For over a decade, Nigeria has made commendable strides in its fight against leprosy, a neglected tropical disease (NTD) that disproportionately affects the poorest and most vulnerable. However, a current crisis threatens to unravel this progress and raises urgent questions about the country’s commitment to equitable healthcare and human rights.

For the past 11 months, Nigeria has been unable to secure Multi-Drug Therapy (MDT) medications essential for treating leprosy. This delay, stemming from procedural bottlenecks in obtaining the Clean Report of Inspection and Analysis (CRIA) and the Certificate of Pharmaceutical Product (CoPP), has left over 3,000 individuals—including 800 children—without access to life-saving treatment.

At its core, this situation represents a grave violation of human rights. Health is a fundamental right enshrined in the Universal Declaration of Human Rights, and denying access to essential medicines infringes upon this right. For individuals affected by leprosy, the lack of timely treatment exacerbates physical disabilities, fuels stigma, and erodes their dignity.

fact that these medications are donated free of charge by the World Health Organisation (WHO) makes the situation even more egregious. The procedural delays preventing their procurement not only deepen the suffering of affected individuals but also expose Nigeria to international embarrassment as the only country unable to secure MDT medications for reasons entirely within its control.

The human angle: Hauwa’s story

Hauwa, a 12-year-old girl from Zamfara State, was diagnosed with leprosy since May 2024. She first noticed patches on her skin and numbness in her fingers. By the time she was diagnosed, the disease had already begun to cause deformities in her hands and feet.

Hauwa’s parents were relieved to learn that leprosy is curable, and that treatment could stop the disease’s progression. However, their hope quickly turned to despair when they were informed that the necessary MDT medications were unavailable due to supply delays.

As weeks turned into months, Hauwa’s condition worsened. The once cheerful girl now struggles with physical deformities and its associated stigma. “I just want to go back to school and play with my friends,” Hauwa says, her voice filled with tears.

Hauwa’s story is just one among thousands. Her suffering underscores the human cost of bureaucratic inefficiencies and the urgent need for intervention.

Untreated leprosy cases act as reservoirs for the disease, increasing transmission and burdening an already strained healthcare system. Nigeria, once proud of its progress in leprosy elimination, now risks becoming a global outlier due to avoidable bureaucratic inefficiencies that have hindered its ability to procure free MDT medications.

On December 23, 2024, the Integration Dignity and Economic Advancement (IDEA-Nigeria), a national association of persons affected by leprosy, organized a press conference to address the gravity of the situation. In his statement, IDEA President, Mr. Peter Terver Iorkighir highlighted the dire consequences of the 11-month delay in MDT supply, emphasizing its human rights and public health implications. He urged President Bola Ahmed Tinubu to promptly address regulatory barriers and ensure affected individuals receive the necessary treatment; stressing the need for decisive leadership to uphold Nigeria’s commitment to leprosy elimination and alleviate the suffering of those affected.

Despite this urgent appeal, however, no action was taken, and the critical delays in treatment have persisted, worsening the crisis.

This crisis is not unique to leprosy. Across low- and middle-income countries (LMICs), systemic barriers hinder access to essential medicines. Complex regulatory requirements, insufficient local manufacturing capacity, and reliance on international donors often create a perfect storm of delays and shortages.

In Nigeria’s case, the additional requirement for a CRIA, compounded by the need for a waiver from the National Agency for Food and Drug Administration and Control (NAFDAC), underscores the procedural inefficiencies that plague access to medicines. These challenges highlight the need for regulatory frameworks that are robust yet flexible enough to prioritize public health emergencies.

Resolving this crisis requires immediate and strategic action. The following recommendations are key:

• Expedited waivers for essential medicines: Regulatory agencies like NAFDAC must establish streamlined processes for waivers during public health emergencies, ensuring that procedural requirements do not delay access to life-saving treatments.
• Strengthened coordination between ministries: The Federal Ministry of Health and Social Welfare and regulatory bodies should enhance collaboration to address bureaucratic bottlenecks and ensure timely procurement of donated medicines.
• Advocacy at the highest levels: The Presidency must recognise the urgency of this crisis and prioritise intervention. A high-level task force should be established to oversee the resolution of this issue and prevent future occurrences.
• Long-term investment in local manufacturing: Nigeria must invest in building local capacity for the production of essential medicines, reducing dependency on international suppliers and mitigating the risk of supply chain disruptions.
• Global accountability: International stakeholders, including WHO and donors, should work closely with LMICs to streamline donation processes and align them with local regulatory requirements.

This crisis is a defining moment for Nigeria’s public health leadership. Beyond the immediate health implications, it is a test of the country’s commitment to its most vulnerable citizens and to its global reputation as a leader in the fight against neglected tropical diseases.

Leprosy is curable, and its elimination is within reach. However, this goal will remain unattainable if procedural inefficiencies continue to obstruct access to the very tools that make elimination possible. The time for decisive action is now.

Nigeria must act swiftly to restore access to MDT medications and reaffirm its commitment to health equity, human rights, and global health leadership. Anything less would be an injustice to those who depend on these life-saving treatments—and a disservice to the nation’s public health legacy.

 

Dr Udo is the Country Director of The Leprosy Mission-Nigeria