Who bears responsibility?
The Health Ministry has taken a “conservative” approach, by temporarily prohibiting the use of liquid medication, in the effort to reduce AKI fatalities, along with a ban on imported antidotes from Singapore and Australia. However, this should not be sole responsibility of the Health Ministry. Other government agencies should also be held accountable as well.
The Trade Ministry, for example, which oversees the importation of medicines and raw materials used in drug production, should tighten supervision. According to the Observatory of Economic Complexity (OEC), the world’s leading data visualization tool for international trade data, in 2020 Indonesia imported US$147 million worth of EG (the 9th largest volume globally).
The Industry Ministry also has the obligation to supervise domestic pharmaceutical industries which are now suspected of bearing responsibility for AKI incidents. The Food and Drug Monitoring Agency (BPOM) found that there were at least five cough syrups containing EG and DEG in excess of the safe limit, namely, a maximum of 0.5 milligrams per kilogram of body weight per day.
BPOM has ordered the pharmaceutical industry to withdraw syrups from circulation across Indonesia and destroy all product batches. This applies throughout the supply chain, including wholesalers, retail pharmacies, hospital pharmacies, community health centers, clinics, drug stores and independent medical practitioners.
Don’t let tragedy be repeated
The high child mortality due to EG poisoning in India, Bangladesh, Gambia and Indonesia should serve as a serious warning that there is still weak oversight of the pharmaceutical industry, as their operations could be a matter of life and death. The government must strengthen its monitoring system to ensure that the tragedy, which is completely preventable, does not happen again. As is the case during the Covid-19 pandemic, the government cannot work alone; there must be synergy and collaboration among all stakeholders to tackle the problem from the beginning.