An initiative of the National Academy of Public Administration, and the Woodrow Wilson School of Public and International Affairs and the Bobst Center for Peace and Justice, Princeton University Oral History Program Series: Governance Traps Interview no.: H1 Interviewee: Dora Akunyili Interviewer: Itumeleng Makgetla Date of Interview: 4 September 2009 Location: Abuja Nigeria Innovations for Successful Societies, Bobst Center for Peace and Justice Princeton University, 83 Prospect Avenue, Princeton, New Jersey, 08544, USA www.princeton.edu/successfulsocieties MAKGETLA: It is the 4th of September 2009 and I'm here in Abuja, Nigeria. My name is Itumeleng Makgetla and I'm here with Professor Dora Akunyili, the Minister of the Federal Ministry of Information and Communication from December 2008. Before that, for nearly eight years she was the Director General of the National Agency for Food and Drug Administration and Control (NAFDAC). Thank you very much for joining us. AKUNYILI: Thank you for coming. MAKGETLA: Before you begin, may I just confirm that I have your consent and that this is a voluntary interview? AKUNYILI: Yes, you have. MAKGETLA: Excellent. Can we then begin by having you give us a brief overview of your career and how you came to be engaged in reforms at NAFDAC? AKUNYILI: How I came to be here or how I came to be in NAFDAC? MAKGETLA: How you came to be in NAFDAC. AKUNYILI: Thank you very much. I was Zonal Secretary of Petroleum (Special) Trust Fund (PTF). It is a trust fund that is given a percentage of Nigeria's oil revenue to be used in providing infrastructural facilities for the entire country. I was in charge of the southeast. I had a strange ailment then and was asked to go to Britain for treatment. I was supposed to have surgery, but it was a wrong diagnosis here in Nigeria. I went with 17,000 pounds: 12,000 for surgery, 5,000 for treatment, tests and others. In the end, it was found that I did not need surgery. So, I asked the hospital to give me the 12,000 pounds, which I had already paid. They were surprised that I wanted to return the money to my employers. When I returned the money to General (Muhammadu) Buhari, a former Nigerian head of state who was the chief executive of PTF, he wrote on the letter: "I did not know there were still some Nigerians with integrity." He said I should return the money to the finance man, and I did. Just before PTF wound up, a friend of (Olusegun) Obasanjo-another former head of state, who had just been elected Nigeria's new President-came to visit his kinsman, who was my friend. When he visited General Buhari, before coming to see the kinsman, he was told about how I returned 12,000 pounds. So, when I went to the man's office some months later, my friend said, "Deddeh, this is the lady who returned the money." He said, "Yes, I'm just coming from General Buhari's office. You returned 12,000 pounds; why did you return it?" For me, it was not a big deal. I said I returned it because it is not my money. I cannot take money that is not my own, even though people felt I should not return it. But I felt strongly to return it and so I returned it. He said, "Are you are pharmacist?" I said, "Yes." He said, "What happened?" I told him the story. He said, "My friend is looking for somebody to sanitize NAFDAC." NAFDAC was not a big name. I heard about it vaguely, but it was not a place I would apply to work because it was not a popular place. I just said, "Oh really?" He said, "Yes, I want your CV (curriculum vitae)." I said, "I don't have my CV here." He said, "Go and type it." I went and typed what I could remember and gave it to him. On a Sunday afternoon, about three weeks or four weeks after, I got a phone call, and the caller said, "My name is Obasanjo." I was in shock. I thought it was a scam. But when he repeated another word, I said, "This is the voice I hear on television and radio." I don't know what I muttered because I was confused, but we agreed I would see him on Tuesday. So, on Tuesday I came to Abuja to see him. He was very nice. He asked me about the 12,000 pounds, and asked me a few questions about counterfeit drugs in the system. I was just myself and he made up his mind to give me the job. Thereafter, there were a lot of fights from the political class because they didn't want him to give me the job. They had their reasons, which sounded very cogent because the Minister of Health was Igbo. I am Igbo and most of the drug counterfeiters are Igbos. Remember, I am also a woman, so gender was equally an issue. But Obasanjo stood his ground and said, "No, this is the woman that will do the job" and that was part of the driving force behind me when I was working in NAFDAC-that confidence in me, somebody he never knew. He just heard some reports about me. Even the Minister of Health then, who handed over to another Health Minister, who was also an Igbo man, was against my appointment. So, I came to the place I'd never been into-regulation. I came from the