The World Health Organization (WHO) has called on India to intensify its efforts to prevent the sale of toxic cough syrup, despite acknowledging some advancements in the country’s pharmaceutical regulations. This comes after at least 24 children died from consuming Coldrif cough syrup, produced by Sresan Pharma, which contained diethylene glycol at levels nearly 500 times the permissible limit. The tragedy follows a global pledge made two years ago to tighten safety measures after similar incidents linked to Indian and Indonesian-made syrups claimed the lives of over 300 children worldwide. Rutendo Kuwana, WHO’s team lead for substandard and falsified medicines, noted that while India has introduced a new rule requiring export medicines to be tested for contaminants like diethylene and ethylene glycol, no such regulation exists for domestically sold syrups—a significant regulatory gap. Kuwana emphasized that India’s pharmaceutical market is vast, with tens of thousands of manufacturers and multiple states to oversee, making enforcement a complex challenge. Recent reports suggest India plans to scrap the export testing rule once companies upgrade their facilities to international standards by year-end. However, the WHO has stressed that medicines should be tested at every stage of production, not just the final product. Kuwana also highlighted a lack of accountability for previous incidents, describing it as a ‘big disappointment’ that no one has been jailed in India despite the deaths abroad. ‘This is not just selling fake shoes,’ he said. ‘It’s a moral issue, but if you don’t follow the rules, it’s criminal, because it has devastating consequences.’