Editorial: Accountability dies, kids too

It is what it is. Pared to the bare essentials, a child with a cough and cold dies of the prescribed medicine contaminated with toxins. This can only happen when the system fails at multiple levels. The government swings into action, and, guess what, predictably calls for a high-level meeting. As a knee-jerk or performative reaction, even a random doctor is arrested. Action is initiated against an individual firm, too. But the truth is that the recent deaths of children in Madhya Pradesh and Rajasthan could have been averted had the government taken corrective steps at a systemic level a few years ago, when the WHO had flagged deaths of African children following the consumption of cough syrup produced in India. Sealing factories, suspending licenses, and introducing stricter protocols were clearly not enough.

The high-level meeting convened by the Union Health Ministry did nothing more than take stock of the situation and reiterate homilies about strict compliance with the Revised Schedule M by all drug manufacturers, and advised the states and union territories to ensure enhanced surveillance, timely reporting by all health facilities. From the official press release, it is not clear if the meeting took cognisance of the systemic issues that plague the small and lesser-known pharma companies that account for over 80% of the industry. Observers have been pointing out that the enforcement of quality control standards has been patchy and inadequate. Besides the shortage of staff, the bigger problem is the systemic corruption in the drug regulatory system, and it is an open secret that it is enabled by collusion and a deep-rooted nexus between government officials and pharma companies. The impunity could be traced to governance deficiencies of the political establishment. The ease with which responsibility for the tragic loss of life can be shrugged off and literally get away with murder ought to be deeply worrying.

The tendency to discredit critics was evident when India questioned the WHO’s findings and accused it of causing damage to the industry’s reputation. Even as public posturing, the messaging was not good, but letting such a thought process seep into regulatory practice at the ground level was even worse. Instead of introspecting and getting the house in order, the industry representatives too chose the easy way out of peddling conspiracy theories about how competitors were working not just against the industry but also the country.

As fixing the corruption and ensuring compliance with quality standards require more time, effort and the will to act against vested interests, the government tends to focus on quick-fix technology solutions or outreach among doctors, pharmacists and parents on rational use of cough syrup for pediatric population, which is important but does not the address the larger and more dangerous issue of adulterated or contaminated drugs.

If India were to be the “pharmacy of the world”, it should adhere to international quality standards and not cut corners, for instance, by substituting cheap and hazardous industry-grade solvents with pharmaceutical-grade solvents or manipulating drug trials, etc, for short-term gains which will eventually end up tarnishing the country’s reputation. Secondly, the government should put in place a swift but fair and just system, not only to hold pharma companies accountable, but also to punish the culprits (belonging to both the industry and the government) whose acts of commission and omission cause deaths.