By Pedro Barata
LISBON, Portugal, Nov 11 2025 – I have been working on climate policy since the late 1990s. I was in the room when Europe’s early carbon market discussions were shaping the architecture that would eventually underpin the Kyoto Protocol.

That framework—built around international cooperation and market-based mechanisms—was born at a time when climate change was understood as a global problem requiring global solutions. For all its flaws, it carried an underlying logic: collective action was indispensable, and market-based tools could harness efficiency and scale.

Today, the mood has shifted. Public budgets are shrinking, geopolitical tensions are rising, and climate impacts are accelerating. Yet in the midst of this urgency, we are witnessing a troubling rise in what can only be called irrationality: a willingness to hold two or three contradictory ideas at once, even when the stakes are so high.

Take, for example, the persistent claim that carbon “offsetting” is no longer possible under the Paris Agreement. The argument goes like this: because countries now have emissions caps under Paris, offsetting somehow ceases to exist. But that is a fundamental misunderstanding. The very logic of cap-and-trade—whether under the EU Emissions Trading System or international markets—rests on offsetting, i.e. compensating emissions reductions elsewhere rather than reducing at home.

Offsetting is perfectly possible and even desirable, from an economic perspective, within a capped environment. The problem has never been with the principle. It has been with the credibility of particular credits, the uneven quality of oversight, and the lack of transparency in certain corners of the market.

These challenges are real. But the rational response is not to walk away from these challenges. It is to double down on the hard work: strengthen guidance and regulation, demand better data, increase transparency, expose bad behavior, and install integrity across the value chain. High-integrity markets are not easy, but they are possible—and they are already delivering results.

What’s more, evidence shows that international cooperation on carbon markets reduces costs in every modeled region compared to countries acting alone, with potential savings of as much as $250 billion by 2030. Walking away from these benefits would be an act of self-sabotage.

The irrationality extends beyond markets. Policymakers readily admit that public coffers are stretched thin, that development aid budgets are shrinking, and that climate is often being downgraded as a priority in national spending. Yet, in almost the same breath, some suggest that international mitigation can and should be financed primarily through public money rather than carbon markets.

Where is this money supposed to come from?

The data are stark: the world needs $8.4 trillion in climate finance annually by 2030, yet just $1.3 trillion was provided in 2021–2022. That leaves a $7.1 trillion gap today, still projected at nearly $4 trillion in 2030 even under business-as-usual scenarios. Magical thinking does not decommission coal plants, stop deforestation, or scale carbon removal.

Private finance is not just helpful, it is essential. External private finance for climate remains around $30 billion per year today. By 2030, that must rise to between $450 and $500 billion annually—an increase of 15 to 18 times.

There is no plausible pathway to close the gap without mobilizing capital at this scale, and high-integrity carbon markets are one of the few tools available right now that can channel such flows directly into mitigation.

What is needed is not purity, but pragmatism. We need the full suite of solutions—a portfolio approach for climate policy. Deep emissions cuts must continue at home. Rapid removals are essential to balance the carbon budget. And massive flows of capital to a wide range of solutions must scale together.

None of these tools alone will solve the climate crisis. There are no silver bullets. But rejecting viable tools because they are imperfect guarantees failure. Delay, not imperfection, is the greater risk.

Of course, criticism plays an essential role. Constructive critique strengthens systems, exposes weaknesses, and pushes for improvement. But when critique tips into absolutism—when markets are dismissed outright, or international cooperation is brushed aside in favor of isolation—it becomes self-defeating. At a time when geopolitical instability makes cooperation harder, walking away from available mechanisms is the height of irrationality.

I do not claim to have the full prescription for restoring rationality to climate policy. But I do know this: cynicism is not a strategy, and delay is not an option. Markets, when well-governed, remain one of the fastest ways to mobilize capital at scale for climate action. Public finance, though limited, must be directed strategically.

