In December last year, Union Finance and Corporate Affairs Minister Nirmala Sitharaman hailed India as the “Pharmacy of the World”, owing to its high and efficient production of “global standard medicine” at affordable costs. However, the image has suffered considerable damage in the past few months following repeated incidents of alleged drug malfunction leading to sickness and deaths, especially among children.
The booming pharmaceutical industry of India is driven by cost-effective innovation when it comes to mass production of life saving drugs that are used by countries globally. During the Covid-19 pandemic, India was at the forefront of delivering essential drugs and vaccines to several nations. According to available data, India exported 5.84 crore doses of Covid-19 vaccines to 70 countries as of March 2021.
The image, however, has been tarnished to some extent by a string of global incidents in the recent past where health authorities abroad have held India-made drugs responsible for deaths and deterioration of health among children.
Concerns over Indian syrups
In October 2022, India started investigating the role of four locally-made cough and cold syrups that were suspected in causing the deaths of about 70 children in the West African nation of Gambia. It was only after the World Health Organization’s (WHO) alert against medical products made by Maiden Pharmaceuticals, a Haryana-based company, whose products were accused of being “contaminated”.
Following the alert, India halted manufacturing of the company’s products and shut down its factory in the Sonipat. But India’s global pharma woes were far from being over.
In December 2022 amid increased scrutiny, India launched yet another investigation into the deaths of 18 children in Uzbekistan that were allegedly linked to the consumption of Indian cough and cold syrups.
As per a statement by the health ministry of Uzbekistan, the children had allegedly died after consuming a medicine named Dok-1 Max, which was manufactured by a company from Uttar Pradesh named Marion Biotech Pvt Ltd. As per the ministry, initial tests revealed the presence of the harmful and toxic ethylene glycol in the cough syrup. The substance has previously been linked with child deaths too.
Ethyl glycol contamination is not new in India, As per a report in The Indian Express, at least five mass DEG contamination cases were reported in India between during 1972-2020 in places like Mumbai, Gurgaon, Chennai, Bihar, and Jammu. As many as 33 children died in the reported incident from Gurgaon while 12 children died in Jammu.
Eye drop under the scanner
It isn’t just ethyl glycol. Soon after the alleged cough syrup deaths and the WHO alert last year, another Indian pharma company halted production of a certain eye drop after US Centers for Disease Control and Prevention (CDC) said that the product may have been involved in infecting 55 people across 12 US states and causing one death.
Symptoms among the other infected patients included vision loss. The cases were recorded between May 2022 and January 2023.
India’s role in global drug security
With its well connected and established manufacturing base and a steady supply of cheap labour, India has a lot of potential when it comes to the global pharma market and worldwide drug security.
The Indian model of effective, low cost drugs is rooted in the reverse engineering of the pre-privatisation era when Indian medicines and drugs were not given product patents. This resulted in a large mass of Indian pharmaceutical manufacturers managing to produce generic and low cost version of medicines and drugs that already had patents from other countries. It was olnly after 2005 that Indian medicines started getting their own patents. Today, India is the largest provider of generic drugs globally.
The reverse engineering allowed Indian manufacturers to to become pioneers in low cost drug production, especially when it came to life saving drugs like market affordable version of HIV and cancer drugs, as well as drugs required for treatment of other deadly diseases like tuberculosis, Hepatitis C, Malaria and others. This revolution of low cost medicines was vital for helping India’s public health programs.
Not just within India, locally made drugs have also been a resource for other nations in terms of providing affordable life saving medication. In 1999, after HID/AIDS was announced as then number one killer in Africa, India enabled the manufacture and supply of affordable HIV antiretroviral at 99.99 percent lower prices than what was being offered nay drug manufactures in the west.
Medical diplomacy as a soft power and India’s place
Political scientist and former US Assistant Secretary of Defense for International Security Affairs Joseph Nye first coined the word “soft power” in 1990 that signified the phenomenon of a nation increasing its sphere of international influence by “achieving desirable influence through attraction and cooperation” as opposed to hard power tactics like war and military force.