university. I was a pharmacist. Regulation is not taught in any pharmacy school. I was keen to succeed. I was desperate to succeed. I, therefore, hit the ground running right from the first day. By the grace of God, by the time I left, the counterfeiters were on the run, so much so that they even started running towards other West African countries. And I pursued them to those places, because they were living in Nigeria and going to establish there. I called other West African food and drug regulators and put in place WADRAN, West Africa Drug Regulatory Authority Network as a platform for interacting with our brothers and sisters in the sub-region-so as to make the environment hostile for them in other countries, and so that they will not find a place to re-group and re-invade us, because drug counterfeiting is actually an invasion. MAKGETLA: Let's go back to those first days where you described yourself hitting the ground running. What were the key challenges that were priorities for you when you came into that position as Director General (DG)? AKUNYILI: The most serious challenge was corruption and conflict of interest. Before I came into NAFDAC, the counterfeiters were paying their way to bring in whatever they wanted to bring in. I came in and said no, it would not happen again. Of course, they were angry. They threatened me with phone calls. They threatened my husband. They nearly kidnapped my son, and so on and so forth. When they got very desperate, they even shot me. A bullet grazed my scalp, and it shattered my headscarf. It was a miracle that I survived. They vandalized NAFDAC facilities, and burned NAFDAC offices across the country in the space of five or six days. I think that was the hardest challenge-the corruption, conflict of interest, threats to life and property; not only of me, but also to NAFDAC officials and our facilities. The fact that most drug counterfeiters come from my place was also a very big issue. At a stage they carried that propaganda, that I was fighting my people. I was convinced that it was not a matter of tribe or religion or my people. It was a matter of telling people, stopping people from circulating poison in the system. We also had the challenge of very poor laws. The laws were very non-deterrent. When people were convicted, the penalty was between 10,000 and 500,000 Naira, or three months to five years imprisonment. Everyone knows that 500,000 Naira to a major drug counterfeiter is like one dollar to you or I, to you and me. Consequently, they are able to go to court and get the best lawyers, and drag out cases for many, many years. In fact, we are in court with some drug counterfeiters from 1996 to the current date. Those cases are still in court. The people who shot me in 2003, the case is still in court. Despite the fact that the people who shot me were identified-five of them were killed, one survived and he is still around as a star witness. So, the case is still in court. Another serious challenge is sophistication in drug manufacturing-clandestine drug manufacturing, such that it is difficult to tell the difference between counterfeit and genuine. These counterfeiters actually use all of their technology in making sure that the copy is perfect, even though the drug may not contain anything. We also have a serious challenge with non-corporation, non-governmental agencies in the ports. We had that problem and that struggling, making sure we did the right thing, and all of this was actually working against us. It was tough. But you see, when you start succeeding in a fight, the burden becomes less. It was very tough when we started, but success came very fast. Criminals are cowards. As long as a regulator does not get compromised, the criminal will eventually be on the run. And when the criminal starts running, he will never stop running because they know they are doing the wrong thing. It is just that for over thirty years, because nobody challenged them, they became like little gods. And it was even a shock to them that I came into that position and gave them a fight for their money. We had other challenges, but these were the major ones. MAKGETLA: What would you identify as the most important changes you were able to effect during your time with the agency? AKUNYILI: First of all, there was awareness. We created so much awareness. Even in the villages, people have to call people who went to school-they call people who are literate to read labels for them before they buy any drug or take any drug, or any food, or whatever consumables, because they know the necessity that it has a NAFDAC number. This is a number that authenticates that this drug is certified by NAFDAC. They ask people to check the NAFDAC number, check the expiry date, and the awareness is now a part of the fight. The criminals have succeeded for over thirty years partly because of lack of awareness. They went on their business unhindered. People were not checking. Secondly, when I came into office