Go to any bus stop in Kano, Bauchi, or Kaduna. You will find him.
He has a folding table. Bottles arranged in neat rows. Sachets with Arabic writing. He speaks with authority. He is not a pharmacist. He has no licence. Nobody has tested what is in those bottles.
By midday, he has sold to dozens of people.
Some of them will get better. Some will get worse. Some may suffer serious complications.
Many will never know whether the product they bought helped them, harmed them, or did nothing at all.
How Bad Is the Problem?
Counterfeit and substandard medicines remain one of Nigeria’s most persistent public health challenges. While estimates vary between agencies and studies, health authorities agree that open drug markets remain a major route through which falsified and poorly regulated medicines reach consumers.
Between July and December 2024, the National Agency for Food and Drug Administration and Control (NAFDAC) destroyed fake, expired and substandard products worth more than ₦120 billion, describing the seizures as part of its nationwide campaign against counterfeit medicines.
In October 2024, the agency destroyed another ₦10 billion worth of counterfeit and substandard products in Gombe State.
Then, in early 2025, one of NAFDAC’s largest enforcement operations targeted major open drug markets in Lagos, Onitsha and Aba, leading to the seizure of counterfeit medicines and other regulated products with an estimated value exceeding ₦1 trillion.
Every box seized represented a product that could have reached a patient who believed it was genuine.
The problem extends beyond Nigeria. According to the World Health Organization (WHO), approximately one in ten medical products in low- and middle-income countries is either substandard or falsified. Such products contribute to treatment failure, drug resistance, preventable deaths and growing public distrust in healthcare systems.
Nigeria also carries one of the world’s highest malaria burdens, accounting for a significant proportion of global malaria cases and deaths. Public health experts have long warned that the circulation of poor-quality antimalarial medicines undermines malaria control efforts by allowing infections to persist and increasing the risk of drug resistance.
Where Did This Come From?
Human societies have always searched for ways to treat disease using the best knowledge available to them at the time.
Long before the development of modern medicine, communities across Africa, Europe, Asia, and the Middle East relied on traditional healing systems based on observation, experience, and the medical knowledge available in their era. Northern Nigeria was no exception. Scholars in cities such as Kano and Sokoto studied medical texts from the wider Islamic world and practised forms of medicine that reflected the scientific understanding of their time.
There is nothing unusual about that. Every civilisation has relied on the best knowledge it possessed.
The problem is that knowledge does not stand still.
Modern medicine is built on a simple principle: claims must be tested. Treatments must undergo laboratory research, clinical trials, independent review, and continuous monitoring before they can be considered safe and effective. A remedy that has not passed through that process remains a claim rather than established medical evidence.
Northern Nigeria today faces a challenge that extends beyond culture or religion. Access to evidence-based healthcare remains uneven, particularly in many rural communities where clinics are scarce, trained health professionals are few, and poverty limits people’s choices.
The roots of this problem are complex. Colonial health services were largely concentrated in urban and administrative centres, leaving many rural communities with limited access to formal healthcare. After independence, successive governments expanded health services but struggled to meet the needs of a rapidly growing population. As a result, significant gaps in access to affordable healthcare remain across many parts of the country.
Whenever reliable healthcare is absent, alternatives emerge.
Some traditional healers act responsibly within the limits of their knowledge and encourage patients to seek hospital care when necessary. Others do not. In the absence of effective regulation, individuals without medical training are able to market untested products as cures for serious diseases, often without providing evidence of safety or effectiveness.
What survives is not simply tradition.
It is an unregulated marketplace where medical claims often circulate without scientific verification or legal accountability.
And it is within that marketplace that the roadside medicine seller continues to thrive.
Why Does It Persist?
More than six decades after independence, the conditions that allow unregulated medicine to flourish have not disappeared.
Northern Nigeria continues to face significant shortages of healthcare facilities, licensed pharmacists, physicians, and other trained medical professionals. For millions of people, especially in rural communities, formal healthcare remains distant, expensive, or difficult to access.
Poverty deepens the problem. When families cannot afford consultation fees, laboratory tests, or prescription medicines, cheaper alternatives become attractive—even when their safety and effectiveness are uncertain.
Culture and religion also influence health-seeking behaviour.
Many people place deep trust in traditional remedies and forms of Tibb al-Nabawi (Prophetic medicine), an important historical tradition within Islamic scholarship. That tradition, however, is distinct from the commercial sale of products that have never undergone scientific testing or regulatory approval.
The difficulty arises when some traders or self-proclaimed healers invoke religious language to market products as guaranteed cures for serious diseases without providing scientific evidence.
A bottle labelled “Prophetic Medicine” is not automatically safe because of its name.
Like any medical product, it should be evaluated on the basis of its ingredients, dosage, quality control, and scientific evidence.
Most customers are not irrational.
They are making decisions under difficult circumstances with limited access to healthcare, limited information, and limited financial resources.
When people lack reliable alternatives, trust often becomes their most valuable currency.
From a humanist perspective, this is the heart of the crisis.
People suffering from malaria, typhoid, diabetes, hypertension, or other illnesses deserve treatments that have been scientifically evaluated for safety and effectiveness.
Faith may provide hope, comfort, and emotional strength.
But bacterial infections, parasites, viruses, and chronic diseases respond to biological mechanisms not to belief alone.
For that reason, scientific medicine and spiritual belief should not be treated as interchangeable.
Both may occupy important places in people’s lives, but they serve different purposes.
Regulatory agencies such as NAFDAC have an essential role to play.
Over the years, the agency has strengthened enforcement operations, closed illegal drug markets, and seized large quantities of counterfeit medicines.
Yet enforcement alone cannot solve the problem.