And international cooperation, however unfashionable, is indispensable. The future will not be won by choosing one path and discarding the others. It will be won by using every tool in the toolbox—and refusing to let irrationality steer us toward inaction.

Pedro Barata is Associate Vice President, Environmental Defense Fund

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By Asoka Bandarage
WASHINGTON DC, Nov 11 2025 – My recent visit to Brazil coincided partly with the Conference of the Parties (COP) 30, the 30th United Nations Climate Conference in Belém. Although I did not attend COP 30, I was very fortunate to visit the Amazon.

It was both awe-inspiring and humbling to experience —even briefly—the mystery and stillness of nature, and the ebb and flow of life in the Amazon: the largest tropical rainforest in the world, sustained by the ever-flowing Amazon River, the largest and widest river on Earth.

The magnificent forest, the river, and its tributaries, such as the black-water Rio Negro, teem with countless interdependent species. The great Samaúma—the “tree of life,” or giant kapok tree—stands tall above innumerable other trees, vines, and plants.

Many trees provide homes for birds and other animals that build their nests high among the branches or near the roots. Sloths do not build nests; instead, they spend their entire lives in the forest canopy, hanging upside down from branches while resting or sleeping.

In contrast, capuchin and squirrel monkeys leap from tree to tree in search of food, while birds—from the tiniest short-tailed pygmy tyrant to the colorful red-crested, green, and black Amazon kingfishers—flit from branch to branch, each awaiting its own prey. As night falls, the beautiful white owl-like great potoo emerges and sits patiently, seemingly forever, waiting for its turn to hunt.

In the river, silvery flying fish—sometimes in droves—leap from the water to catch insects, while gray and pink dolphins bob up and down, chasing fish or simply playing. Along the banks, proud egrets and fierce spectacled and black caimans lie in wait for their prey. Overhead, flocks of birds, including parakeets, fill the sky with song as vultures descend to feed on the remains of fallen animals below.

Humans have also lived in the Amazon for tens of thousands of years, in close symbiosis with other species, hunting in the forest and fishing in the river for their survival. Petroglyphs—carvings of human and animal figures, along with abstract shapes etched into rocks along the Amazon River—speak of their deep respect for nature and their ways of communicating with one another.

Even today, many of the indigenous communities who inhabit the Amazon remain devoted to protecting Mother Earth, upholding their eco-centric values and traditional ways of life.

There are also the river people (ribeirinhos), many of mixed indigenous and Portuguese descent, living along the Amazon River—often in floating homes or houses built on stilts. Their livelihoods and cultures are deeply intertwined with the river and forest, making the protection of the Amazon essential to their survival.

The Amazon lost an estimated 54.2 million hectares of forest—over 9% of its total area—between 2001 and 2020, an expanse roughly the size of France. The Brazilian Amazon, which makes up 62% of the rainforest’s territory, was the most affected, followed by Bolivia, Peru, and Colombia. Along with deforestation, the Amazon is estimated to lose 4,000 to 6,000 plant and animal species each year.

COP 30

At the opening of the COP 30 Conference in Belém last week, Luiz Inácio “Lula” da Silva, the President of Brazil pointed out that concrete climate action is possible and that deforestation in the Amazon has been halved just in the past two years. He declared that the “era of fine speeches and good intentions is over” and that Brazil’s COP 30 will be a ‘COP of Truth and Action’, “COPs cannot be mere showcases of good ideas or annual gatherings for negotiators. They must be moments of contact with reality and of effective action to tackle climate change.”

President da Silva also emphasized that Brazil is a global leader in biofuel production—renewable energy derived from organic materials such as plants, algae, and waste—stressing that “a growth model based on fossil fuels cannot last.” Indeed, at COP 30, the future of the world’s tropical forests, vital ecosystems, and the shared climate of humanity and other species is at stake.

