By Ope Adetayo and Jennifer Rigby
NASARAWA, Nigeria (Reuters) -The World Health Organization says it will send leprosy drugs to Nigeria this weekend after resolving testing hold-ups that led to a year-long delay in thousands of patients, including children, getting the medicine they need to prevent disability.
Africa’s most populous nation, Nigeria reports over 1,000 cases of leprosy yearly, a disease caused by a bacterium, Mycobacterium leprae, and mainly affecting the skin, peripheral nerves, and eyes. It is curable with multi-drug therapy, but without treatment, the disease progresses and causes disfiguring sores and disabilities like blindness and paralysis. Patients also face significant stigma.
But Nigeria ran out of stock of the multi-drug therapy in early 2024 as a bureaucratic delay in supplies and new domestic testing regulations on imported medicines held up the drugs in India, where one of the components is made.
The delay, which caused significant suffering in Nigeria, is just one example of the vulnerability of a global system that has seen stockouts in countries including India, Brazil and Indonesia in recent years, the U.N. special rapporteur for leprosy told Reuters.
A WHO spokesperson told Reuters that Nigeria had run out of leprosy medications, and the U.N. health agency, which organises shipments of the drug, had asked for a one-time waiver on the new testing policy. In January that waiver was granted.
“A dispatch of leprosy drugs from India has been confirmed for 8 March, with arrival in Nigeria on 9 March,” the spokesperson said by email.
‘THE PAIN IS WORSE’
At ERCC Hospital in Nasarawa state, 200 km (124 miles) west of the capital Abuja, only two leprosy patients were admitted when Reuters visited in February, after 26 others had been sent home since last year due to the shortage, raising the risk of spreading the infectious disease, which is thought to spread through respiratory droplets and prolonged contact.
Awwal Musa, one of the patients, said her health had deteriorated in the past year since her treatment stopped. All her fingers were clawed and her legs discharged pus.
“Before last year, my wounds were getting healed but now they are getting worse. The pain is worse,” she told Reuters during a visit to the health facility.
Health workers at ERCC said their goal in the past year was to prevent patients from being permanently disabled.
“If they lose their fingers, where are you going to get the fingers and give them again? If they lose their sight, who will give them sight? The complications are increasing day by day,” said Kuzeh Thomas, a director at the hospital.
WHO data shows that Nigeria is one of 12 countries reporting between 1,000 to 10,000 cases annually, behind Brazil, India and Indonesia.
Each country requests leprosy doses, a capsular medication, administered over a period of 12 months, from the WHO every year. Health sources said Nigeria’s request was late.
Nigeria’s National Tuberculosis and Leprosy Control did not respond to a request for comment.
The drugs are made by Novartis and donated for free to a WHO programme. Health sector sources said Nigeria’s National Agency for Food and Drugs Administration and Control required additional testing for doses produced by Sandoz, a spin-off company of Novartis, when the shipment reached Nigeria, because that component was made in Indian facilities.
A Sandoz spokesperson said “for contractual reasons, [we] cannot share details of our supplies to third parties.” Novartis said it “remained committed to work towards the eradication of this disease” without giving further detail.
Quontrol, an India-based laboratory, told Reuters that it inspected the drugs but did not release the results of the inspection. The drugs were submitted for testing in Nigeria in November, and got approval in December 2024.
The U.N. Special Rapporteur on the elimination of discrimination against persons affected by leprosy and their family members, Beatriz Miranda-Galarza, told Reuters that “while the MDT (multi-drug therapy) distribution system appears well-structured on paper, in practice, it faces significant structural and political challenges.”
Sunday Udoh, head of non-profit Leprosy Mission Nigeria added: “This is the first time we are seeing this kind of very strange, very painful situation where leprosy patients who belong to the poorest of the poor are not able to access this life-saving medication.”
(Reporting by Ope Adetayo in Nasarawa and Jennifer Rigby in London; Additional reporting by Maggie Fick in London and Rishika Sadam in Hyderabad, India; Editing by MacDonald Dzirutwe, Sandra Maler and Sharon Singleton)
