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The Cost and Evolution of Quality at Cipla Ltd., 1935–2016

Published online by Cambridge University Press:  10 June 2021

Abstract

This article examines the evolution of Indian pharmaceutical manufacturer Cipla toward producing drugs that met the quality standards of European and U.S. regulators. It employs new research in both Cipla's corporate archives and a wide range of oral histories. The article argues that, along with a long-standing corporate culture of self-reliance rooted in nationalism starting from the company's inception in 1935, major factors in Cipla's strategy from the 1960s through the early 2000s included the early adoption and continued use of quality-control technology, along with efforts to create global goodwill for affordable high-quality generic drugs during the HIV/AIDS epidemic of the early 2000s.

Type
Research Article
Copyright
Copyright © The President and Fellows of Harvard College 2021

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References

1 Owen, Thomas, “From ‘Pirates’ to ‘Heroes’: News, Discourse Change, and the Contested Legitimacy of Generic HIV/AIDS Medicines,” International Journal of Press/Politics 18, no. 3 (2013): 259–80CrossRefGoogle Scholar.

2 In addition to the numerous studies of Cipla by business history and strategy scholars cited throughout this article, our analysis depended on the following four sources: the Cipla Archives at Cipla headquarters in Mumbai, India (hereafter cited as CA); Cipla oral history records provided by Cipla Archives Office and the office of the chief archivist (hereafter, CAOH); interviews with Cipla quality assurance leadership team in Mumbai and interviews with regional leadership in South Africa, Uganda, and Latin America with a particular focus on quality-control practices within Cipla; and an interview with Dr. Yusuf Hamied on Cipla history, corporate culture, and emerging markets, by Tarun Khanna, Mumbai, India, 29 Apr. 2013, Creating Emerging Markets Project, Baker Library Historical Collections, Harvard Business School, http://www.hbs.edu/creating-emerging-markets/ (hereafter CEM).

3 Centers for Disease Control and Prevention, “AIDS: The Early Years and CDC's Response,” by Curran, James W. and Jaffe, Harold W., Morbidity and Mortality Weekly Report, supplement 60, no. 4 (7 Oct. 2011): 64–69Google ScholarPubMed.

4 Hoen, Ellen ’t, Berger, Jonathan, Calmy, Alexandra, and Moon, Suerie, “Driving a Decade of Change: HIV/AIDS, Patents and Access to Medicines for All,” Journal of the International AIDS Society 14, no. 1 (2011)CrossRefGoogle Scholar, https://doi.org/10.1186/1758-2652-14-15.

5 The issue of quality and access has been a central pillar in Cipla's campaign for affordable HIV drugs. See, for example, “Cipla Pharmaceuticals’ Yusuf Hamied: ‘I Am Not against Patents . . . I Am against Monopolies,’” Knowledge@Wharton, 7 May 2009, https://knowledge.wharton.upenn.edu/article/cipla-pharmaceuticals-yusuf-hamied-i-am-not-against-patents-i-am-against-monopolies/.

6 For a personal account of the history of Cipla, see Khwaja Abdul Hamied, Hamied: An Autobiography; A Life to Remember (Bombay, 1972).

7 For a discussion of indigenous medicine and the interaction of traditional medicine during the Raj, see Kumar, Deepak and Basu, Raj Sekhar, eds., Medical Encounters in British India (New Delhi, 2013)Google Scholar; Sehrawat, Samiksha, Colonial Medical Care in North India: Gender, State and Society c. 1840–1920 (New Delhi, 2013)CrossRefGoogle Scholar; Bala, Poonam, ed., Contesting Colonial Authority: Medicine and Indigenous Responses in Nineteenth- and Twentieth-Century India (Delhi, 2016)Google Scholar; and Sharma, Madhuri, Indigenous and Western Medicine in Colonial India (New Delhi, 2012)Google Scholar.

8 On the issue of patents in Indian businesses, see Tripathi, Dwijendra and Jumani, Jyoti, The Oxford History of Contemporary Indian Business (New Delhi, 2013)Google Scholar; Halliburton, Murphy, India and the Patent Wars: Pharmaceuticals in the New Intellectual Property Regime (Ithaca, 2017)Google Scholar; and Sinha, Aseema, Globalizing India: How Global Rules and Markets Are Shaping India's Rise to Power (Cambridge, U.K., 2016)CrossRefGoogle Scholar.

9 On the impact of the Swadeshi movement on Indian manufacturing, see Tripathi, Dwijendra, The Oxford History of Indian Business (Oxford, 2004), 153–62Google Scholar.

10 Bhattacharya, Nandini, “Between the Bazaar and the Bench: Making of the Drugs Trade in Colonial India, ca. 1900–1930,” Bulletin of the History of Medicine 90, no. 1 (2016): 61CrossRefGoogle ScholarPubMed.

11 Roy, Tirthankar, A Business History of India: Enterprise and the Emergence of Capitalism from 1700 (Cambridge, U.K., 2018), 183CrossRefGoogle Scholar.

