Dynamic disease burden: An increasing shift towards NCD incidence

Historically, Nigerian epidemiology has been similar to that of the entire continent: dominated by infectious diseases like malaria, cholera, neglected tropical diseases (NTDs), HIV, and many others, most recent of which is diphtheria, which is raging across West Africa. Even compared to other LMICs, Nigeria has a high burden of disease and disability attributable to communicable, maternal, neonatal, and nutritional disorders and deficiencies.

 

However, the shift towards non-communicable diseases (NCDs) has been notable in recent years. In 2019, NCDs were responsible for 27% of total deaths in Nigeria. Cancer, especially prostate and breast cancer, has been growing fast. As for other NCDs, there has been an urban vs rural divide: while hypertension dominates in rural Nigeria, overweight and obesity take the cake in urban areas.

 

This epidemiological shift is a matter of interest not only to policymakers and public health authorities but also to private investors in the Nigerian pharmaceutical market. It calls for developing and producing drugs and other pharmaceutical products for NCD management and care. Treatments for diabetes and heart conditions are expected to grow substantially in demand.

 

As investments and international development support for the Nigerian health sector, have been primarily focused on infectious diseases so far, there remains a critical gap to be filled for NCD management with prescription drugs. Moreover, the Nigerian healthcare system is also more accustomed to providing acute care, presenting opportunities to service Nigerian health delivery systems as they build capabilities for the long-term management of chronic NCDs.

At 70%, out-of-pocket spending claims lion’s share of healthcare expenditures in Nigeria. Combined with the growth of the middle and upper classes, this paints a picture of promising growth for the pharmaceutical market in Nigeria. This upward trajectory will be fueled by substantial growth in household consumption expenditure; McKinsey predicts an increase of $94 billion in household consumption in the decade following 2016. Add to this the benefits of the African Continental Free Trade Area (AfCFTA), and Nigeria is expected to witness a massive reduction in poverty levels. Such an economic landscape sets the stage for a Nigerian population with greater purchasing power and increasing interest in taking their health into their own hands.

 

The most notable transformation to impact the pharma market in Nigeria, however, is the recent passage of the National Health Insurance Authority (NHIA) Act and support from the WHO for its operationalisation. Private health insurance in Nigeria accounts for only 5% of health spending, while just about 23% of Nigerians some form or another of health coverage. The new NHIA Act mandates health insurance for all legal residents. This gives another 83 million Nigerians access to better healthcare, widening the opportunity for local and international players to leverage Nigeria's booming pharma market

The pharmaceutical manufacturing industry in Nigeria boasts 132 licensed companies. The sector is largely private and Lagos-centred, though there are some public entities and companies spread across Ogun, Enugu, Oyo, and Imo states. Market leaders in Nigerian pharma include European multinationals, Indian generics-makers, homegrown enterprises, and public-private partnerships (PPPs).

 

Compared to 1944, when May & Baker, Nigeria kicked off pharma manufacturing in Nigeria, the Nigeria pharmaceutical market 2023, is substantially evolved. International pharma players like Novartis, Sun Pharma, and Swipha have a presence in Nigeria, but the growth of Nigerian homegrown companies is the most impressive.

 

Founded in 1984, Emzor Pharmaceuticals is a privately owned indigenous pharma manufacturer. The multi-billion Naira company manufactures over 140 pharma products like anti-malarials, analgesics, vitamins, and antibiotics. 

Fidson Healthcare, founded in 1995 was the first company in sub-Saharan Africa to manufacture antiretroviral (ARV) drugs in 2005; today, it produces anti-infective, anti-malaria, cough and cold, central nervous system, gastrointestinal, and other kinds of medicines. 

Juhel Pharma, Tuyil Pharma, and Innovative Biotech are other indigenous companies contributing to the rapidly expanding pharma manufacturing landscape in Nigeria and West Africa.

Entering the pharmaceutical market in Nigeria demands tailored solutions and a unique approach. Nonetheless, in terms of product portfolios, there are opportunities for growth available across the production of infectious and non-communicable disease treatments, vaccines, generics, active pharmaceutical ingredients (APIs), and other medical products. Enjoying the benefits of the expanding pharmaceutical market size in Nigeria is possible through many such avenues:

 

• Pioneer products: The Nigerian Investment Promotion Council (NIPC) has designated specific industries and products as eligible for pioneer status. Achieving pioneer status grants companies various incentives, including tax holidays. The manufacture of pharmaceuticals and medical chemicals is classified as a pioneer industry, with products like antibiotics, essential vitamins, salicylic and o-acetylsalicylic acids, antisera, vaccines, blood processing products, medical diagnostic preparations, radioactive in-vivo diagnostic substances, biotech pharmaceuticals, medical supplies like impregnated wadding, gauze, bandages and dressings, and pharmaceutical glassware being recognised as pioneer products. Incentives for manufacturing these products in Nigeria make investing in them a promising growth opportunity.
• NCD treatments: The epidemiological shift towards NCDs in Nigeria and the larger African population presents a major unmet need. Pharma companies looking to enter the pharma market in Nigeria can find massive growth opportunities in bringing treatments for cancer, heart conditions, obesity, diabetes, and other NCDs to the West African market through manufacturing in Nigeria.
• Vaccines: A report by PharmAccess projects that the African vaccine market will grow 6 to 15% annually between 2020 and 2030. In Nigeria alone, the vaccine market is estimated to be worth about $208 million, with the need for routine and supplemental vaccines soaring to a massive $2.7 billion by 2028. The African Development Bank (AfDB) even views Nigeria as a potential hub for vaccine manufacturing in West Africa. Nigeria urgently needs to bridge gaps in the production of legacy vaccines like DTP, Covid vaccines, and other vaccines required in the region. This presents a massive opportunity for manufacturers to enter the pharmaceutical market in Nigeria, either directly, through public-private partnerships, or by teaming up with homegrown companies.
• Generics: As pharmaceutical demand grows across income levels in Nigeria, the demand for generics will form a substantial proportion of all drugs purchased. Also, as Nigeria shifts away from international aid in its immunisation programmes, a cost-conscious government will surely value the cost-effectiveness of generics. Local manufacturers of generic drugs in Nigeria can also seek the support of international development agencies, even seeking pre-qualification support from the WHO. Overall as Nigeria aims to improve access to quality healthcare and medicines, local manufacturing of quality generics is an area shows great promise.

 

As Nigeria continues to navigate its path towards self-sufficiency in pharmaceuticals, the sector is poised to become a key player in the global health arena, offering a plethora of opportunities for investment, collaboration, and innovation. The future of Nigeria's pharmaceutical market is bright, promising a healthier, more prosperous future for its people and a model for pharmaceutical growth and development across Africa.