While activists are celebrating the Union government’s decision to ban 344 “irrational” fixed dose combinations, there is another looming crisis that deserves attention: The unregulated availability and irrational use of beneficial drugs.
Last month, the National Centre for Disease Control revealed that over 70% of the population has become resistant to common antibiotics and about 20% to Carbapenems, the most sophisticated and broadest form of antibiotics that are used in exceptional situations.
Such unfettered use of medications affects not only those take them but also others.
Researchers at the All India Institute of Medical Sciences have found antibiotics in water samples collected from the Yamuna in quantities high enough to cause drug resistance among people who drink the water.
These contaminants were no simple formulations; they included fluoroquinolone that is used to treat respiratory and urinary tract infections, and macrolides and penicillin, both broad-spectrum antibiotics used for a large range of bacterial infections such as pneumonia, scarlet and rheumatic fevers.
The first State of the World’s Antibiotics Report published by the Washington-based Centre for Disease Dynamics, Economics and Policy last year found that country annually popped the highest number of antibiotic pills— 13 billion as against 10 billion in China and seven billion in the US.
The reasons behind such overuse include oversight and rampant corruption — the 11,000-odd companies have approval to manufacture 70,000 medicines and these are distributed with little regulatory control through a network of pharmacies that stretch into the vast country side.
Some years ago, the Indian Retail Druggists and Chemists Association claimed that there are 5, 50,000 pharmacies but recent estimates say the number is 6, 43,000.
Many of these run without a licence and registration and so it is difficult to track the sales.
A mapping survey conducted in 2013 in West Champaran district of Bihar found that out of 1,944 pharmacies in the district, only 272 had a licence and registration.
In such a vast landscape, attempts to control the flow of drugs have produced disastrous results leading to unethical entrepreneurship, corruption and a drug inspector raj.
Now, the government has an opportunity through the Digital India initiatives to rein in the sector. The electronic trailing of drugs could start when the medicines leave the factory — all in the organised sector — and a controlled flow through the electronic links will lead up to providers and consumers.
Currently, once the medicines leave the warehouse, it is almost the wild west scenario.
By marrying the flow of supplies with an electronic backbone and replacing the current time-consuming reporting processes with mandatory electronic reports can help India contain the problem.
Gopi Gopalakrishnan is president, World Health Partners
The views are personal