Eighteen children using the Indian-manufactured pharmaceutical “Doc-1 Max” cough syrup and pills have died in Samarkand, Uzbekistan in the last two months. 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 related child deaths in West Africa, but Uzbekistan’s health officials did not heed the warning. Doc-1 Max and other cough syrups developed in India remained in markets across Uzbekistan until December 22; as a result, the amount of child deaths linked to these pharmaceuticals is likely much higher.
Popular Uzbekistan blogger Nikita Makarenko questioned Uzbekistan’s health officials regarding the official disregard of the WHO’s previous warning, but Uzbekistan’s health officials’ lax attitude toward the pharmaceutical industry in the country is nothing new. In fact, in 2021, a young girl in Angren, Uzbekistan died from Ceftriaxone, an injectable antibiotic. The antibiotic should be administered under the supervision of a doctor, but in this particular case, it was given at home by a relative lacking any medical training. There were two other similar child deaths due to unsafe Ceftriaxone injections in Angren in 2021. While there are no available statistics from Uzbekistan’s government, there are likely other child and adult deaths that may be linked to the misadministration of injectable antibiotics. The drug is still widely available in pharmacies throughout Uzbekistan, and as a pharmacy worker in Tashkent, Feruza (who wished to only provide her first name) confirmed, “anyone can request and buy this drug. A doctor does not need to directly provide it.”
These worrying trends in the pharmaceutical sector are evident throughout Central Asia.
Central Asia’s healthcare sector suffers from a lack of investment, poorly trained staff, and outdated equipment. In addition to these issues, treatment at hospitals and clinics is expensive, so many people in the region resort to at-home treatments. The pharmaceutical industry consists of public and private pharmacies, oftentimes operating without oversight. In Uzbekistan, there are over 901 different medicines that can be bought over the counter. In Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan, access to and overuse of antibiotics without a prescription have 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. Likewise, Uzbekistan in 2019 attempted to curb the sale of antibiotics without a prescription, but the implementation and enforcement of this initiative has failed, as the deaths of children in Angren in 2021 demonstrate. Access to medication without a prescription in Uzbekistan has become so widely known that it is explicitly mentioned in popular tour guides.
The ease of accessing medication without a doctor’s guidance not only creates antimicrobial resistance and jeopardizes the health of individuals, but also presents an alternative to illicit drug use.
All Central Asian states have strict laws against drugs and drug trafficking, providing for several years in prison for users and sellers. Over the years, as access to drugs like marijuana and opium has decreased, drug users have sought alternative ways of getting high by using pharmaceuticals. These drug addictions have increased throughout Central Asia; even narcotics are available over the counter. Despite strict law enforcement at the national level, enforcement by pharmacists is limited. Oftentimes private pharmacies will allow customers to purchase any available medication. In Kazakhstan, nearly 200 pharmacies have been punished for selling narcotics without a prescription or drugs not approved for sale in the country since 2019. Even with 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 outlets frequently feature articles warning against the use of Tramadol among students. The situation is similar in Uzbekistan, where individuals, especially students, see Tramadol as an easy and cheap way of getting high. Popular bloggers have demonstrated the abuse of pharmaceuticals by highlighting the copious amounts of trash discarded outside of pharmacies.
Another dangerous trend in the Central Asia pharmaceutical industry is the wide presence of fake and expired medicines. As the prices for medicines, especially ones for the treatment of chronic diseases like diabetes have increased, counterfeit drugs have flooded the market. In Kazakhstan alone, it is estimated that 10-12 percent of all drugs are fake. Authorities in Kyrgyzstan and Tajikistan frequently report raids of pharmacies that are suspected of selling expired or fake medicine. Uzbekistan has even found warehouses producing counterfeit medicines. Yet, the vast amount of unregulated public and private pharmacies renders it nearly impossible to stop all these healthcare violations.
Central Asia’s pharmaceutical industry is in dire need of reform. As the region’s healthcare sector recovers from the COVID-19 pandemic, it must continue to focus on mitigating health risks. However, so far, most reforms in this sector are simply 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 deem a “European standard,” which requires specific spatial dimensions for pharmacies. However, this “European standard” does not require any new standards for safety. Until real reforms and enforcement at all levels are made, individuals living in Central Asia are at continued risk of harm by an industry that is meant to improve and save lives.
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