After a number of child deaths in Gambia, 99 children in Indonesia and another 70 in Ghana have lost lives after taking fake cough syrup made by India. The deaths of children in Indonesia prompted the country to suspend sales of all syrup and liquid medication. Indonesia said syrup medicine produced by India was found to contain ingredients linked to acute kidney injuries (AKI), which have killed 99 young children this year. Earlier this month, the World Health Organization (WHO) issued a global alert over four cough syrups that were linked to the deaths of almost 70 children in The Gambia. Earlier this month, the World Health Organization (WHO) issued a global alert over four Indian-made cough syrups that were linked to the deaths of almost 70 children in The Gambia. The WHO found the syrups used there – made by an Indian pharmaceutical company Maiden Pharmaceuticals – contained “unacceptable amounts” of diethylene glycol and ethylene glycol. India has a history of making fake medicines. In 2013, Indian pharmaceutical giant “Ranbaxy” paid $500 million fine in USA for fake medicines. The tainted drugs and the tragic deaths again shone a spotlight on India’s $42bn – half of the revenues come from exports – drug manufacturing industry. Some 3,000 firms operate 10,000 pharmaceutical factories making generics (copies of branded medicines that usually sell for a fraction of their price), over-the-counter medicines, vaccines and ingredients in what is one of the world’s largest drug-making countries. Yet such breathless growth has been clouded by allegations of problems of quality and weak regulation. India’s own government records reveal that between 2007 and 2020, more than 7,500 drugs sampled in just three of India’s 28 states and three union territories had failed quality tests and had been declared drugs “not of standard quality”. Industry body Assocham in a paper a few years ago reported that 25% of drugs sold in India are adulterated or of a sub- par quality, among those red flagged were common everyday medicines like Crocin and Betadine. Assocham had warned that by 2017, the fake drug manufacturing industry would cross $10 billion in an Indian market that stands at $24 billion with upward projections. Inadequate regulations combined with the paucity of qualified drug inspectors allow for this industry to flourish unregulated. One of India’s largest pharmaceutical company Ranbaxy in a landmark case in 2013 agreed through Ranbaxy USA to pay a fine of $500 million after pleading guilty to knowingly making false statements to the US Food and Drug Administration. Three counts of felony had been slapped against the company including accusations of falsifying data and substandard manufacturing practices. Ranbaxy admitted that incomplete testing records had been discovered during inspection of one of its testing facilities. Dinesh Thakur, the whistle-blower in the Ranbaxy case in a recently co-authored article in The Guardian writes that a database hosted by the Indian government lists more than 8000 drugs that have failed quality tests adding that while not all would lead to death, they would have severe health implications.