as the DG of NAFDAC, we had about 70% of drugs in circulation as fake and counterfeit. Of course, people were dying. We had lots of treatment failures, and resistance to antibiotics and anti-malarials. As people were dying, legitimate businesses were collapsing. Multinationals left this country out of frustration. Boehringer, Merck, Pfizer, Lily, and many of them left because they were not on even playing ground. How can you be competing with someone compressing chalk or making a drug with little actives? Or a drug that has actually expired, but was relabeled, or so on and so forth? Or people who are just paying for packaging? By the time we gave them a fight for one, two, three years, by the time we actually consolidated, because they already saw that the game was up, the level of incidence of fake drugs came down to 16.7% as shown by a study conducted by WHO and DFID. People were dying less, our doctors were happy in hospitals, and the general atmosphere changed. The counterfeiters were no longer moving in a convoy of cars-yes, it was as bad as that. In the late 1990s, Chief Marcel Nnakwe and his son, the greatest drug counterfeiters in this country, used to move around Onitsha with a convoy of cars and policemen. Impunity, that's the word. By 2003, they could no longer even come out. They were hiding. As the level of incidence of fake drugs came down, less people were dying, the medical officers became happy, our drug industry started to revive-we had 70 drug manufacturing outfits, but that rose to 150 by 2007. Most of them were expanding very fast because by 2001, all were about to close-even the 70 that were in existence were near closure. By 2006, as I said, we had 150 and they were all very vibrant. Most multinationals that left Nigeria out of frustration started coming back. Our drugs started to be accepted by other West African countries-our drugs that were banned. By 2001, made-in-Nigeria drugs were banned across Africa. And as we were working in the area of drug we were also working aggressively in the area of food. Consequently, Nigeria became the first developing country to achieve universal salt iodization. This iodization is critical for childhood survival. We also worked in the area of Vitamin A fortification of food, fluoridation of toothpaste and standardization of cosmetics. We worked aggressively to stop the use of toxic bromate in bread production, among many other food issues. Food, drugs and cosmetics received equal attention, but people were more interested in drug issues for obvious reasons. When I look back, I feel really comfortable with how far we were able to get and I pray that as the present DG always says, if we have formidable structures on ground, those formidable structures will continue to make NAFDAC function effectively such that these criminals would not dream of coming back. And so even that 16.7% should come down, because by the time I left NAFDAC, the 16.7% was the figure of 2006. Our own assessment was less than 10%, about 9-10%. But we didn't publish it because it was a preliminary study. I always said that we would publish when WHO, with any other international agency, saw this and gave us the figure. So, our own assessment was less than 10% by last year. I pray that it continues to go down because even 9%, 10, 2 or 1% is still unacceptable because we are talking about life. But remember that drug counterfeiting is not just a Nigerian issue, of course. Even in the US it is becoming a very big problem and I have always been interacting and coordinating activities with USFDA (United States Food and Drug Administration) since 2001. MAKGETLA: Talking about working with other actors to advance your reforms, how did you build public support for these efforts and whom did you see as key individuals or institutions or other actors that you could turn to build support for these initiatives? AKUNYILI: We were able to build support for NAFDAC-public and government support- because of our sincerity of purpose and honesty and level-handedness in dealing with everybody. You see, when you work, people watch. If they trust you, especially Nigerians, they follow and support you. The support of the people went side by side with the support of government. Government also saw that we were doing very well and started giving us particular attention. Even the President would not say much at functions, without talking about NAFDAC. That was more than money because it means that even the President of Nigeria appreciated what we were doing. In Nigeria, that's a lot. That public support, as I said, was built through establishing trust and confidence, both from the people and from government. It continued to widen because as years went by, it was clear to everybody that our activities were not a fluke but genuine. They were seeing results: less people were dying in hospitals, doctors were speaking up, pharmacies and drug manufacturers were rejoicing and are now seeing their profits in newspapers. Everybody