“Truth and Action”

Notwithstanding President da Silva’s optimistic pronouncements at Belém, troubling developments continue on the climate front in Brazil and around the world. In preparation for COP 30, the Brazilian government—along with India, Italy, and Japan—launched an ambitious initiative in October 2025: the “Belém 4x” pledge, which aims to quadruple global sustainable fuel use by 2035. This goal is projected to more than double current biofuel consumption.

However, environmentalists have expressed concern that a massive expansion of biofuel production, if undertaken without strong safeguards, could accelerate deforestation, degrade land and water resources, harm ecosystems, and threaten food security—particularly as crops such as soy, sugarcane, and palm oil compete for land between energy and food production.

Just days before COP30, the Brazilian government granted the state-run oil company Petrobras a license to drill for oil near the mouth of the Amazon River. The government, including Minister for the Environment Marina da Silva, has defended the move, claiming that the project would help finance Brazil’s energy transition and help achieve its economic development goals.

Environmentalists have criticized the decision, accusing the government of promoting fossil fuel expansion and worsening global warming. They warn that drilling off the coast of the world’s largest tropical rainforest—a crucial carbon sink—poses a serious threat to biodiversity and indigenous communities in the Amazon region.

According to environmental activists, in the Amazon, “31 million hectares of Indigenous Peoples’ territories are already overlapped by oil and gas blocks, with an additional 9.8 million hectares threatened by mining concessions.”

Moreover, a controversial four-lane highway, Avenida Liberdade, built in Belém in preparation for the COP30 climate summit, is being defended by the Brazilian government as necessary infrastructure for the city’s growing population. Environmentalists and some locals are alarmed that clearing more than 100 hectares of protected Amazon Rainforest to build the road will accelerate deforestation, harm wildlife, and undermine the climate goals of the COP summit.

The onus of protecting the Amazon Rainforest—often called “the lungs of the planet”— cannot rest on Brazil alone; it is a shared responsibility of all humanity. Numerous studies show that the world can thrive without fossil and biofuels by adopting alternative renewable energy sources such as solar, wind, and hydroelectric power.

The global order, led by the United States and other Western nations, bears primary responsibility for the climate and environmental crises, as well as for deepening global inequality. Emerging powers from the Global South—particularly the BRICS nations, including Brazil—are now called to move beyond rhetoric and take concrete action. As President Lula da Silva himself has stated, COP 30 presents a critical opportunity to move decisively in that direction.

Negotiators and policymakers at COP 30 must take firm, principled moral action—resisting pressure from the fossil fuel lobby and prioritizing the interests of the planet and its people over short-term, profit-driven growth.

Dr Asoka Bandarage is the author of Women, Population and Global Crisis: A Politico-Economic Analysis (Zed Books, 1997), Sustainability and Well-Being: The Middle Path to Environment, Society and the Economy (Palgrave MacMillan, 2013) and numerous other publications on global political economy and the environment including “The Climate Emergency And Urgency of System Change” (2023) and ‘Existential Crisis, Mindfulness and the Middle Path to Social Action’ (2025). She serves on the Steering Committee of the Interfaith Moral Action on Climate.

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By Jomo Kwame Sundaram
MANILA, Philippines, Nov 11 2025 – US President Trump’s economic strategy for his second term aims to get the rest of the world, especially its wealthy allies with greater means, to pay more to help strengthen the US economy.

Jomo Kwame Sundaram

Recent US initiatives have undoubtedly accelerated de-dollarisation but these have largely been unavoidable consequences of its own actions rather than due to any conspiracy by others to that end.

De-dollarisation distraction
Harvard economist Kenneth Rogoff recently observed, “We are absolutely at the biggest inflection point in the global currency system since the Nixon shock to end the last vestige of the gold standard.”

After the Bretton Woods Conference in 1944, the gold price was set at $35 per ounce. In August 1971, US President Richard Nixon ended this gold-dollar parity.

De-dollarisation has gradually continued since, with occasional brief spurts and reversals. For example, capital flows abroad rose following the 2008-09 global financial crisis.

