Article by Lalita Panicker, Consulting Editor, Views and Editor, Insight, Hindustan Times, New Delhi
Families of 20 Gambian children who died after consuming cough syrups made in India will take their government to court this month for allegedly mishandling drug imports — a rare step in one of Africa’s poorest countries, where few have the means to challenge authorities. https://www.japantimes.co.jp/news/2023/07/15/world/crime-legal-world/gambia-children-lawsuit-cough-syrup/#:~:text=DAKAR%2C%20Senegal%20%E2%80%93%20Families%20of%2020,the%20means%20to%20challenge%20authorities.
The parents’ allegations and testimony, detailed in court documents, paint a comprehensive picture of the panic, confusion and heartbreak caused by the drugs in an already stretched medical system.
From one mother who unwittingly continued to give her child toxic medicine for two days after he started vomiting, to a family forced to repair a leaking intravenous drip that the hospital had attached to their child, the affidavits show parents in desperation as children with originally minor ailments succumbed.
At least 70 children died from acute kidney injury in Gambia last year, cases the World Health Organization linked to medicines made by Indian drugmaker Maiden Pharmaceuticals that were contaminated with diethylene glycol (DEG) and ethylene glycol (EG), toxins normally used as industrial solvents and antifreeze agents.
Unscrupulous actors sometimes substitute a key ingredient with DEG and EG because they are cheaper, pharmaceutical experts say. Last year, medicines laced with DEG and EG also allegedly killed about 200 children in Indonesia and Uzbekistan.
India’s government has said its own tests showed the syrups were safe, and Maiden, which did not respond to requests for comment for this story, has denied wrongdoing.
Now, parents of 20 of the children are taking legal steps, seeking about $250,000 in compensation for each child.
Three Gambian lawyers said this is the highest profile case of its kind against the nation’s health ministry and the drug regulator, as well as against Maiden itself.
The case shows the risks of importing drugs into countries which — like Gambia — have no means of testing them before consumption. It also highlights how, in a globalized economy, tainted medicines can poison people across the world with no clear path to redress for victims.
The lawsuit, prepared by lawyers working for no fees, argues that authorities failed to uphold their own laws requiring they ensure that all drugs imported into Gambia are safe.
The regulator “did not take … any measures to inspect or test the cough syrups for the adulteration and thereby was in breach of statutory obligations,” according to the suit. It adds that the regulator and the health ministry failed to ensure that drugs were prescribed “with the expected standard of care.”
Gambia’s health ministry did not respond to requests for comment. In a June letter to the parents’ lawyers, it said it had “initiated a number
of steps,” including a probe into the incident, which is currently under review.
After the deaths, the World Bank approved funding for Gambia to build a medicines testing lab. An environmental assessment is underway, after which construction will begin, a spokesperson said last month.
Tiny parasites can have huge consequences. Flatworms belonging to the genus Schistosoma infect hundreds of millions of people worldwide, causing pain and weakness, stunting the growth and cognitive development of children, and, in some people, leading to liver disease or cancer. Now, researchers have shown in a trial in Senegal that a simple intervention could reduce the risk of infection and break the resulting spiral of poverty and disease. When they removed from local rivers or lakes the aquatic plants that help the snails hosting the worms thrive, that slashed the rates of schistosomiasis, as the parasitic infection is known, in those villages. Local farmers benefited further by using the vegetation for fertilizer and animal feed. https://www.science.org/content/article/win-win-win-strategy-reduces-dangerous-parasite-infections-african-villages?
The study is a great example of a “win-win-win” scenario in public health, says Joanne Webster, a parasitologist at Imperial College London who studies schistosomiasis but wasn’t involved in the work. The intervention not only reduces parasite infections, but also provides financial benefits to farmers and reduces the impact of fertilizer on the environment.
The parasites known as schistosomes divide their time between human hosts and water snails that thrive on the algae growing on freshwater aquatic plants. Infected people pass eggs with their urine and stool. If this happens in a pond or river, the eggs develop into larvae that infect certain snail species, in which they reproduce. Free-swimming larvae are then released from the snails into the water and when humans come into contact with the water, these larvae burrow through their skin to infect them, completing the cycle.
Although a drug called praziquantel exists that can kill the worms, often some survive and people are rapidly reinfected. A chemical that kills the snails is also sometimes applied to local waters, but it can be difficult to procure and it can kill other animals, too, says Stefanie Knopp, a parasitologist at the Swiss Tropical and Public Health Institute. Removing the plants on which the snails feed has previously been suggested, she says, but there has been little good evidence for this intervention—until now.