12 William Greene, “The Emergence of India's Pharmaceutical Industry and Implications for the U.S. Generic Drug Market” (Office of Economics Working Paper No. 2007-05-A, U.S. International Trade Commission, Washington, DC, May 2007), 2, https://www.usitc.gov/publications/332/EC200705A.pdf.

13 Markovits, Claude, Indian Business and Nationalist Politics 1931–39: The Indigenous Capitalist Class and the Rise of the Congress Party (Cambridge, U.K., 2002), 4Google Scholar.

14 Gandhi's visit to Cipla was on July 4, 1939. For details on the nationalist movements and how they affected Indian entrepreneurs, see Markovits, Indian Business and Nationalist Politics.

15 Singh, Harikrishan, “Khwaja Abdul Hamied (1898–1972)—Pioneer Scientist Industrialist,” Indian Journal of History of Science 45, no. 4 (2010): 535–36Google Scholar.

16 On the influence of European politics on Khwaja Hamied, see Kenneth X. Robins and John Mcleod, “A Story of the Holocaust and the AIDS Epidemic: The Romance of an Indian Muslim Freedom Fighter and a Lithuanian Jewish Woman,” Lithuanian Jewish Community (website), 29 Jan. 2016, https://www.lzb.lt/en/2016/01/29/a-story-of-the-holocaust-and-the-aids-epidemic-the-romance-of-an-indian-muslim-freedom-fighter-and-a-lithuanian-jewish-woman/.

17 Sir Syed Ahmad Khan, considered among the leading freedom fighters of the Indian independence movement, contributed to the effort by creating educational institutions such as MAO College, which later became Aligarh Muslim University. See Muhammad, Shan, Sir Syed Ahmad Khan: A Political Biography (Meerut, India, 1969)Google Scholar.

18 Yusuf Hamied, interview by Tarun Khanna, Mumbai, India, 29 Apr. 2013, CEM, https://www.hbs.edu/creating-emerging-markets/interviews/Pages/profile.aspx?profile=yhamied.

19 Singh, “Khwaja Abdul Hamied,” 541.

20 For a detailed analysis of the evolution of testing, quality, and analysis in the Indian public sector, see Zaman, Muhammad H., Bitter Pills: The Global War on Counterfeit Drugs (New York, 2018), 8789Google Scholar.

21 For details on Juran's work, see Joseph M. Juran and A. Blanton Godrey, Juran's Quality Handbook, 5th ed. (New York, 1999); Juran, , “Early SQC: A Historical Supplement,” Quality Progress 30, no. 9 (1997)Google Scholar; and Bisgaard, Soren, “Quality Management and Juran's Legacy,” Quality and Reliability International 23, no. 6 (2007): 665–77CrossRefGoogle Scholar. Furthermore, we note that while the impact on Pharma in India was limited, companies in other industries, such as Tata, had benefited from the global movement of quality control. See Lall, Sanjaya, Learning to Industrialize: The Acquisition of Technological Capability by India (London, 1987)CrossRefGoogle Scholar.

22 Hamied, An Autobiography, 44.

23 Salil Panchal, “YK Hamied: Cipla's Fearless Crusader,” Forbes India, 24 Nov. 2016, http://www.forbesindia.com/article/leadership-awards-2016/yk-hamied-ciplas-fearless-crusader/44893/1.

24 Ibata-Arens, Kathryn C., Beyond Technonationalism: Biomedical Innovation and Entrepreneurship in Asia (Stanford, 2019), 1983Google Scholar.

25 Hamied interview.

26 Haley, George T. and Haley, Usha C. V., “The Effects of Patent-Law Changes on Innovation: The Case of India's Pharmaceutical Industry,” Technological Forecasting and Social Change 79, no. 4 (2012): 607–19CrossRefGoogle Scholar.

27 Desai, Ashok V., “The Origin and Direction of Industrial R&D in India,” Research Policy 9, no. 1 (1980): 74–96CrossRefGoogle Scholar.

28 The issue of hostility has been captured by numerous medical journals and media outlets. See, for example, Richard Lane, “Yusuf Hamied: Leader in the Indian Generic Drug Industry,” Lancet 386, no. 1011 (2015), https://doi.org/10.1016/S0140-6736(15)00839-9.

29 For a detailed history of antibiotic discovery and demand, see Zaman, Muhammad H., Biography of Resistance: The Epic Battle between People and Pathogens (New York, 2020), 107–19Google Scholar.

30 Achilladelis, Basil and Antonakis, Nicholas, “The Dynamics of Technological Innovation: The Case of the Pharmaceutical Industry,” Research Policy 30, no. 4 (2001): 535–88CrossRefGoogle Scholar.

31 Quality control and quality assurance staff from the 1970s and 1980s, interviews by Cipla chief archivist Dr. Usha Iyer, 2015–2018, transcripts, Cipla oral history records, CAOH.