Growing weaponisation of economic relations has probably accelerated de-dollarisation. Rogoff observed, “this was happening for a decade before Trump. Trump is an accelerant.”

Governments, central banks and BRICS countries have been de-dollarising. Even US dollar hegemony advocates no longer deny alternatives to the dollar’s role as global reserve currency.

Meanwhile, private foreign investors, including foreign asset managers, investment banks and pension funds, do not want to be left behind.

Investment fund managers are increasingly ‘de-risking’ by cutting exposure to dollar-denominated assets.

Mar-a-Lago plan
Economist Stephen Miran has proposed a new Trump initiative to require other governments to pay the US for services purportedly rendered.

First appointed chair of Trump’s Council of Economic Advisers, Miran has since been appointed to the US Federal Reserve Board.

A few days after Trump announced his Liberation Day tariffs on April 2, Miran articulated five expectations. These expect other nations to pay the US for ‘public goods’ services it ostensibly provides the world.

Allies will be expected to pay the US more for the ‘security umbrella’ it provides to NATO and other allies. The US also expects those buying Treasury bonds to pay more for the ‘privilege’

In November 2024, Miran’s A User’s Guide to Restructuring the Global Trading System proposed the Mar-A-Lago accord, named for Trump’s exclusive Florida island resort and residence.

He also referred to the Plaza Accord, which the Reagan administration imposed on its G5 allies in September 1985. Then, the US forced Japan and Germany to appreciate their currencies against the dollar.

The yen’s appreciation fuelled a massive Japanese asset price bubble that burst with devastating consequences in 1989, ending its post-war boom.

Trump now seeks the appreciation of other major currencies. Already, he has succeeded in getting his European allies to agree.

However, it seems unlikely that Trump will get China and other BRICS economies to do so, as they are aware of how the Plaza Accord affected Japan.

Century bonds
Other national monetary authorities buying US Treasury bonds to stabilise their own currencies have long caused dollar appreciation.

They are now expected to help depreciate the dollar. Miran has proposed that the US issue century, i.e., 100-year bonds, at very low interest rates, well below the current rates for US Treasury securities.

Miran wants foreign central bank reserve currency managers to sell off their dollar-denominated assets. They should “term out” their “remaining reserve holdings” and refinance short-term debt with long-term borrowings.

Miran is explicit: “The US Treasury can effectively buy duration back from the market and replace that borrowing with century bonds sold to the foreign official sector.”

His plan thus intends to force foreign holders of US government debt (‘Treasuries’) to extend the duration of their loans.

Very low interest rates for century bonds will ensure that foreign bondholders effectively pay the US more for the ‘privilege’ of borrowing dollars.

For Miran, the appreciation of other currencies against the dollar will also strengthen the American economy. US manufacturing will strengthen as its exports become more competitive.

Thus, his Mar-A-Lago accord plan expects other nations to pay more to strengthen the world’s largest and richest economy.

Miran’s Mar-A-Lago plan is not yet official US policy. However, this can change with Miran’s likely appointment as the next Fed chair, replacing Trump 1.0 appointee Jerome Powell.

BRICS de-dollarisation?
However, Miran’s declared plan to strengthen the US economy by depreciating the dollar against other major currencies has also accelerated de-dollarisation.

In recent years, the BRICS have been accused of conspiring to accelerate de-dollarisation worldwide, but this is certainly not a shared ambition.

Lacking significant trade surpluses, Brazil and South Africa have long advocated de-dollarisation. But Russia’s complaints have more to do with recent NATO weaponisation of financial instruments against it.

There is no comparable enthusiasm among other BRICS member states, which have much healthier trade surpluses and more dollar assets.

Its recent membership expansion will make an official BRICS de-dollarisation stance even more unlikely.

Nevertheless, Trump’s leadership relies on the American public believing the rest of the world is conspiring against them.