keeps saying, "Thanks to NAFDAC." These all contributed to build public confidence. To some point, people were praying for me in both churches and mosques, even though I'm not a Muslim. Whenever I heard that in a mosque I was being prayed for, it really lifted my spirits and other NAFDAC officers also felt good about it. When I came to NAFDAC, there was no structure. We have put in place structures such that everybody in NAFDAC knows what happens when a drug is submitted for registration-step one, step two, and step three; what happens when you detect a drug in a shop that is fake-step one, step two, step three to the step of closing down the shop. These standard operating procedures and operational guidelines helped us a lot, together with public support, and, very importantly, our strong will never to be compromised. That is the number one rule for a regulator to succeed. Once a regulator gets his or her hands soiled, the regulation is finished; the people you are regulating will become your masters. But as long as you are not compromised, you will remain their master and they will remain afraid of you, such that they can never do anything brazenly or with impunity. MAKGETLA: You have discussed the resistance the agency faced when trying to implement its mandate. How did you deal with the resistance? How did you address that challenge and what difficulties arose? AKUNYILI: When they were threatening me, I tried to deal with it by not always talking about it. When they nearly kidnapped my son-they went to school and called him out, telling him that an uncle of his was looking for him-when my son came out, two men grabbed his two hands. But when they wanted to be sure that he was my son, he fooled them, saying, "Dr. (Mrs.) Akunyili is not my mom; she is my aunt." And he swore by it, and they left him. We had to send him to America to join his other siblings, because I won the American visa lottery in 1996 and that actually let my children become entitled for their green cards. So, with my son away, it remains myself and my husband. My husband had his own security given to him by the government and I had eight to nine policemen staying with me from morning to night, until I slept. I had four, but after being shot, it increased to about nine or ten. They were always with me, but more importantly, I am a very firm believer in God, that the people who are guiding me will guide in vain if my God is not there. After all, I didn't have policemen the day I was shot. And, again, President Obasanjo ordered that security should be beefed up at all of our facilities after the vandalization of the lab and the burning of our facilities. Thank God for the way I handled that burning-the burning of our facilities actually pained me more than the shooting, because after the shooting, I survived it, while our burnt facilities could never be recovered. It was like they had done their worst. I came on a Monday morning-Sunday night it was on TV that NAFDAC was burning-I looked at the place. The smoke was all over the air and the fire was coming down. I came out of the car, looked at it, and I just decided to say nothing because I didn't want to start crying. That wouldn't be too good for me. I went back to my house and sent for all the staff. When they came to my house, I told them that we were not going to show these people that we were distressed because this was becoming a psychological warfare. I told them that I was going to see the President that day, so we could find a place so that we could resume work immediately. I flew to Abuja and saw the President who gave me free access. He was instrumental to our success because I had free access. He called the Minister of Housing, gave us land in Ikoyi. I flew back to Lagos the same day, and called to tell the staff that I would see them later in the evening. I told them I would get some money for us to get canopies and to buy some chairs from the street, so that we could stay there and work. By the next day, we were putting up canopies, buying chairs, and people were amazed. I felt that we needed to pretend that we were not shaken. That we could still go on. What actually happened that time, one of my staff members got bitten by an insect because we were sitting on chairs by the grass, and that insect formed maggots on her leg-a very bad insect. That was when it struck me that it was getting too dangerous. Then we quickly bought portable cabins, which we used before we moved to the laboratory, and so on. Something struck me. I called the Director of Enforcement that Monday before I left for Abuja. I said, "Director, we are supposed to go on raid to a particular place." I said that he must go to that particular place. He didn't say anything. I said, "I am talking to you. I said we must go on raid today. Forget about the fire because they want to break us psychologically." He said, "The smell of the smoke is still in the air." Then it dawned on me that some of my staff were too