In a randomized, controlled trial, researchers led by Jason Rohr of the University of Notre Dame paid residents of eight villages in Senegal to remove water plants every 3 months. Over the course of 3 years, they fished out more than 400 tons of plant material. In eight other villages, the water plants were left untouched. The researchers found that removing the aquatic plants reduced the number of snails eightfold the following year. And the percentage of schoolchildren infected with one flatworm parasite, Schistosoma mansoni, was 23.5% in sites where the vegetation was removed, whereas it was 31.5% in control villages, Rohr and colleagues report in Nature. The
researchers did not detect a significant decline in a different, less common species called S. haematobium, but the study may simply have been too small for that, Rohr says. “We are conducting follow-up studies and we are hopeful that it will decline as well given that the snails that harbour S. haematobium went down profoundly.”
Rohr’s team also investigated whether the removed plant material could be put to use. Collaborating with local farmers, they composted the material and found that its use on fields increased yields of peppers and onions, two local crops. They also tested whether it could be used to feed animals. Goats, the animals they tried first, did not want it. “They’ll eat plastic bags, garbage, you name it. But for whatever reason they were not interested in eating this vegetation,” Rohr says. Sheep, donkeys, and cattle, however, did eat the plants.
It’s a critical part of the results, Rohr says, because one reason vegetation removal has never been widely used to combat schistosomiasis is that it suffers from the tragedy of the commons. “Everyone thinks everyone else will remove the vegetation for the good of public health,” Rohr says. Showing that there is an economic benefit to removing vegetation could encourage more individuals to take on the task themselves, though he acknowledges it is not without risk. “There could be conflict over who gets to turn the vegetation into their private good,” Rohr says.
Villagers have not done this in the past in part because they aren’t aware of the role of the snails and the environment in schistosomiasis, says Sidy Bakhoum, a Senegalese researcher involved in the work. “Most of them don’t know how the transmission happens.” In a
follow-up trial in 88 villages, the researchers are educating some villages just about the benefits of using these plants as compost or feed, some about the public health benefits of removing the plants, and others about both or none of these.
Two scientists who are co-authors of a 3-year-old article on the origin of the COVID-19 pandemic faced down Republican lawmakers today in what might be the most in-depth discussion ever of a scientific paper in the halls of the U.S. Congress. At a House of Representatives subcommittee hearing, Republicans asserted that top officials at the U.S. National Institutes of Health (NIH) prompted the researchers to write the paper to try to “kill” the theory that SARS-CoV-2 leaked from a laboratory in Wuhan, China. https://www.science.org/content/article/politicians-scientists-spar-over-alleged-nih-cover-up-using-covid-19-origin-paper?
Evolutionary biologist Kristian Andersen of Scripps Research and virologist Robert Garry of Tulane University’s School of Medicine, two of the article’s five co-authors, flatly rejected the allegation. And as the hearing extended over 3 hours, committee Democrats chided their colleagues on the other side of the aisle for staging a “vendetta” and “weaponization” of the origin discussion, and for slinging “baseless allegations” that amounted to a “mission to destroy two people” and “vilify” public health experts. The paper, titled “The Proximal Origin of SARS-CoV-2,” was published in Nature Medicine on 17 March 2020 and argued that SARS-CoV-2 had most likely evolved naturally, rather than being engineered by scientists. It has become central to the assertions of many lab-leak proponents that NIH funded risky coronavirus experiments, which, in turn, led to the pandemic. In this scenario, high-ranking agency officials, such as Anthony Fauci, then director of the National Institute of Allergy and Infectious Diseases (NIAID), and Francis Collins, NIH’s director, tried to suppress any scientific discussion that could expose this.
In a battle of documents released shortly before the hearing began, Republicans issued a 53-page report, titled The Proximal Origin of a Cover-up, based on “25 hours of testimony” from five of the paper’s co-authors and a review of 8000 pages of documents—including their subpoenaed emails and Slack messages. Democrats shot back with their own 22-page report, titled They Played No Role, which argued that U.S. government officials did not attempt to suppress the lab-leak theory through the paper and had little to do with the article’s genesis. (Andersen told Science he found the subpoenas “deeply disconcerting,” saying: “Scientists need to talk amongst themselves and not worry that their communications will be distorted by politicians.”)
The hearing held by the House Select Subcommittee on the Coronavirus Pandemic focused largely on how the two scientist witnesses over a short period of time went from thinking the virus appeared to be lab made to ruling out that hypothesis. “We’re examining whether government officials, regardless of who they are, unfairly, perhaps biasedly, tipped the scales toward a preferred origin theory,” said subcommittee chair Representative Brad Wenstrup (R–OH) at the start of the hearing.
Andersen and Garry spent much of their time explaining the scientific process to the committee. “I think it’s important that we take a step back and focus on what’s possible versus what is probable,” said Andersen, who decried that he and his co-authors were “pawns in a political game” staged by the subcommittee. “We concluded that the virus very likely emerged as the result of a zoonosis, that is, a spill over from an animal host. This remains the only scientifically supported theory for how the virus emerged. If convincing new evidence were to be discovered, suggesting otherwise, we would, of course, revise our conclusions. This is science.”