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The Road to Belém is laid with layers of ambitious actions and outcomes including a plan to mobilize at least USD 1.3 trillion annually in climate finance for developing countries by 2035.

By Erik Solheim
OSLO, Norway, Nov 11 2025 – When world leaders now gather in Belém, Brazil for the UN climate conference, expectations will be modest. Few believe the meeting will produce any breakthroughs. The United States is retreating from climate engagement. Europe is distracted. The UN is struggling to keep relevant in the 21st century.

But step outside the negotiation tents, and a different story unfolds—one of quiet revolutions, technological leaps, and a new geography of leadership. The green transformation of the world is no longer being designed in Western capitals. It is being built, at scale, in the Global South.

Ten years ago, anyone seeking inspiration on climate policy went to Brussels, Berlin or Paris. Today, you go to Beijing, Delhi or Jakarta. The center of gravity has shifted. China and India are now the twin engines of the global green economy, with Brazil, Vietnam and Indonesia closely behind.

Erik Solheim

This is not about rhetoric; it is about results. China accounts for roughly 60 percent of global capacity in solar, wind, and hydropower manufacturing. It dominates in electric vehicles, batteries, and high-speed rail. China’s 93 GW installation of solar in May 2025 is a historic high and exceeds the monthly or short‐term installation levels of any other country to date.

China has made the green transition its biggest business opportunity, turning green action into jobs, prosperity and global leadership. China is now making more money from exporting green technology than America makes from exporting fossil fuels.

India, too, is reshaping what green development looks like. I was in Andhra Pradesh last month, when I visited a wonderful six-gigawatt integrated energy park—solar, wind, and pumped storage. It delivers round-the-clock clean power. There is nothing like that in the West. In another state, Tamil Nadu, an ecotourism circuit is protecting mangroves and marine ecosystems while creating local jobs in tourism. The western state of Gujarat, long a laboratory for industrial innovation, has committed to 100 gigawatts of renewables by 2030, with the captains of Indian business – Adani and Reliance – driving large-scale solar and wind investments with the state government.

These are not pilot projects. They are national strategies. And they are succeeding because the economics have flipped.

The cost of solar power has fallen by over 90 percent in the last decade, largely thanks to the intense competition between Chinese solar companies. Battery storage is now competitive with fossil fuels. What was once an environmental aspiration has become a financial inevitability. In Indian Gujarat, solar-plus-storage projects are already cheaper than coal. Switching to clean energy is no longer a cost—it is a saving.

That is why climate action today is driven not by diplomacy, but by economics. The question is no longer if countries will go green, but who will own the technologies and industries that make it possible.

Europe, long the moral voice of the climate agenda, now risks losing the industrial race. After years of blocking imports from developing countries on grounds of “inferior” green quality, it now complains that Chinese electric vehicles are too good— too cheap and too efficient. Europe cannot have it both ways. The world cannot build a green transition behind protectionist walls. The markets must open to the best technologies, wherever they are made.

President Luiz Inácio Lula da Silva of Brazil understands this new reality. That is why he chose Belém, deep in the Amazon, as the site for climate talks. The location itself is a statement: the future of climate policy lies in protecting the rainforests and empowering the people who live within them.

Forests are not just carbon sinks; they are living economies. When I was Norway’s environment minister, we partnered with Brazil and Indonesia to reward them for reducing deforestation. Later, Guyana joined our effort—a small South American nation where nearly the entire population is of Indian or African origin.

Guyana has since turned conservation into currency. Under its jurisdictional REDD+ programme, the country now sells verified carbon credits through the global aviation market known as CORSIA. In the third quarter of this year, these credits traded at USD 22.55 per tonne of CO₂ equivalent, with around one million credits sold through a procurement event led by IATA and Mercuria.

