When a patient in Agartala, in the northeast Indian state of Tripura, runs out of medicine, the nearest supplier may not be in Mumbai or Ahmedabad — it may be across the border in Bangladesh, just 40 km away. Yet that option remains, for now, unavailable. This has not been taken seriously at the regional level or in Indian health policy circles. A medicine produced at Dhaka or Narayanganj and exported through Akhaura arrives Agartala in less time and at a lower cost than the same medicine coming from Ahmedabad, more than two thousand kilometres to the west.

Northeast India's Medicine Supply Problem

The geographical features of India's Northeast directly impact the region’s healthcare. The eight states of the region are connected to the rest of India through a narrow corridor of twenty-two kilometres in West Bengal known as Siliguri Corridor. This is a choke point that serves the roads, rails and supply lines for an entire region.

India's pharma manufacturing is not even in the vicinity of it. Half of the production is from the western states (Maharashtra, Gujarat and parts of Himachal Pradesh). Sikkim is the only pharmaceutical cluster in Northeast with a contribution of about one percent of the country. Assam, Tripura, Meghalaya, and Mizoram import their medicines from more than a thousand kilometres away.

This system runs slowly and expensively for most of the year and completely freezes from May to September. Pre-monsoon floods disrupt the road connectivity across the region and the already fragile Siliguri Corridor becomes even more volatile. Consequently, the flow of medicines does not slow down-it literally breaks down. During monsoons, hospitals are often short of vital medicines when the monsoon related disease rates climb high. This is an annual problem.

Bangladesh's Pharmaceutical Capacity

Over the last two decades, the pharmaceutical industry in Bangladesh has grown substantially and has emerged as an important exporting power in the pharmaceutical industry.  The exports grew from USD 70.9 million to USD 322.5 million in five years, growing by 4.5 times, in FY2019-20 to FY2023-24. Today, the industry is able to meet approximately 98% of the domestic drug demand and is certified by the USFDA, UK MHRA, EU GMP, Health Canada, TGA Australia, among others. These certifications are not only formalities but a testament to the industry's willingness to invest in quality systems that most developing-country's pharmaceutical industries have not achieved.

Numerous pharmaceutical firms in Bangladesh produce antibiotics, insulin and oncology drugs, exactly the categories Northeast India most needs during a supply shortage. Bangladeshi insulin already competes in European markets. It is nearly impossible to overstate the proximity. A consignment from Narayanganj can reach Agartala depot in less than three hours through Akhaura land port. Under normal conditions the same consignment from Ahmedabad takes days. If the Siliguri Corridor is blocked, it doesn't reach at all.

Why Imports Are Blocked

India's Central Drugs Standard Control Organization (CDSCO) regulates all drug imports nationally. Although the manufacturer might have a license from another country, they will have to obtain a CDSCO license for selling in India, irrespective of their location. The paperwork and timelines are the same for a firm in Dhaka as well as one in São Paulo. The approval process takes about eighteen months to two years. None of that timeline is directed towards a monsoon emergency as there wasn't a pathway constructed for it.

The question to ask is what is this registration requirement protecting against? The manufacturers of Bangladesh already have a standard higher than many countries have for their domestic market. This regulatory barrier doesn't stop poor-quality products. It removes a feasible solution.

A Power Delhi has not Used

The Drugs and Cosmetics Act gives the power to the Indian Government to ease drug regulations by gazette notification in the case of public interest emergency. The recurring disruption of the Siliguri Corridor due to the monsoon is a potential supply contingency but no action has been taken so far to use it to expedite import from certified pharmaceutical manufacturers of Bangladesh. 

States like Assam and Tripura do not have the power to declare the emergency by itself, but can submit a formal request to the Union Government to declare a standing emergency notification, which will allow them to immediately purchase the CDSCO approved medicines from Bangladesh if the corridor connectivity is disrupted. The legal framework exists; the problem, however, is the political will to make use of it.

The opportunity in the long term is more structured. Bangladesh Standards and Testing Institution and Bureau of Indian Standards are negotiating mutual recognition of product standards in preliminary discussions. Extending this to the pharmaceutical sector will enable WHO prequalified pharmaceuticals to enter Indian markets without comprehensive retesting and re-registration.The antibiotic should not need to be re-registered because of crossing a forty-kilometre boundary.

A Resource Left Untapped

This should not be seen as a bilateral trade negotiation where Bangladesh asking India for concessions in a slow bilateral process. The real question is simpler: do Indian states want to use a resource that is geographically closer, internationally certified, available already, or would they prefer to continue to suffer from a yearly deficit on the other side of the Corridor?

Bangladesh has an established pharmaceutical industry that is capable of competing in the most demanding controlled markets in the world. India's existing supply chain is not addressing the pharma supply challenge of Northeast India. The distance between these two facts is just 40 km — and there is as yet no policy decision being made to bridge the gap!

(The writer is an undergraduate student in the Department of International Relations, Jahangirnagar University, Bangladesh. Views expressed are personal. He can be reached at sabbir01883@gmail.com. )