In a village pharmacy in rural Kwara State, the shelves that once held artemisinin-based antimalarials and first-line antibiotics stood half-empty for weeks during the 2020 lockdown. The owner, a patent medicine vendor licensed only to sell pre-packaged over-the-counter drugs, had no way to restock. His wholesaler in Lagos had suspended deliveries. Transport routes were closed. The imported medicines he relied on were either stranded at ports or never manufactured at all. His customers, many of them mothers managing childhood fevers and elderly patients rationing hypertension tablets, had nowhere else to go.
Scenes like this played out across thousands of communities in rural Nigeria during the COVID-19 pandemic. They tell a story that healthcare strategists like Lucky Ilodigwe have spent years trying to make policymakers understand.
“What we had before COVID-19 was not a resilient system,” he told Pharmanewsonline in a recent conversation. “It was a system that functioned only in the absence of shocks. The pandemic simply proved what the data had been telling us for years.”
Ilodigwe, a Nigerian healthcare strategy professional, advises on health system strengthening and pharmaceutical supply chain design across West Africa. In an exclusive with Pharmanewsonline, he opened up on what the pandemic exposed about the country’s drug distribution architecture, the rural communities it failed most acutely, and what it would take to build something more durable in its place. The picture he paints is sobering, but the diagnosis is clear, and so are the remedies.
A supply chain built on borrowed stability
Ilodigwe’s starting point is not the virus itself, but the architecture that preceded it. Nigeria’s pharmaceutical market is the largest in West Africa, worth between two and two and a half billion dollars, yet it is overwhelmingly dependent on imports. By widely cited industry estimates, roughly 70 per cent of the country’s drug supply comes from abroad, and nearly all active pharmaceutical ingredients (APIs) are sourced from India and China. Local manufacturers, he explains, mostly operate at the formulation and packaging stage, assembling medicines from components produced elsewhere.
“We don’t make the molecules,” Ilodigwe says. “We assemble them. And when the source countries locked down, our assembly line went dark.”
When manufacturing hubs in India’s Gujarat and Maharashtra states—two of the most important centres of global generic drug production—shut their gates in early 2020, the effects reached Nigerian wholesale markets within weeks. Buffer stocks were thin, regulatory pathways for emergency substitution were slow, and the informal end of the distribution chain had no resilience to draw on.
For Ilodigwe, the vulnerability is structural rather than situational.
“Every foreign exchange fluctuation, every shipping delay, every geopolitical tension—it all transmits directly into drug pricing and availability at the village level,” he says. “COVID-19 did not create that transmission mechanism; it activated it all at once.”
The diseases that did not wait
The most consequential impact of the pandemic on rural health, Ilodigwe argues, was not COVID-19 itself, but the disruption of treatment for conditions that kill far more Nigerians every year.
“Malaria does not observe a lockdown,” he says. “Neither does tuberculosis. Neither does hypertension. When you shut down the supply chain for three months, you are not just delaying treatment. You are sentencing people.”
The projections that emerged in 2020 gave this warning numerical weight:
- Malaria: Modelling by international researchers estimated that if antimalarial case management and seasonal prevention were cut in half, prolonged service interruption could produce roughly 42,000 additional malaria deaths in Nigeria within a single year, and more than 200,000 across sub-Saharan Africa.
- Tuberculosis: Nigeria’s then-Minister of Health acknowledged that TB testing fell by about 30 per cent after the second-quarter lockdowns, leading to a 17 per cent reduction in case finding and notification.
“Those are not just numbers on a dashboard,” Ilodigwe says. “Each one of those missed diagnoses is a patient who went home thinking they had a persistent cough, when in fact they had active TB and were spreading it undetected.”
The picture in the private health sector, where most Nigerians actually seek care, was equally bleak. Surveys of facilities in Kano and Lagos later found that medicine vendors were the facility type most likely to close during lockdowns, with around 93 per cent of closures attributable to government mandates.
For patients managing chronic conditions, the consequences were immediate. Studies of consumer access during the pandemic found that more than three-quarters of respondents—77.3 per cent in one widely cited survey—reported an increase in the cost of their medicines.
Ilodigwe says the figure squares with what he saw in the field: “Patients were rationing medication, splitting tablets, switching to cheaper alternatives of uncertain quality, or simply stopping treatment. In rural areas, the choice was not between branded and generic. It was between something and nothing.”
The vendors who are the system
Any credible conversation about drug access in rural Nigeria must reckon with patent and proprietary medicine vendors, or PPMVs. Research has long established that these informal outlets are the first point of care for around 75 per cent of Nigerians in rural and underserved areas. For Ilodigwe, that statistic is not a footnote; it is the defining feature of the system.
“PPMVs are not an aberration. They are the system,” he tells Pharmanews. “They are the primary mechanism through which millions of people access antimalarials, antibiotics, analgesics, and oral rehydration salts—the medicines that determine whether a child survives a fever or a grandmother manages her blood pressure.”
Yet, PPMVs are licensed by the Pharmacy Council of Nigeria (PCN) only to sell pre-packaged, over-the-counter medicines. In practice, as Ilodigwe and many others in the sector have observed, many sell well beyond that remit, including antibiotics, antihypertensives, and even psychotropic drugs. These are often sourced through informal wholesale channels where quality verification is minimal. Meanwhile, the minimum qualification to operate such a store remains the basic ability to read and write.
“We are asking people with no pharmaceutical training to be the frontline of drug access for three-quarters of rural Nigeria,” Ilodigwe says. “That is not a regulatory gap. It is a structural reality that policy has chosen not to confront.”