The proceeds go directly to forest communities—building schools, improving digital access, and funding small enterprises. It is proof that the carbon market can deliver real value when tied to real lives. You cannot protect nature against the will of local people. You can only protect it with them. Last year in Guyana, I watched children play soccer and cricket beneath the jungle canopy—a glimpse of life thriving in harmony with the forest, not at its expense.

That, ultimately, is what Belém should represent: not another round of procedural debates, but a vision for linking markets, nature and livelihoods.

The Global South has also sidestepped one of the West’s greatest political failures: climate denial. In India, there is no major political party—or public figure, cricket star or Bollywood artist—questioning the reality of climate change. Leaders may differ on ideology, but not on this. Across Asia, from China to Indonesia, climate action unites rather than divides. Because here, ecology and economy move together.

Prime Minister Narendra Modi of India puts it simply: by going green, we also go prosperous. President Xi Jinping of China and President Lula of Brazil share that same message—a vision that draws people in, instead of lecturing them. It is this integration of growth and sustainability that explains why the Global South is moving faster than most of the developed world.

None of this means diplomacy is irrelevant. The UN still matters. But its institutions must evolve to reflect the realities of the 21st century. The Security Council, frozen in 1945, still excludes India and Africa from permanent membership. Without reform, multilateralism risks losing its meaning.

Yet, while negotiations stall, transformation continues. From solar parks in Gujarat to high-speed rail across China, from mangrove tourism in Tamil Nadu to carbon markets in Guyana—climate leadership is happening in real economies, not in press releases.

Belém will not deliver a grand agreement. But it doesn’t need to. The world is already moving—faster than our diplomats.

The story of Belem will not be written in communiqués, but in kilowatts, credits, and communities.

The real climate leaders are no longer in Washington or Brussels.

They are in Beijing, Delhi, São Paulo, and Georgetown.

The future of climate action is already here.

It just speaks with a southern accent.

The author is the former Executive Director of the United Nations Environment Programme and Norway’s Minister for Environment and International Development.

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Excerpt:

As climate leaders gather in the Amazon, the world’s green transformation is speaking with a southern accent—powered by markets, technology, and a new economic logic.

By Tanka Dhakal
BELÉM, Brazil, Nov 11 2025 – Indigenous leaders from across the Amazon region are calling on climate negotiators to base climate initiatives on the recognition of the land rights of affected Indigenous communities. From the COP30 venue in Belém, these leaders are demanding full participation in the design and implementation of proposed projects.

The Indigenous leaders presented evidence that reforestation initiatives, carbon market schemes, and renewable energy projects could displace Indigenous and local communities and harm ecosystems if they are developed without community involvement and respect for their rights. According to the UNFCCC assessment report, active participation of Indigenous and local communities is key to the success of climate change-related initiatives, whether funded by public or private sources.

In this context, IPS spoke with Elcio Severino da Silva Manchineri (also known as Toya Manchineri), an Indigenous leader from the Manchineri people of Brazil. Manchineri is the General Coordinator of the Coordination of Indigenous Organizations of the Brazilian Amazon (COIAB).

Elcio Severino da Silva Manchineri at COP30. Credit: Tanka Dhakal/IPS

IPS: COP30 is happening on the land of Indigenous people here in Belém. What is the call from the Indigenous community to the negotiators?

Toya: Our main request to negotiators is to include Indigenous land demarcation as a climate solution—recognizing Indigenous lands as a climate response strategy.

IPS: Why is the recognition of land rights for Indigenous communities in climate negotiations so important?

Toya: It’s important because 80 percent of biodiversity is found in Indigenous territories, which means we conserve life. Land titling here and in other countries is crucial. If countries want to meet their targets for zero deforestation, they need to title Indigenous lands.

IPS: What is your view on reforestation efforts that happen without negotiation with Indigenous communities?

Toya: Reforestation is one of the key issues. But really—who is going to take care of those forests? We are the ones who care for them. We will be responsible for those forests. It’s been proven that 98 percent of our territories are well preserved. So, the real issue behind reforestation is guaranteeing the rights of Indigenous peoples to ensure our survival as well.

