mutate and actually cause the disease. The IPV, which is preferred in the developed world for routine childhood immunisations, uses a killed virus.

The viral samples found in the affected northern states were this vaccine-derived form of the virus—specifically Type two. Originally, there were three types of wild poliovirus. Types two and three have been vaccinated into extinction; Type one remains at large. The vaccines used in NIDs include protection against both one and three—since three was wiped out only recently. Vaccinations against Type two were discontinued in 2016, which made it vexing that it was that type that turned up in the northern-state sewage.

“The vaccines might simply have been discarded when they were no longer needed,” says Dr.Funsho. “Even when a vial looks empty, there can be some traces of virus left.”

To prevent this kind of careless contamination, doctors and other caregivers are cautioned to dispose of vaccine leftovers much more carefully. Vials that are returned to labs can be handled and destroyed like any other medical waste. In villages, empty vials are given something akin to the nuclear waste treatment, boiled and then buried five meters, or about 15 feet, underground. The burial site is then covered with a slab of concrete. In Bauchi State, used vials are taken to the local Ashaka Cement Factory and incinerated in an industrial oven.

It says something about Nigeria that so many of its institutions—political, medical, industrial, to say nothing of the volunteer community—are engaged in the eradication campaign. But it says something about the particular cruelty polio too—a disease that steals the happy, kinetic activity that is supposed to define childhood—that it inspires such immovable human resolve. The virus has no mind. Humans have both minds and hearts. The contest, in the end, isn’t even close.

Culled from Time Magazine