Cough syrup deaths: A systemic problem that needs a solution

The official reaction to the terrible mishap in Madhya Pradesh, resulting in the death of 19 children, is as knee-jerk as it is absurd. The deaths were allegedly caused by the consumption of Coldrif, a cough syrup whose samples contained diethylene glycol (DEG), an industrial toxic chemical that severely damages the kidneys. Two drug inspectors and a deputy director of the Food & Drug Administration have been suspended, the state’s drug controller transferred, a Special Investigation Team (SIT) constituted, and a Chhindwara-based pediatrician Dr Praveen Soni, arrested for alleged negligence.

Meanwhile, the Tamil Nadu-based manufacturer of the syrup has been booked. Several states have banned Coldrif. Given the nature of the sordid episode, the state government’s action against the culpable has been mired in controversy. The Indian Medical Association (IMA) has opposed the arrest of the doctor, blaming pharma company and government lapses instead for the lapses. The IMA has a point: the doctor can only prescribe what is available at a government hospital; they can’t ensure the quality of medicines in the pharmacies at these hospitals.

Besides, the severity of the action against the doctor also raises questions; whereas those responsible for supplying government hospitals have only been suspended, the pediatrician has been arrested. The unvarnished truth is that the official reaction is necessarily inadequate because the problem is essentially systemic, and those running the system—politicians—are little bothered about the plight of people. The recurring pattern points to the failure of the regulatory ecosystem, not isolated negligence.

State drug control departments are chronically understaffed, underfunded, and riddled with political interference. Quality checks are infrequent and often reduced to paperwork. Laboratories lack modern testing equipment. Many small and medium-scale drug manufacturers cut corners, confident that oversight is lax and penalties are minimal. Even when tragedy strikes, accountability rarely climbs the chain of command. The low-level functionaries are disciplined, while the political leadership—which controls the budgets, appointments, and regulatory priorities—escapes scrutiny, let alone penalty. The bureaucratic instinct is to demonstrate “quick action,” not deep reform.

This explains the swiftness with which Dr Soni was arrested. It is much easier to produce a culprit in a white coat than to confront the uncomfortable truths about how the government’s procurement and quality assurance mechanism functions. The doctor becomes the face of the tragedy-a convenient distraction from the failures of the state, the scapegoat for all practical purposes.

The reaction also exposes a dangerous mindset within Indian governance-the belief that public anger can be doused with symbolic punishment. But each time the state responds this way, it corrodes public trust a little more. For families who lost their children, the arrests and suspensions bring no solace. They need assurance that such a catastrophe will never happen again—and that can only come from genuine systemic reform. What would such reform look like? First, drug regulation must be professionalised and depoliticised.

State and Central drug control agencies require both autonomy and resources to function effectively. Second, procurement systems in public hospitals must be overhauled. Medicines must go through mandatory batch testing by accredited labs. Third, manufacturers must face swift and severe penalties for violations. Fourth, whistleblower protections within the pharmaceutical and regulatory ecosystem should be strengthened. And, finally, political accountability must be enforced. Until and unless the country’s leaders are made accountable, it will be difficult to avoid such tragedies.