IPS: My follow-up question is: how can Indigenous communities and climate finance or climate progress come together? Is there a way?

Toya: We are working on climate hack finance and direct access to climate finance. Only direct access will strengthen what people are already doing in their territories. At the heart of it is the question: how can climate finance support what we’re already doing? That’s the important part.

IPS: To gain direct access to finance, you might need a place at the negotiation table. Do you think there is space for Indigenous leaders like you?

Toya: No, I don’t have a place—and that’s the problem. We need countries to consider us as negotiators, as part of official delegations, because we are the ones who know how to care for the forest and the environment.

IPS: Since you don’t have a place at the negotiation table, but Indigenous people have the knowledge to mitigate and adapt to climate change, how can climate projects or negotiations integrate Indigenous knowledge? Is there a way for Indigenous communities, their knowledge, and the negotiation process to come together?

Toya: It’s not only our traditional knowledge that can help mitigate climate change—we can also influence scientific knowledge. Sometimes scientists think they’re the only ones who can speak, but we can too. Our lands capture large amounts of carbon, which helps clear the air and reduce emissions. That’s the knowledge and practice we bring.

IPS: Finally, is there anything you want to see come out of the Belém climate conference? What is your top agenda?

Toya: What we really want to see in the final document is countries recognizing land titling for Indigenous peoples as a climate strategy—as a climate mitigation strategy. The just transition needs clear timelines to be effective. It must be just, but we also need to know by when.

Note: This feature is published with the support of Open Society Foundations.

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By Zofeen Ebrahim
KARACHI, Pakistan, Nov 11 2025 – When 23 children died in India’s Madhya Pradesh after consuming contaminated cough syrup in early September, the news barely registered across the border. In Pakistan—where self-medication is rampant and syrup bottles are household staples—the tragedy strikes dangerously close to home.

Many in Pakistan remain unaware that those sweet, over-the-counter syrups can be fatal. In the recent Indian case, the children—all under six—died of kidney failure after consuming syrup laced with diethylene glycol (DEG), a toxic solvent found at 500 times the permissible limit.

Investigations revealed the manufacturer, Sresan, had sourced industrial-grade propylene glycol from local chemical and paint dealers instead of certified pharmaceutical suppliers. With no qualified chemist overseeing production, the syrup went untested—and deadly.

This isn’t the first such incident. In 2022, Indian-made syrups caused the deaths of at least 70 children in The Gambia and 18 in Uzbekistan. Between December 2019 and January 2020, at least 12 children died in Indian-administered Kashmir after taking similarly contaminated syrup.

The prescribing doctor in India was the first to be arrested, followed by the suspension of the drug inspector and deputy director. The manufacturer, who had been absconding since September, has now been caught.

“It shows that even doctors can get caught in legal and ethical trouble, even when unaware of a drug’s quality issues,” said Professor Mishal Khan of the London School of Hygiene & Tropical Medicine. “The tragedy is a warning for Pakistan—weak regulation hurts everyone: doctors, pharma companies, and patients alike.”

A 2024 study by Khan found that approximately 40 percent of Karachi doctors accepted incentives in return for prescribing medicines from a fake pharmaceutical company without any checks on the company’s manufacturing standards or medicine quality. Antibiotics and cough syrups were among the medicines they agreed to promote.

As Pakistan enters its flu season, Karachi’s hospitals are filling up. “Between 50 to 70 percent of children who visit our clinics have respiratory tract infections,” said Dr. Wasim Jamalvi of Dr. Ruth K. M. Pfau, Civil Hospital Karachi.

And with the flu comes a predictable companion: cough syrup.

“If a child is brought for consultation for fever, cough and cold, parents feel a prescription is incomplete without a cough syrup,” said Dr. D.S. Akram, a senior pediatrician, who stopped prescribing them two decades ago. “Cough syrups don’t work—they just make the children drowsy or irritable,” she said.