Medical diplomacy has become an influential and effective form of strengthening soft power for developed nations. The US monopoly over drug patents and high pricing due to high cost of innovation has helped the country’s billion-dollar pharmaceutical industry grow leaps and bounds. But skewed global rules for pharmaceutical patenting adversely impact access to medicines in the developing world. This is where a country like India with its affordable manufacturing and supply chain of life saving drugs can emerge as a friend of developing nations.
In their 2014 paper, Medical Diplomacy in Achieving U.S. Global Strategic Objectives, researchers Aizen J. Marrogi and Saadoun al-Dulaimi write that “the diplomacy of medicine can achieve the dual goals of improving global health while helping repair failures in diplomacy, particularly in conflict areas, maturing theaters, and resourcepoor countries”.
The Covid-19 pandemic showed how India could channelise its medical diplomacy to increase its soft power. In the face of the pandemic, the Narendra Modi government at the Centre positioned itself as “humanitarian” and caring friend of other nations.
“In the post-Covid world, we need a new template of globalisation based on fairness, equality, and humanity,” said Modi at 2020 NAM Summit, comparing the new commitments made to “a new human-centric concept of globalisation”.
Importance of pharma sector and government push
According to the Annual Report 2021-22 of the Union Ministry of Chemicals & Fertilizers’ Department of Pharmaceuticals, the Indian pharma industry is the third largest in the world in terms of volume and 14th largest in terms of value. The Total Annual Turnover of Pharmaceuticals in 2010-20 was Rs. 2,89,998 crore. The report also noted that the total pharmaceutical exports and import accounted for Rs. 1,46,260 crore and Rs. 42,943 crore respectively in the same period.
In her Budget 2023-24, Union Finance Minister Sitharaman announced new programme to promote research and innovation in pharmaceuticals to be taken through centres of excellence. The move received sheers from the pharmaceutical sector which hailed it as a boon for the growing industry.
Last January, while inaugurating 11 new medical colleges and a new campus of Central Institute of Classical Tamil in Tamil Nadu, Modi said he envisaged India as a hub for “medical tourism” and a “go-to destination” for those seeking quality and affordable healthcare across the world.
“I say this based on the skills of our doctors,” said Modi.
How quality concerns can dent the image
The latest string of lapses in the quality of India-made medicines can throw a spanner in the wheel when it comes to India’s rise as a reliable “medical superpower”. While Indian manufacturing and pharma bodies and insiders blame tough competition and Western lobbies, health sector activists in India have long blamed lack of transparency of drug regulatory bodies in the country for the increase in faulty medications and drugs.
In an interview to Al Jazdeera, public health activist Prashant Reddy had said that lack of transparency is the key cause of pharmaceutical failures. He repeats the accusation in an editorial written for The Indian Express where he claims that denial and lack of accountability are common patterns when it comes to how drug regulators and bodies including the Union Ministry of Health and the Central Drugs Standard Control Organisation (CDSCO) respond to incidents of contamination or manufacturing lapses.
While administrators and politicians in India continue to hail India as the ‘pharmacy of the world’, the numbers are speaking a different story.
In her book Bottle of Lies, American journalist Katherine Egan underlines how getting approval for drugs by the Drugs Controller General of India was not a matter of providing relevant data but boasting of relevant connections. In addition, the ‘jugaad’ model of developing and manufacturing medicines has led to a culture of producing results using the most cost- and time-effective ways which has further led to an increase in circulation of subpar medical products that not only fail to provide effective treatment but also harm the patient’s resistance toward other similar drugs that are proven effective against the same ailment.
Following the alleged deaths in Gambia, former Commerce and Industry Minister Anand Sharma raised the question in Parliament and demanded swift fixing of accountability for the incident.
Sharma said, “India has a firm legal framework and regulatory mechanism on safety, quality and standard of manufacturing. No drug that fails the test of safety can be marketed, let be alone exported.”
Sharma also added that India’s “casual statements” that the drug was not sold in India and was only exported to Gambia were also “not reassuring” and could have a severe impact on India’s claim to being a ‘pharmacy for the world’.
Quality control and transparency are thus the two pegs on which the future of India’s image as the ‘pharmacy of the world’ stands. How it deals with the lapses in Gambia, Uzbekistan, and other recent cases of contamination will reveal how the nation plans to tackle these challenges in the coming days.