In Pakistan, counterfeit cardiac medication dispensed by the Punjab Institute of Cardiology (PIC) led to hundreds of casualties and over a hundred deaths.  As of today, the death toll reached 121 people. An estimated 50,000 patients have been issued the medicine, threatening an exponential increase in inpatient influx for Pakistani hospitals, who have already been overwhelmed by the number of patients and families reporting ailments the past month.According to multiple reports, the deaths were due to metallic poisoning from excessive amounts of mercury, arsenic, cadmium, or beryllium. About 10 grams of metal is harmful to the body, and although the counterfeit medicines were about 5mg, consistent, daily use for months will eventually lead to poisoning from chronic intake. The substandard drugs were manufactured from at least three pharmaceutical companies, who allegedly purchased their raw materials from unlicensed chemical sellers.

Despite efforts by the government of Punjab and urging of citizens to take greater action, the sources of the counterfeit materials purchased by the drug manufacturers could not be pinpointed.

In light of this tragedy, many have criticized PIC’s inability to control the quality of medication dispensed, but others have blamed the Punjab government for not maintaining its responsibility of checking the quality and authenticity of products and materials imported into Pakistan.

Meanwhile, the government has placed blame upon the PIC, DTL (drug testing laboratory), and provincial and district health departments for failing to properly oversee the quality of products coming into Pakistan’s provinces. In a bold move, the government suspended senior medical staff and doctors of the PIC for their alleged involvement in the scam. The suspensions were met with strikes threatened by younger doctors and medical staff who believe that the PIC should not be blamed for the shortcomings of the government (update: strike postponed).

Eight different teams are investigating incidents relating to the substandard drugs, while three pharmaceutical companies (headquartered in Karachi) linked to the deaths of at least 25 people have been closed down.

A recent development found that Mega Pharmaceuticals, one of the pharmaceutical companies allegedly involved in this scam, has also been manufacturing and packaging two different drugs under one label.