Jamalvi agrees, “We don’t recommend syrups for under-fives, but parents still give them—they’re easily available over the counter.”

Self-Medication Culture

In Pakistan, cough syrups—often called sherbet—are viewed as harmless cures.

“I swear by this syrup a doctor gave me years ago,” said Mohammad Yusuf, a 31-year-old houseboy. “One spoon at night and I sleep better.”

Two weeks ago, when Rakhi Matan’s children, aged 10 and 13, came down with the flu, she reached for a bottle of leftover cough syrup from last year. “It saved me the doctor’s fee—he’d have prescribed the same thing,” she said.

Such casual self-medication is common—and hard to control.

Dr. Qaiser Sajjad, former secretary general of the Pakistan Medical Association, said regulating cough syrup sales is nearly impossible with thousands of quacks operating in the city. Medical store worker Majid Yusufzai agreed, admitting syrups are sold freely without prescriptions and “entire families share the same bottle.”

Health experts say Pakistan’s culture of self-prescription—reinforced by weak enforcement and cheap access to medicines—makes the system vulnerable to similar disasters.

Dr. Obaidullah Malik, heading the Drug Regulatory Authority of Pakistan (DRAP), told IPS that Pakistan imported the majority of the raw materials (for several drugs, including cough syrups) from India and China.

With over 100,000 drug manufacturing companies, India, referred to as the ‘pharmacy of the world,’ is known for affordable generic drugs. But recent deaths have cast a long shadow on its safety standards.

Tighter Drug Oversight

“It is of great concern,” said Malik, adding that scrutiny of domestic quality control was enhanced after it received a global alert from the WHO on October 13, of three substandard cough syrups manufactured in India.

“Thankfully, the contaminated syrups were never exported to Pakistan,” confirmed Malik. “There’s no evidence of illegal shipments either—but we’re staying vigilant to ensure a tragedy like India’s doesn’t happen here.”

“DRAP has made it mandatory for all pharmaceuticals, including herbal and nutraceutical manufacturers as well as importers, to pre-test additives such as glycerin, propylene glycol, and sorbitol—either in their own laboratories or through public sector facilities like the Central Drugs Laboratory (CDL) in Karachi or the 12 provincial drug testing,” said Malik. The authority is double-checking vendor credentials and certifications and instructed field teams to step up sampling and testing—both of raw materials coming in and the finished syrups.

Recently, it trained pharma company reps from Nepal, Gambia, Sierra Leone, Maldives, and Sri Lanka on a quick detection method called Thin Layer Chromatography (TLC), which helps spot contamination early—saving time, cutting costs, and improving safety checks nationwide.

There are between 700 and 800 pharmaceutical companies across Pakistan, but only about 300 are members of the Pakistan Pharmaceutical Manufacturers Association—leaving much of the industry operating with little oversight. Yet, despite its fledgling state compared to India’s, Pakistan’s pharma sector is eager to expand into global markets. Khan cautioned that the recent scandal over unsafe medicines could jeopardize those ambitions before they even take off.

To avoid a similar crisis and protect its reputation abroad, Pakistan’s regulator has stepped up oversight at home. “Since November 2023, DRAP has recalled 63 finished products contaminated with diethylene glycol (DEG) and ethylene glycol (EG), identified 44 impurities, and issued 13 alerts about contaminated raw materials,” said DRAP’s CEO.

As Karachi’s clinics continue to fill up this flu season, syrup bottles are flying off shelves—often with no pharmacist in sight. “It’s just a syrup,” said Yusuf. He does not know, but for dozens of families across the border, that sweet bottle brought irreversible loss.

IPS UN Bureau Report

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Excerpt:

India’s cough syrup tragedy is a warning for Pakistan, where self-medication is common and the sweet cure fills every home. Experts call for tighter safety checks.