32 Sheela Patkar, interview by Usha Iyer, 2016, Cipla Oral history records, CAOH.

33 For a brief history of HPLC, see Arnaud, Celia Henry, “50 Years of HPLC,” ACS Chemical and Engineering News 94, no. 24 (2016): 28–33Google Scholar. See also Zaman, Bitter Pills, 176–79.

34 See comments by Y. Hamied such as those found in Yusuf Hamied, “The Indian Patents Act, 1970 and the Pharmaceutical Industry,” Cipla Ltd, Bombay, National Seminar on Patent Laws, New-Delhi, vol. 22 (New Delhi 1988); and Hamied interview.

35 Patkar interview.

36 Savio Daroud (head of QC in the 1980s), interview by Usha Iyer, 2016, CAOH. On FDA approval of other companies, see Bower, D. Jane and Sulej, Julian C., “The Indian Challenge: The Evolution of a Successful New Global Strategy in the Pharmaceutical Industry,” Technology Analysis & Strategic Management 19, no. 5 (2007): 611–24Google Scholar.

37 Bower and Sulej, “Indian Challenge.”

38 Dr. Ranjana Pathak (head of quality control, Cipla), interview by Muhammad H. Zaman, Aug. 2017.

39 For a full discussion of the quote, its context, and the relationship of Indian regulators with the FDA, see Sushmi Dey, “If I Follow US standards, I Will Have to Shut Almost All Drug Facilities: G N Singh,” interview, Business Standard, 30 Jan. 2014, https://www.business-standard.com/article/economy-policy/if-i-follow-us-standards-i-will-have-to-shut-almost-all-drug-facilities-g-n-singh-114013000034_1.html.

40 Daroud interview. On FDA approval of Cipla, see Fred Luthans and Jonathan Doh, International Management: Culture, Strategy, and Behavior, 8th ed. (New York, 2018), 99.

41 For details, see “HIV and AIDS Timeline,” CDC website, accessed 7 Dec. 2020, https://npin.cdc.gov/pages/hiv-and-aids-timeline.

42 It is important to note that the early phase of HIV as a public-health crisis was embroiled in confusion and controversy. On the various “diagnoses” of the disease, see “A Timeline of HIV and AIDS,” HIV.gov, accessed 7 Dec. 2020, https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline; and Merson, Michael and Inrig, Stephen, The AIDS Pandemic: Searching for a Global Response (Cham, Switzerland, 2018)CrossRefGoogle Scholar.

43 Merson and Inrig, AIDS Pandemic.

44 Philip Boffey, “Reagan Defends Financing for AIDS,” New York Times, 18 Sept. 1985.

45 Sara Fritz, “$105-Billion Spending Measure Passed by Congress; Funding for AIDS Doubled,” Los Angeles Times, 7 Dec. 1985; and Bill Keller, “Pentagon to Test All New Recruits for Possible Signs of AIDS Virus,” New York Times, 31 Aug. 1985.

46 Ramasubban, Radhika, “HIV/AIDS in India: Gulf between Rhetoric and Reality,” Economic and Political Weekly 33, no. 45 (1998): 2865–72Google Scholar.

47 CIPLOG, the company newsletter aimed at Cipla employees and their families, was started in 1984 and discontinued in 1995. It resumed publication in 2013. Dr. Hamied contributed to most issues.

48 CIPLOG, inaugural issue, Nov. 1984–Jan. 1985, available in Cipla archives.

49 CIPLOG, inaugural issue.

50 CIPLOG, Inaugural issue.

51 “The Pursuit of Quality,” CIPLOG 3, no. 4 (Aug. 1987).

52 “Computerisation: An Update,” CIPLOG 3, no. 4 (Aug. 1987).

53 “A Pioneer Venture towards Better Drugs” CIPLOG 2, no. 4 (1986).

54 “Ciplog Newsletter,” CIPLOG 5, no. 4 (1989).

55 Dr. Michael Jaegar to Dr. J. A. Gogtay, 10 Aug.1995, CA, .Cipla Archives, Mumbai, India

56 Greene, “India's Pharmaceutical Industry.”

57 Ramani, Shyva V. and Mukherjee, Vivekananda, “Can Breakthrough Innovations Serve the Poor (bop) and Create Reputational (CSR) Value? Indian Case Studies,” Technovation 34, nos. 5–6 (2014): 295–305CrossRefGoogle Scholar, esp. 301.

58 Hamied interview.

59 For a detailed history of the early period of AIDS, see Merson and Inrig, AIDS Pandemic, 29–45.

60 Lindsay Knight, UNAIDS: The First 10 Years, 1996–2006, Joint United Nations Programme on HIV/AIDS (Geneva, 2008).

61 David Perlman, “Worry, Hope at AIDS Conference: Breakthroughs Have Too High a Price for Many,” San Francisco Chronicle, 8 July 1996, A1.

62 For example, see “Chirac Calls for African Aids Funding,” BBC News, 8 Dec. 1997, http://news.bbc.co.uk/2/hi/37809.stm.

63 David Katzenstein, