New Wellcome Trust-funded research project at CHSTM

The Nigeria in the Antimicrobial Eras project is a four-year research initiative funded by the Wellcome Trust. We explore four key phases in Nigeria’s antimicrobial history, focusing on shifts in drug regulation, healthcare policies, and antimicrobial stewardship.

Phase One: 1950s–1980s – Early Years of Antibiotics and Antibiotics Surveillance

The project examines how Nigeria engaged with global trends, particularly the rise of therapeutic rationalist movements that sought to regulate antibiotic prescriptions and usage in hospitals and drug markets. We also investigate how antimicrobial surveillance programs were implemented within Nigerian healthcare institutions and the role of key actors in shaping knowledge production around antibiotics.

The 1950s marked a turning point in antimicrobial development, with groundbreaking research leading to the mass production and commercialization of broad-spectrum antibiotics. These new drugs rapidly gained prominence in pharmaceutical markets, replacing older therapeutic approaches. However, this era also witnessed growing concerns about the excessive enthusiasm for antibiotics among pharmaceutical companies, industrial agriculture, and the general public, leading to irrational prescription and usage. In response, advocacy movements emerged to promote responsible antibiotic use, targeting not only patients but also healthcare professionals and pharmaceutical manufacturers.

Phase Two: 1980s–1990s – Global Healthcare Programmes and Drug Regulation

In this phase we explore the impact of international healthcare initiatives, such as the Primary Healthcare Programme and the Essential Drug List Programme (both introduced in the 1980s), on antimicrobial availability and quality in Nigeria. We examine the networks involved in antimicrobial procurement, the institutions responsible for quality control, and the emergence of regulatory bodies such as the drug regulation department within the Nigerian Ministry of Health and the National Agency for Food and Drug Administration and Control (NAFDAC).

A key aspect of this phase is the study of changes and continuities in NAFDAC’s approach to quality control technologies. By analyzing these developments, we highlight how global regulatory trends have influenced local pharmaceutical policies and innovations in Nigeria.

Phase Three: Antimicrobial Stewardship in Nigeria Since the 1980s

In this section we focus on Nigeria’s engagement with global antimicrobial stewardship policies. We examine how international protocols on antimicrobial resistance were interpreted and implemented within the Nigerian context. Through an analysis of selective hospitals at tertiary, secondary, and primary levels, the project investigates how policies on antimicrobial stewardship were formulated and applied within healthcare institutions.

Phase Four: Antibiotics Regulation Beyond Hospitals (1993–Present)

Beyond the hospital setting, in this phase we examine NAFDAC’s role in regulating the over-the-counter sale of antibiotics since its establishment in 1993. With its mandate to conduct regular inspections of pharmacies, drug outlets, and other points of sale, NAFDAC has played a crucial role in enforcing compliance with drug regulations. However, despite government efforts, challenges persist. The 2017 National Action Plan on Antimicrobial Resistance emphasizes the importance of responsible antibiotic use, yet social and economic factors continue to hinder regulatory enforcement.

Our research goes beyond merely documenting these challenges. Instead, we seek to analyze the evolution of NAFDAC’s strategies for addressing self-medication and antibiotic misuse, providing insights into both institutional constraints and policy innovations. Existing studies (e.g., Eticha, 2014) highlight that antibiotic use in Africa is heavily influenced by cultural beliefs and attitudes toward self-medication. This project aims to explore how these social factors intersect with regulatory efforts.

Methodology

The study employs a qualitative approach, gathering primary data through archival research and in-depth interviews. Updates on research activities will be shared via the CHSTM Blog.

Community Engagement

Findings from the project will be disseminated through workshops and seminars, engaging both academic colleagues and key stakeholders. A major stakeholder engagement workshop will also be held in Nigeria at a later stage of the project.

The Research Team

The research team consists of three members: Adedamola Adetiba, Tolulope Fadeyi, and Titilayo Adeosun.

Adedamola serves as the principal investigator and is a research fellow at CHSTM. He is a recipient of the Wellcome Early Career Fellowship Award and holds a PhD in History from Rhodes University. His research experience includes postdoctoral fellowships at the University of Huddersfield, Rhodes University, and the African Humanities Programme. His research focuses on how communities at the socio-economic margins of global health, particularly in Africa, assert agency over medical knowledge and the local implications of medical ideas disseminated through imperial and international networks.

Tolulope is a research associate on the project and is nearing the defence of her PhD, which explores the history of maternal health and midwifery in Nigeria. She has previously served as a Research Associate and Honorary Research Fellow at the University of Basel, Switzerland, and City University of London, where she made significant contributions to understanding the historical frameworks shaping contemporary healthcare practices in Africa. With her extensive expertise in Nigeria’s maternal health history, Tolulope brings valuable historical insights into the evolving landscape of health policies and planning, particularly at the intersection of maternal health and antimicrobial resistance.

Titilayo is a research assistant on the project. She holds a bachelor’s degree in pharmacy from Obafemi Awolowo University and a master’s degree in public health from the University of South Wales. Her experience spans hospital and community pharmacy roles in Nigeria and over three years in project implementation with organisations like the Clinton Health Access Initiative and Accelerated Health Impact Solutions. She brings expertise in data collection, stakeholder engagement, research methodology, programme facilitation, and fieldwork.

If you have any questions about the project, please get in touch with the PI, Dr Adedamola Adetiba.

Image: Photograph of Dr Michael Okpara, one time premier of Eastern Nigeria and Minister of Health. He was on a visit to a laboratory in Italy in August 1960. The laboratory was renowned for research and development of antibiotics.

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