Introduction

Treatment of animals with different forms of veterinary drugs has always been the major approach to prevention and control of various animal diseases and parasites in livestock farming worldwide, and the Inter-Governmental Authority on Development (IGAD) region.  Access to effective veterinary treatment is therefore essential for many people’s livelihoods.  However, illegal veterinary drugs which have penetrated many market places have made disease prevention and control difficult. While regulators scramble to catch up with illegal veterinary drugs problem, livestock owners have resulted into buying medicines and treating the livestock themselves. They also report to Community Animal Health Workers (CAHWs) who are inadequately equipped to treat animal diseases.  

The circulation of illegal drugs has been informally reported at the cross-border areas of the IGAD region. This risk may be driven by weak regulatory, surveillance and monitoring systems in the region. The illegal veterinary drugs may have contributed to antimicrobial resistance (AMR), food insecurity and safety, and loss to livelihoods.  Because the status of the illegal veterinary drugs use in the IGAD region is not well known, IGAD commissioned a study to assess the status, magnitude and source of illegal drugs at the cross-border areas of South Sudan with Sudan and Uganda. This was undertaken through a consultancy from November 2020 to January 2021. After completion of the study, IGAD organized a workshop with the public and private veterinary drugs supply chain stakeholders from South Sudan, Sudan and Uganda on 12^th March 2021 in Naivasha, Kenya to validate the report as well as create awareness.

Workshop Objectives

1. To validate the report on the assessment of status, magnitude and source of illegal veterinary drugs use at cross-border areas of South Sudan with Sudan and Uganda.
2. To create awareness on the findings of the assessment of illegal veterinary drugs use at the cross-border areas of South Sudan with Sudan and Uganda to the drug supply chain stakeholders.

Opening Remarks

The Director, IGAD Center for Pastoral Areas and Livestock Development (ICPALD), Dr. S. J. Muchina Munyua opened the workshop by welcoming the participants. In his remarks, he observed that illegal veterinary medicines use in the IGAD region is a concern in terms of socio-economics, veterinary and public health. He cited a case where counterfeit augmentin was used in Kenya in 2019 which did not have any of the active ingredients (Amoxicillin trihydrate — Potassium clavulanate) that affected children.  There is need to know the reasons for the flourishing of the illegal drugs business and how it can be addressed. Moreover, a number of drugs will be found displayed in open-air markets during market days in contravention of the manufacturers’ directives on how they should be stored. He noted that raising awareness about illegal drugs should precede legislation, in particular the aspect of law enforcement. The workshop was attended by 13 participants from public and private sectors from South Sudan, Sudan and Uganda as well as the consultant and ICPALD.

The consultant made a plenary presentation with emphasis on methodology and findings of the study. The recommendation developed from the findings of the study were presented to the participants for ratification. Subsequent to the presentation, the participants retreated to country groups to discuss the report. They were to correct any anomalies in the report, and include omissions made by the consultant.  

Workshop Outputs

1. The report on the assessment of status, magnitude and source of illegal veterinary drugs use at cross-border areas of South Sudan with Sudan and Uganda validated;
2. Awareness creation on the findings of the assessment of illegal veterinary drugs use to the drug supply chain stakeholder undertaken.

Plenary Discussion of the Report

Fruitful plenary discussions ensued after the report presentation that led to the development of the workshop recommendation as indicated below. The following issues were raised during the discussions:

IGAD

1. IGAD will endeavour to coordinate prevention and control of illegal veterinary drugs in the Horn of Africa countries despite her main focus being trans-boundary animal diseases. This has been captured in the signed cross-border MoUs and implementation frameworks on cooperation and collaboration for control of TADs and sanitary measures between all IGAD Member States;
2. There is need for a comprehensive follow up study on illegal use of veterinary drugs extended to other IGAD clusters that IGAD is willing to support;
3. Countries of the IGAD region ought to come together to ensure only quality veterinary drugs are used in the region through adequate control of imports and mitigation of illegal inflows;
4. Countries should include all available avenues to sensitize stakeholders on illegal fake drugs in the region.

South Sudan

1. In South Sudan, private sector does not own vaccine storage facilities;
2. Vaccines found in the market in South Sudan may be from the remnants of vaccination campaigns by field veterinarians;
3. Border entry points between South Sudan and Uganda are well established unlike those on the South Sudan–Sudan border;
4. In South Sudan, vaccines are imported by government, Food Agriculture Organization of United Nations and International Committee of the Red Cross (ICRC);
5. The assessment report indicated that drugs were not readily available in the study area of South Sudan. The South Sudan delegate clarified that this does not reflect the position in the rest of the country;
6. The vaccines used in South Sudan include Peste des Petits Ruminants, Contagious Bovine Pleuro-Pneumonia, rabies, blackquarter and anthrax that are imported from various sources and are quality controlled at Pan African Veterinary Vaccine Centre of African Union before being allowed into the country. 

