Preventable deaths from substandard medicines: lessons from a century of pharmaceutical malpractice

In 2022, more than 300 children in the Gambia, Indonesia and Uzbekistan died of acute kidney injury associated with contaminated cough syrups containing diethylene glycol (DEG) and ethylene glycol (EG). Over a few months, at least seven countries reported such incidents, prompting the World Health Organization (WHO) to issue urgent global alerts and call for ‘immediate and coordinated action’ to protect children from contaminated medicines [1]. These syrups, sold over the counter for minor illnesses, contained industrial solvents that should never be present in medicines [1, 2]. The recent events are only the latest in a long line of DEG disasters stretching back to the 1937 Elixir Sulfanilamide tragedy in the United States and subsequent outbreaks in Haiti, Bangladesh, India, Nigeria and Panama. Nearly a century on, children are still dying from the same preventable error. These repeated incidents are symptoms of deeper failures in pharmaceutical governance and health system oversight.