Deadly Doses: How cough syrups turned into poison

India, as we all know, is often referred to as the pharmacy of the world. But after several mishaps, the death of children, the pharmacy of the world is facing a credibility crisis, which is of its own making. For decades, its vast pharmaceutical industry has been globally well accepted and recognised for providing affordable generic drugs to both developing countries and advanced economies. From life-saving HIV antiretrovirals to COVID-19 vaccines, India’s medicine exports have reached nearly every nation of the world, including humanitarian international organisations, supplying over 20% of the world’s generic drugs. But beneath this gleaming record lies an issue that is popping up intermittently, threatening the very reputation of our country by some exploiters, thus shaking the trust that has been painstakingly gained.

A series of tragic poisonings linked to contaminated cough syrups, recent deaths of dozens of children in Madhya Pradesh and Rajasthan by using Coldrif, cough syrup, has again exposed the deep fissures in the nation’s regulatory system. Even though the company is sealed and the owner is arrested, but only after, once again, at the cost of the reputation of the country and the death of a score of innocent children. Nearly every international media outlet carried the news story, reminding readers of deaths by cough syrups, as has happened in the past, too. Domestically, the latest toxic cough syrup scare is forcing patients to abandon any brand of cough syrups and look for alternative treatments. Several states issued public alerts confirming a couple of other cough syrups that contained diethylene glycol, “a toxic chemical that can cause serious poisoning, including kidney failure, neurological complications, and even death, especially among children.” The World Health Organisation told Reuters recently that it had received confirmation from India that three contaminated syrups were identified and none officially exported, though it warned that some unofficial shipments could not be ruled out.

Expressing “deep concern,” WHO highlighted regulatory gaps in domestic screening and tests. Under national laws, drugmakers must test all raw materials and final products. Since 2023, exports of cough syrups have required additional government lab testing after earlier deaths in Gambia, Uzbekistan, and Cameroon. Government documents cited by Reuters showed that Coldrif, made by Sresan Pharmaceutical Manufacturer, was sold only locally, while Gujarat officials said the other two syrups also banned were distributed in other states. The deaths of dozens of children in Madhya Pradesh and Rajasthan this year, and hundreds earlier in recent years, have cast a shadow over India’s pharmaceutical prowess.

The stories published in the media and international news agencies are tragically similar. In December 2019, two-month-old Irfan from Jammu began coughing and running a fever. His father bought a bottle of Coldbest-PC, a cough syrup. Within hours of the first dose, the baby began vomiting and stopped urinating. Days later, his kidneys failed. Media reports then suggested that Irfan was one of 16 children who died after consuming the syrup, later found to contain 34% diethylene glycol (DEG). The tragedy was traced to a Pharma, a family-run company in Himachal Pradesh, one of India’s key drug-manufacturing hubs. Similar patterns of neglect and impunity have followed in later cases.

Fast forward, October 2025, in Madhya Pradesh’s Chhindwara district, the scene repeated itself. A spate of child deaths from kidney failure led to the discovery of Coldrif, another cough syrup containing allegedly 48% DEG, nearly 480 times the permissible limit, reports the media. The manufacturer, Sresan Pharmaceuticals of Tamil Nadu, had been operating for two decades with little scrutiny. By the time officials confirmed the contamination, at least 21 children had died.

This is not an isolated tragedy but part of a grim continuum. In 2022, at least 70 children died in Gambia after consuming tainted Indian syrups. Soon after, 65 children in Uzbekistan and six in Cameroon suffered the same fate. Investigations found DEG and its chemical cousin ethylene glycol (EG) in medicines produced by some of the Indian firms, which were later banned. The World Health Organisation (WHO) has since linked contaminated Indian-made syrups to more than 300 child deaths worldwide. WHO officials said these deaths might have been prevented if basic safety checks had been followed. An earlier Reuters investigation revealed that the implicated companies either did not test for toxins or failed to show proof of testing, a share violation of country’s law. We do not know how many companies continue violating the law of the land.

The reputational damage is already palpable. Western media stories are speaking about quality tests and lapses at the source. Already, after the Gambia and Uzbekistan incidents, several African nations quietly reduced imports of Indian syrups. Multinational buyers have begun demanding stricter documentation and batch-level audits, media reports.

India’s global image as a reliable supplier of affordable medicines, carefully built over decades, now risks being reduced to suspicion. As one European trade analyst put it, that If India can’t guarantee safety in a spoonful of syrup, why should the world trust its other drugs or vaccines?

This erosion of trust could have catastrophic economic consequences. India’s pharmaceutical exports, worth over $25 billion annually, depend heavily on screening and regulatory goodwill. With U.S. tariffs on certain medical exports now adding new commercial pressures, any reputational slip could cost millions in lost orders and years of rebuilding credibility. India’s pharmaceutical industry is not just a business; it is a lifeline for much of the developing world. But it stands at a crossroads. To preserve its status as the “pharmacy of the Global South,” India must revisit its drug regulation and implementation from the ground up.

First, quality control must become independent and mandatory, not discretionary. Every batch of medicine, especially liquid formulations, should undergo toxicity testing verified by accredited third-party laboratories.

Second, accountability must be enforced through law. The law allows for imprisonment of up to life for culpable homicide; it must be applied without fear or favour for violators.

Third, international oversight mechanisms should be invited, not resisted. India could benefit from aligning its practices with the WHO’s Global Benchmarking tool for regulatory systems, or even establishing joint inspection frameworks with importing nations. Transparency will restore trust.

Finally, it is high time that the government must invest in modernising inspection regimes. It must adopt digital traceability, from raw material sourcing to finished product shipment, to ensure that no cheap, industrial-grade chemical ever finds its way into a child’s medicine bottle again.

This must change. People may forgive an honest error; they will not forgive a pattern of deceit. For every child whose life ended with a spoonful of poison, we, as a nation, owe a moral responsibility. As Prime Minister Narendra Modi and his team are hard-selling India’s leadership of the Global South in this competitive, difficult world, the nation cannot afford to be seen as exporting death in the guise of medicine. The pharmaceutical industry must clean up its act before international buyers turn away. Because if the pharmacy of the world loses its credibility, no tariff, treaty, or trade diplomacy will bring it back. India has achieved wonders in medicine, and we all need to strengthen trust-building. Let us all vow that no innocent child will become another tragedy in future by consuming spurious medicine.

Surinder Singh Oberoi,

National Editor Greater Kashmir