down-spirited for me to continue driving them. That was just before I left and went to Abuja. So, we continued to manage as if nothing had happened. Three days after the Lagos fire, or two days after, early in the morning I got a call. My husband said, "Well, what I'm telling you, even if they burn NAFDAC facilities in the 36 states you will not kill yourself." I said, "What kind of story is this? 6 a.m. and you're talking about what I would do if people burn NAFDAC facilities in the 36 states." He said, "Well, what will you do if you hear that Kaduna has been razed down-your lab?" I said, "How? What type of joke is that?" He said, "Well, they have burned that place down." I said, "When?" He said "at night." That was when I got hysterical and I sent people to go to Kaduna-I did not go because I felt it was beginning to affect my health. The next day, the arsonists went to Maiduguri. The day after, they went to Benin, but President Obasanjo had ordered more policemen to be sent and they did not succeed; they were chased out. It was hard, but when I look back, what is important is that I'm alive to tell the story, because at a stage, I kept feeling and kept discussing with my children, "What if I die on this job?" And my children said, "Mommy, we have been telling you to leave this job." My children actually insisted I would leave this job after my first tenure. When we were having a meeting, the four-year anniversary in Lagos, my husband came for the celebration and got up to talk-we didn't discuss that he was going to say that, it came from his heart-he said, "Well, this job by next year, by the grace of God, my wife will conclude her first term and she's not going for a second term." People got crazy about it and angry. And well, I needed to support my husband who had said that kind of thing in public. We had individuals, organizations going to my husband, coming to me, pleading that I should reconsider it. The one that actually touched me the most was the President invited my husband and I went with him. He encouraged him to encourage me. We decided that I would stay on for the second term. But even for that second term, normally after the first term you apply, stating that your tenure has ended and that you wished to continue. For two years, I didn't apply. I didn't write anything until in a council meeting, when the council members of NAFDAC said, "No, you must renew your tenure because legally, you are actually here for almost two years without renewal." So, I now wrote a letter and renewed it. MAKGETLA: This is my last question. As Director General, you had to bring a team to work with you in the office. How did you go about identifying and attracting people with the necessary skills to support your reform efforts? AKUNYILI: I knew some people before I came to NAFDAC. I knew some people at Enugu, some pharmacists. I knew their capabilities. I invited them and they came. I invited my special assistant who worked with me when I was in local government, and he came. Actually, I invited pharmacists who I knew earlier and non-pharmacists who I also knew about and their credibility and competence, and they came. We worked together until I left. MAKGETLA: This program is designed to help leaders share their experiences and innovations to address challenges that arise in building new states and institutions. Is there anything that we've missed or which you would like to add? AKUNYILI: What I want to say, actually, is that an institution assumes the character of its leadership. Responsible and honest leadership is critical to the survival of any establishment or institution. An institution assumes the character of the leader. If the leader is honest, the people are bound to follow suit most of the time. But once the leader is dishonest, the system gets destroyed. If, as the Director General, I ever got compromised, all the others along the line would go on to be compromised. Or, if I allowed them to get compromised on my behalf, then that would just be impunitive, because it is like the support is from the top. So, I like what you are doing because African leaders need to be sensitized, to know that leadership is critical to the survival of this continent. Because without purposeful and honest leadership, Africa will continue to grope in darkness, and corruption will continue to eat us like a canker worm such that our God-given natural resources may never really take us to where we were supposed to be. MAKGETLA: Thank you so much. AKUNYILI: You are welcome. Innovations for Successful Societies Series: Governance Traps Oral History Program Interview number: H-1 ________________________________________________________________________ ________________________________________________________________________ 4 Use of this transcript is governed by ISS Terms of Use, available at www.princeton.edu/successfulsocieties Use of this transcript is governed by ISS Terms of Use, available at www.princeton.edu/successfulsocieties