Nigeria’s counterfeit medicine trade operates through thousands of informal sellers spread across towns, villages, markets, and transport hubs.
Closing one warehouse does not eliminate the demand that created it.
As long as affordable, accessible, evidence-based healthcare remains out of reach for millions of Nigerians, unregulated medicine will continue to find willing buyers.
What Would Actually Change Things?
The solution is not simply more arrests or larger seizures.
Law enforcement is important, but it addresses the symptoms rather than the underlying causes.
People buy medicines from roadside vendors because, for many families, they are the most accessible and affordable option available. If a primary healthcare centre has no medicines, no trained staff, or is located many kilometres away, the roadside seller becomes the healthcare system by default.
Expanding access to quality healthcare is therefore one of the most effective ways to reduce demand for unregulated medicines.
Every well-equipped primary healthcare centre, every licensed community pharmacy, every trained community health worker, and every affordable consultation gives people a safer alternative.
Public education is equally important.
Many consumers do not know how to identify genuine medicines, understand dosage instructions, or recognise the dangers of counterfeit products. Others are unaware that NAFDAC provides tools, including its Mobile Authentication Service for selected medicines, to help consumers verify the authenticity of certain regulated products.
Health education should not be treated as an occasional campaign.
It should become a permanent part of public life through schools, primary healthcare centres, radio programmes, television, social media, and community engagement conducted in local languages such as Hausa.
Religious leaders, traditional rulers, teachers, healthcare professionals, and civil society organisations all have an important role to play in promoting evidence-based healthcare while encouraging people to seek qualified medical advice when they become ill.
The issue is not one of faith versus science.
It is one of ensuring that medical claims are supported by scientific evidence before they are trusted with human lives.
The roadside seller also deserves careful consideration.
Many are operating within an economy marked by unemployment, weak regulation, and limited opportunities. Some may genuinely believe in the products they sell. Others knowingly exploit vulnerable people.
Regardless of their intentions, every product sold for medical treatment should meet the same scientific and regulatory standards expected of medicines dispensed in licensed pharmacies.
Public health cannot depend on good intentions alone.
It depends on evidence, transparency, accountability, and effective regulation.
The Cost of a False Medical Claim
Consider what many Nigerians encounter every day on television, radio, and social media.
Advertisements regularly promote products claiming to cure HIV, diabetes, cancer, infertility, hypertension, and many other serious illnesses. Some of these advertisements rely on religious language or testimonials rather than scientific evidence, encouraging viewers to believe that a single herbal mixture or spiritual remedy can succeed where decades of medical research have not.
Many of these claims are never supported by published clinical trials or approval from Nigeria’s health regulators.
The consequences can be devastating.
Take HIV as an example.
Modern antiretroviral therapy (ART) does not cure HIV, but it allows millions of people around the world to live long, healthy and productive lives. When taken consistently, antiretroviral medicines suppress the virus to very low levels, protect the immune system, and dramatically reduce the risk of transmitting HIV to others.
Problems arise when patients abandon proven treatment after being promised a miracle cure.
Doctors and public health experts in Nigeria have repeatedly warned that some patients discontinue their prescribed medicines after being persuaded to rely on unverified traditional or faith-based remedies. When treatment stops, the virus can rebound, the immune system weakens, and the patient’s health may deteriorate rapidly.
This pattern is not unique to HIV.
Similar risks exist when people abandon treatment for tuberculosis, diabetes, hypertension, epilepsy, or cancer in favour of products that have never been scientifically evaluated.
False hope can become a public health hazard.
From a humanist perspective, every person has the right to make informed decisions about their healthcare.
But informed consent depends upon truthful information.
Anyone who advertises a product as a cure for serious disease without credible scientific evidence places vulnerable people at unnecessary risk.
Whether those claims are motivated by profit, personal conviction, or sincere belief does not change the biological consequences.
Diseases respond to biology.
Medicine must respond to evidence.
Faith can provide comfort and emotional resilience.
It should never be presented as a substitute for scientifically validated medical treatment.
The Table Will Be There Tomorrow
At the end of the day, the roadside medicine seller packs up his table and goes home.
Tomorrow, he will return.
So will his customers.
Some will recover because their illness was mild and would have improved anyway. Others may receive medicines that are genuine. But many will continue to purchase products whose safety, quality, or effectiveness has never been scientifically verified.
The tragedy is not simply that counterfeit and unregulated medicines exist.
The greater tragedy is that millions of Nigerians still have little choice.
When reliable healthcare is unavailable, when licensed pharmacies are too far away, when hospitals are understaffed, and when poverty limits people’s options, informal medicine markets become a substitute for the healthcare system.
That is not a failure of culture.
It is not a failure of faith.
It is a failure of public policy.
For decades, Nigeria has struggled with underinvestment in primary healthcare, shortages of trained health professionals, weak regulation of medicine supply chains, and widespread health misinformation.
These are problems that governments can address.
They require stronger institutions, better funding, more healthcare workers, improved public education, and consistent enforcement of drug safety regulations.
As a Humanist, I believe every person deserves access to healthcare that is safe, affordable, and supported by scientific evidence.
Respect for culture and freedom of religion are important values.
But no belief religious, cultural, or personal should exempt a medical product from scientific testing when human lives are at stake.
The distinction between belief and evidence has transformed medicine over the last century.
Vaccines, antibiotics, insulin, anaesthesia, and countless other medical advances exist because researchers demanded evidence before accepting medical claims.
Northern Nigeria deserves the same standard.
Its people deserve medicines that have been tested.
They deserve healthcare that is accessible.
They deserve information that is truthful.
Above all, they deserve the opportunity to make healthcare decisions based on evidence rather than desperation.
Because when science is absent, misinformation fills the vacuum.
And when misinformation replaces medicine, ordinary people pay the price.
