Eighty Years After America’s Wake-Up Call, the World Still Lets Children Die from Medicine

In the small town of Parasia, India, a father carried the lifeless body of his three-year-old child through the narrow streets, clutching a bottle of cough syrup that was supposed to bring relief. The label read Coldrif, a medicine sold over the counter to ease a child’s cough.

Instead, it became a death sentence.

This month, more than twenty children in India have died from consuming contaminated cough syrups laced with industrial chemicals. Their symptoms were consistent: a mild cough followed by vomiting, confusion, then kidney failure. The World Health Organization (WHO) confirmed the culprit– toxic levels of diethylene glycol (DEG) and ethylene glycol, chemicals commonly used in brake fluid and antifreeze.

The Pattern of Poison

What happened in India is part of a repeating nightmare. In 2022, at least 66 children died in The Gambia after consuming contaminated cough syrup made by an Indian company. A few months later, 18 children in Uzbekistan and more than 20 in Indonesia suffered the same fate. Each case was initially treated as an isolated tragedy until WHO investigators began to connect the dots.

“This is not some sort of accident,” says Dr. Saifuddin Ahmed of Johns Hopkins University. “It’s intentionally done to reduce costs and pocket more money.”

The pattern is disturbingly global. Over the past century, more than 1,300 people, most of them children, have died from such poisonings, stretching from the U.S. in 1937 to Africa and Asia today. The mechanism has barely changed: pharmaceutical companies substitute safe solvents with cheaper, industrial-grade ones to cut costs, often with falsified documentation and minimal oversight.

The 1937 tragedy in the United States, where 105 people died from a contaminated antibiotic syrup, spurred the creation of the modern Food, Drug, and Cosmetic Act, giving birth to the FDA’s regulatory power. Yet, nearly ninety years later, in much of the Global South, children are still dying, not from disease, but from medicine itself.

Inside the Poison: How Safe Ingredients Turn Deadly

To understand how such tragedies unfold, one must look inside the syrup itself. A typical cough syrup contains an active ingredient, such as dextromethorphan, dissolved in a pharmaceutical-grade liquid base, often propylene glycol. This substance is colorless, viscous, and safe for consumption.

But industrial versions of these solvents, diethylene glycol (DEG) and ethylene glycol (EG) are far cheaper. To an unscrupulous manufacturer, the temptation is obvious: substitute one for the other, slash production costs, and reap higher profits.These chemicals are lethal because they destroy the kidneys. When ingested, they convert into acids that shut down renal function.  

Adding to the danger, the globalized pharmaceutical supply chain makes tracing responsibility nearly impossible. A batch of propylene glycol might be produced in South Korea, repackaged in China, and shipped to a small factory in India. Somewhere along the chain, a drum can be refilled, relabeled, or adulterated. Once mixed into syrup, the poison is invisible, until the children start dying.

Systemic Failure: India’s Regulatory Void

India’s role in this crisis cannot be overstated. As the “pharmacy of the Global South,” India supplies affordable medicines to much of Africa, Asia, and Latin America. Unfortunately, their fractured regulatory system often fails to protect its foreign consumers and even its own citizens.

Oversight is divided between two entities:

• The Central Drugs Standard Control Organization (CDSCO), under India’s Ministry of Health, regulates imports, large manufacturers, and exports.

• State drug controllers handle licensing, inspections, and local surveillance.

In theory, this dual model should ensure layered protection. In practice, it has bred confusion and loopholes. States often lack accredited labs, trained inspectors, and even the authority to shut down violators promptly. The CDSCO itself has acknowledged that state labs and regulatory bodies frequently lack capacity.

When WHO warned of contamination in The Gambia in 2022, India promised reform. It launched the Online National Drug Licensing System and required additional export screening. Yet the Coldrif disaster in 2025 shows that these safeguards seem to be futile.

Inside Sresan Pharmaceuticals’ 2,000 square foot factory, the maker of Coldrif, inspectors found over 350 violations: rusted machinery, filthy floors, missing quality tests, and half-burned product labels strewn across the yard. Photographs revealed what looked less like a pharmaceutical plant and more like a garage workshop. Still, the factory had been licensed.

“The system responds only after people die,” said one retired scientist. “Once the media leaves, the checks fade again.”

A Watchdog Without Teeth

In the aftermath of each tragedy, the WHO has stepped in, issuing medical product alerts, coordinating recalls, and pressuring governments to act. After the deaths in India, WHO immediately released a global advisory against three brands: Coldrif, Respifresh TR, and ReLife.

It also worked jointly with the United Nations Office on Drugs and Crime (UNODC) to map the criminal networks behind these poisonings. Their 2024 joint report exhibited falsified documents, reused chemical drums, bribed customs officials, and cross-border corruption that shields perpetrators from justice.

Yet, WHO’s power is mostly soft. It cannot impose sanctions, enforce prosecutions, or directly regulate manufacturers. Its alerts depend on cooperation from national authorities, and in countries like India, that cooperation often arrives late, if at all.

WHO has developed a certification system for pharmaceutical products, which India has not fully implemented. Its testing methods for solvent purity are simple and low-cost, but adoption remains inconsistent. As WHO analyst Murat Yildiz put it bluntly: “There are bad actors who exploit regulatory gaps between countries. And because punishments are so low, they know they can get away with it.”

Accountability and Reform: Lessons from the Past

If the United States could overhaul its drug safety system in the 1930s, why can’t the world do it now? The 1937 Elixir Sulfanilamide disaster prompted Congress to act within a year, giving the FDA authority to test, license, and recall medicines before they reached the public, and even prosecute perpetrators. 

India and other major drug exporters face a similar crossroads. The repeated deaths in The Gambia, Uzbekistan, Indonesia, and now at home reveal that isolated arrests and factory closures are not enough.

A few concrete steps are needed:

1. Unify drug regulation: merge state and central oversight under a single, empowered national authority.

2. Adopt WHO’s certification and testing protocols for all exported and domestic medicines.

3. Increase penalties for falsification and contamination to create real deterrence.

4. Create stronger international legal frameworks to hold all manufacturers accountable.

In the long term, WHO and partner agencies could champion an international treaty that standardizes quality checks and enables data sharing. Without such mechanisms, the cycle of death and denial will continue.

Conclusion

Every contaminated bottle tells a story of systemic failure of underfunded inspectors, overburdened regulators, and profit-driven shortcuts. But behind those statistics are parents who trusted a label, pharmacists who didn’t know, and children whose only mistake was catching a cold.

Unless governments, regulators, and the WHO build real accountability, this tragedy will repeat as a grim inevitability.

Because as long as the world’s poorest children rely on the cheapest medicine, they will keep paying the highest price.