Central Asia’s dangerous pharmaceutical industry – The Diplomat


In the past two months, eighteen children have died in Samarkand, Uzbekistan, while taking the pharmaceutical “Doc-1 Max” cough syrup and pills made in India. The suspected cause of death is kidney failure. On October 5, 2022, the World Health Organization (WHO) issued a warning about Indian cough syrups after many child deaths in West Africa, but Uzbek health officials ignored the warning. Doc-1 Max and other cough syrups developed in India remained in markets across Uzbekistan until December 22; As a result, the number of child deaths related to these drugs is likely to be much higher.

Popular Uzbek blogger Nikita Makarenko questioned Uzbekistan’s health authorities over its official disregard of the WHO’s previous warning, but Uzbek health authorities’ lax attitude towards the country’s pharmaceutical industry is nothing new. In fact, in 2021, a young girl died in Angren, Uzbekistan from ceftriaxone, an injectable antibiotic. The antibiotic was supposed to be administered under the supervision of a doctor, but in this particular case it was administered at home by a relative with no medical training. In 2021, there were two other similar child deaths in Angren from unsafe ceftriaxone injections. Although no statistics are available from the Uzbek government, there are likely other deaths among children and adults that could be linked to the incorrect administration of injectable antibiotics. The drug is still widely available in pharmacies across Uzbekistan, and as a pharmacist in Tashkent, Feruza (who only wanted to give her first name) confirmed: “Anyone can request and buy this drug. A doctor does not have to provide it directly.”

These worrying trends in the pharmaceutical sector are evident across Central Asia.

Central Asia’s healthcare sector suffers from a lack of investment, poorly trained staff and outdated equipment. Adding to these problems, treatment in hospitals and clinics is expensive, leading many people in the area to resort to home treatments. The pharmaceutical industry consists of public and private pharmacies, which often operate without supervision. In Uzbekistan there are over 901 different medicines that can be bought without a prescription. In Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan, access to and overuse of antibiotics without a prescription has increased antimicrobial resistance. In 2019, Turkmenistan banned the sale of antibiotics in private pharmacies, but with limited access to information and data from the country, it is difficult to determine the policy’s effectiveness. Uzbekistan also tried to curb the sale of antibiotics without a prescription in 2019, but implementation and enforcement of this initiative has failed, as evidenced by the deaths of children in Angren in 2021. Access to medicines without a prescription has become so well known in Uzbekistan that it is explicitly mentioned in popular travel guides.

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Easy access to medicines without medical guidance not only creates antimicrobial resistance and endangers individual health, but also represents an alternative to illicit drug use.

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All Central Asian states have strict anti-drug and drug-trafficking laws that provide long-term prison terms for users and sellers. Over the years, as access to drugs like marijuana and opium decreased, drug users sought alternative ways to get high from drug use. This drug addiction has increased throughout Central Asia; Even narcotics are available over the counter. Despite strict law enforcement at the national level, enforcement by pharmacists is limited. Often, private pharmacies allow customers to buy all available medicines. In Kazakhstan, nearly 200 pharmacies have been fined since 2019 for selling narcotics without a prescription or selling medicines not approved in the country. Despite an apparent crackdown on violations, pharmacies continue to illegally sell narcotics without a prescription. The situation is even more acute in Turkmenistan and Uzbekistan: in Turkmenistan, news agencies often run articles warning against the use of tramadol among students. The situation is similar in Uzbekistan, where individuals, particularly students, see tramadol as an easy and inexpensive way to get high. Popular bloggers have demonstrated drug abuse by highlighting the vast amounts of rubbish dumped outside of pharmacies.

Another dangerous trend in the Central Asian pharmaceutical industry is the widespread proliferation of counterfeit and expired medicines. As drug prices, particularly those used to treat chronic diseases like diabetes, have risen, counterfeit drugs have flooded the market. In Kazakhstan alone, an estimated 10-12 percent of all medicines are counterfeit. Authorities in Kyrgyzstan and Tajikistan often report raids on pharmacies suspected of selling expired or counterfeit medicines. Uzbekistan has even found warehouses manufacturing counterfeit medicines. However, the large number of unregulated public and private pharmacies makes it nearly impossible to stop all these health care breaches.

The pharmaceutical industry of Central Asia is in urgent need of reform. As the region’s healthcare sector recovers from the COVID-19 pandemic, it must remain focused on health risk mitigation. So far, however, most reforms in this sector have been cosmetic; For example, Kazakhstan has already prepared changes for 2023 with the possible closure of all kiosks and small pharmacies. Kazakhstan is attempting to adopt what officials have dubbed the “European standard”, which requires specific spatial dimensions for pharmacies. However, this “European standard” does not require any new safety standards. Until real reforms and enforcement are implemented at all levels, people living in Central Asia face an ongoing risk of being harmed by an industry designed to improve and save lives.