During the pandemic, that fragile last-mile infrastructure simply buckled. Wholesalers reduced deliveries or shifted to bulk purchasers with faster payment cycles, leaving smaller PPMV outlets deprioritised. When they reopened, many operated with depleted and inconsistent stock.
“Patients were choosing between no treatment and treatment of uncertain provenance,” he says. “That is not a choice. That is a failure of the system to protect the people it is supposed to serve.”
Counterfeit medicines: Two decades of progress at risk
Supply chain disruption does not merely reduce the quantity of available medicines; Ilodigwe stresses that it also degrades their quality.
Older readers will remember that in 2001, the World Health Organisation (WHO) estimated that as many as 70 per cent of the drugs sold in Nigeria were counterfeit—a figure so alarming that several neighbouring countries banned Nigerian pharmaceutical products outright. The appointment of Dr Dora Akunyili as Director-General of the National Agency for Food and Drug Administration and Control (NAFDAC) marked the beginning of a sustained enforcement campaign. Two decades on, this has produced measurable results; NAFDAC today places the share of fake and substandard medicines on the market at roughly 13 to 15 per cent.
Ilodigwe views those gains as genuinely significant but highly fragile.
“NAFDAC’s progress from 70 per cent to 13 per cent is one of the most important public health achievements in Nigeria’s history,” he says. “As COVID-19 showed, those gains can quickly erode. When formal supply lines contract, informal channels fill the vacuum, and those are the channels through which counterfeit and substandard medicines circulate.”
He describes a pandemic dynamic in which patients, faced with limited options and rising costs, turned in greater numbers to unregulated sellers, open-market vendors, itinerant drug hawkers, and unlicensed shops, where authenticity is virtually impossible to verify.
The consequences, he warns, extend well beyond the individual patient.
“When a substandard medicine harms someone, they do not blame the unregulated seller,” he explains. “They blame the healthcare system. They blame pharmacists. They lose trust in formal care. Once that trust is lost, it creates a negative feedback loop: people avoid formal facilities, self-medicate more, and the problem compounds.” In many rural communities, the act of seeking treatment itself became a hazard—a legacy of the pandemic that will outlast the crisis that produced it.
From crisis response to system redesign
For Ilodigwe, the central lesson of the pandemic is not that Nigeria’s pharmaceutical supply chain failed under extraordinary pressure, but that the pressure was not, in any meaningful sense, extraordinary.
“COVID-19 was a stress test,” he says. “It revealed weaknesses that will reproduce the same failures in any future shock—whether another pandemic, a foreign exchange crisis, or a disruption in the India-China API corridor on which we depend. The question is whether we redesign the system or simply wait for the next failure.”
He identifies three strategic imperatives to fix the system:
1. Designing the last mile
Nigeria’s distribution model is commercially driven and fragmented, optimised for markets that are easiest to serve. “During the pandemic, medications clustered in accessible urban centres while harder-to-reach communities were systematically deprioritised,” Ilodigwe notes.
The way forward is decentralised: mobile distribution points, community-based dispensing, and structured coordination between public facilities and PPMVs. “Scaling those models requires regulatory frameworks that recognise how care actually reaches people, including the reality that PPMVs are not replaceable in the short or medium term.”
2. Real-time supply chain visibility
“During the crisis, decision-makers frequently had no idea where shortages were emerging or which communities were most affected,” Ilodigwe says. “Inventory data, where it existed, was fragmented across suppliers, distributors, facilities, and informal vendors with no mechanism for aggregation.”
Drawing on his work at PwC Nigeria, he argues that supply chain visibility is a precondition for serious pandemic preparedness, and that this principle extends well beyond medicines to diagnostics, medical devices, and vaccine logistics. “You cannot redirect supply to where it is needed if you do not know, in real time, where the gaps are.”
3. Boosting local manufacturing capacity
Nigeria’s near-total dependence on imported APIs means every global shock translates mechanically into drug scarcity at the community level. He acknowledges that the African Continental Free Trade Area (AfCFTA) offers a useful framework for regional pharmaceutical coordination, but he remains blunt about its limits.
“Integration without domestic production capacity merely enlarges a trading bloc. It does not create pharmaceutical sovereignty.” India’s API success, he notes, was the product of decades of state-backed investment, regulatory maturation, and petrochemical development. “Nigeria’s path will differ, but the direction is clear: reduce import dependency through selective backward integration, beginning with high-volume essential medicines where domestic demand justifies the capital.”
Resilience is built before emergencies
The pandemic did not break Nigeria’s rural drug distribution system. As Ilodigwe sees it, the system was already broken, held together only by favourable import conditions and the sheer determination of informal providers operating without institutional support. When those conditions changed, the fractures became impossible to ignore: 42,000 projected additional malaria deaths, a 30 per cent decline in tuberculosis testing, and three-quarters of consumers reporting that their medicines had become more expensive.
“A supply chain that cannot withstand a single quarter of disrupted imports is not a supply chain,” he tells Pharmanews. “It is a contingency dependent on the absence of contingencies.”
The question facing Nigeria’s health sector leaders is not whether another systemic shock will come, but whether the pharmaceutical supply chain will be structurally different when it does. For the millions of Nigerians in rural communities who depend on patent medicine vendors, open markets, and whatever stock happens to be available on a given day, the stakes are not abstract. Access delayed, as the pandemic demonstrated with brutal clarity, quickly becomes access denied.
