Cough Syrup Tragedies and the Commercial Determinants of Health

Child deaths related to consumption of adulterated cough syrups in India and other low- and middle-income countries highlight an ongoing public health crisis. Recent tragedies linked to diethylene glycol adulteration of cough syrups expose weaknesses in drug regulation, supply chain oversight, and market transparency, and need to be viewed through the lens of commercial determinants of health (CDoH)-the conditions, actions, and omissions by commercial actors that affect health. These incidents reflect intersections of high demand for cough syrups, irrational fixed-dose combinations, widespread over-the-counter sales, and limited public awareness on the one hand, and rising prices of pharmaceutical-grade glycerin and adulteration on the other hand. Addressing CDoH requires strict enforcement of regulatory system, alongside generating relevant evidence, advocacy and partnerships and dialogue with the commercial actors.