Sudan

1. Distribution of veterinary vaccines in Sudan is controlled by veterinary authority;
2. The vaccines used in Sudan are blanthax (anthrax/blackquarter), hemorrhagic septicemia, peste des petits ruminants, and sheep and goat pox;
3. Resistance reported on Samorin was due to supply of fake products/batch;
4. There is a big gap in surveillance of veterinary pharmacological products in the Sudan and the IGAD region;
5. The last mile project has raised awareness to livestock owners on illegal veterinary drugs particularly on how to differentiate fake or counterfeit drugs from quality drugs by hiring para-veterinarians;
6. The community animal health workers have undergone refresher training and linked with field veterinarians;
7. Sudan has developed a draft bill on establishment of a veterinary drugs regulatory agency to be forwarded to the cabinet for deliberation.

Uganda

1. There is market competition between legitimate and illegal/ fake veterinary drugs with stakeholders buying cheap drugs;
2. Foot and mouth disease, peste des petits ruminants, contagious bovine pleuropneumonia and rabies vaccines are controlled by the government;
3. Implementing the findings and recommendations of the assessment report will enhance regulation of veterinary drugs;
4. Drugs were smuggled into the country disguised as other products like clothes, fish, etc;
5. The drugs regulator (NDA) does not take regulation of veterinary medicines seriously;
6. The enforcement agents have no knowledge of the laws regulating drugs;
7. Illegal veterinary medicines have found their way into the country through official border entry points.

Workshop Recommendations

1. This rapid assessment of the magnitude of illegal veterinary medicines determined basic estimates of prevalence of illegal veterinary drugs. In order to acquire accurate data on magnitude of illegal drugs in the region, IGAD should consider a comprehensive quantitative analytical study to verify the prevalence of illegal drugs in the IGAD region.
2. In order to sufficiently manage illegal veterinary drugs in the IGAD region, there is need for a regional coordinated and harmonized approach to the problem involving drug supply chain stakeholders. IGAD to consider nurturing the approach to illegal drugs.
3. IGAD should develop a regional regulatory and legal frameworks model to regulate veterinary medicines in the region that will be domesticated in member countries, and will culminate to development of Memoranda of Understanding (MoUs) among IGAD countries binding them to work jointly to achieve common objectives.
4. The governments in the IGAD region, in close collaboration with the key stakeholders, should consider establishing veterinary drugs regulatory agencies through a statutory instrument.
5. The drug regulators and ministries responsible for animal health should train and create awareness to veterinary drugs supply chain stakeholders on responsible and prudent use of veterinary drugs; and on presence, effects, identification and reporting of illegal drugs; using social media target messages where applicable.
6. In view of this study revealing presence of illegal veterinary drugs in the region, the drug regulators and ministries responsible for animal health, in close collaboration with counterfeit control agencies, are recommended to enhance post market drug surveillance, pharmacovigilance inspections and monitoring of drugs in the IGAD region with regular sharing of the results.
7. The governments are urged to revise and enforce existing policies, laws and regulations governing veterinary medicines to adequately address regulation of veterinary drugs and vaccines.
8. The national and local governments, and the national drug regulators are advocated to employ adequate number of veterinary professionals in the cross-border areas and facilitate them perform their obligations especially veterinary drugs regulation.
9. IGAD should consider establishing a regional quality assurance laboratory for veterinary drugs to serve IGAD member countries.

Way Forward

1. IGAD was urged to develop a project that will promote rational appropriate use of veterinary drugs and vaccines in IGAD countries to oversee the implementation of the study recommendations.
2. The Countries, including both public and private sectors, coordinated by representative of Veterinary Departments (Dr. Ben Ssenkeera, Dr. Hanan Mohamed and Dr. Matur Alembany) were tasked to develop a concept paper to be shared with ICPALD towards the development of above referred project.

Closing Remarks

During the closing session of the workshop, Dr. Munyua re-emphasized that illegal veterinary drugs are a threat to public health and access to markets for livestock and livestock products. He noted that investors in drug industry are ready to support regulation of veterinary drugs and control of illegal drugs if the accrued benefits are visible. Dr. Munyua thanked the private sector stakeholders in the drug supply chain for their support and participation in the workshop.  He wished all the participants safe journey back to the countries.