Poison in cough syrup bottles: The never-ending saga of DEG-related deaths
As long as protecting the reputation and interests of the Indian pharmaceutical industry is the top priority, it is unlikely that there will be any meaningful reforms to prevent future tragedies caused by DEG. The bid to cover up, distract and obfuscate, as seen in the last few days, serves as valuable pointers
A familiar story played out last week as news broke that adulterated cough syrups were the likely reason for the mysterious deaths of 14 children in Chindwara, Madhya Pradesh. The first death was in the last week of August after the children were brought to hospitals with acute kidney injury (AKI). It took around a month for doctors to zero in on the cough syrups as the possible cause of death. Testing by government laboratories in Tamil Nadu and Madhya Pradesh, on October 2 and October 3, respectively, confirmed that the suspect cough syrup — Codrif — manufactured by a firm in Tamil Nadu was contaminated with high levels of diethylene glycol (DEG), a chemical generally used as anti-freeze agent and which is known to cause renal failure in humans.
Cover-up bid foiled
Yet, on the evening of October 3, the Union Ministry of Health informed the news agency ANI that the cough syrups were not contaminated since they cleared testing in government laboratories. Other advisories from the Union Ministry of Health, urging the “rational use” of cough syrups, without any mention of adulteration of cough syrups, further obfuscated the matter. Such cover ups and obfuscations by the bureaucracy are routine as we witnessed after the tragedy in The Gambia, when the Drug Controller General of India (DCGI) berated the World Health Organization (WHO) for alerting the world that Indian cough syrups were suspected to be the cause of deaths of 70 children and accusing it for a “narrative being built internationally targeting the quality of Indian pharmaceutical products”. A similar playbook was used after the deaths of three children in a Delhi government hospital in 2021 — initial reports indicated that the cough syrups were the cause but the final inquiry report was never made public by the AAP government which was then in power.
In the present case, the Union Ministry of Health may have succeeded in its cover up, had it not been for the Drug Controller in Tamil Nadu going on the record with the press and admitting that samples picked up from the manufacturing facility failed testing due to the presence of extrememly high levels (48.6%) of DEG.
While a detailed investigation report is awaited, it is very likely that the source of the contamination was the solvent propylene glycol (PG), which is used to dissolve medicine into the form of a sweet syrup that can be administered on children. Pharmaceutical grade PG should not contain chemicals like DEG, and in any event, pharmaceutical firms using such solvents should have detected such contamination in legally mandated testing before they used the solvent. DEG contamination is a known problem in the pharmaceutical industry across the world, claiming hundreds of lives in mass tragedies since 1937. The cause of death is generally renal failure and children who tend to have smaller kidneys are always the first casualties of DEG poisoning.
Killer syrups
In the last five years, cough syrups manufactured in India have been blamed for the deaths of 12 children in Jammu, approximately 70 children in The Gambia and 68 children in Uzbekistan. While the Union Ministry of Health did almost nothing to improve the quality of drug regulation, in 2023, the Ministry of Commerce worried about the reputation of the Indian pharmaceutical industry invoked its powers under a trade law to mandate the testing of cough syrups in government labs before being exported. But this requirement did not apply to cough syrups used within the country. The number of cough syrups failing this mandatory testing requirement for exports was truly alarming. In July 2024 The Economic Times reported that the syrups manufactured by 100 different firms and meant for export failed testing in government labs. This astounding figure should have rung the alarm bells across the country because it was very likely that those 100 firms were also selling their cough syrups in India. Even otherwise, the large-scale failure of cough syrups to make the cut should have alerted the government about how widespread the problem was.
Commercial interests reign supreme
Astonishingly, the government never made the names of these delinquent firms publicly available so as to warn the general public against consuming the cough syrups manufactured by these firms. Such criminal negligence is hardly surprising as the government has always brazenly let commercial interests of the pharmaceutical industry override public health priorities. The next logical step of any such tragedy should be a fact-finding inquiry so that an official record is created of all the failures in Tamil Nadu and Madhya Pradesh that led to this tragedy. India used to have such a tradition of accountability in the past. For example, after the deaths of 14 patients due to cough syrups containing DEG in J.J. Hospital in Mumbai in 1986, the State government setup a Commission of Inquiry under Justice Lentin of the Bombay High Court to investigate the tragedy. The resulting report laid bare the corruption and maladministration that led to the tragedy. In today’s India, we are unlikely to see such a Commission of Inquiry and therein lies the bigger tragedy. Without an acknowledgment of the faults in the present system, there will be no reforms to prevent the next inevitable tragedy.
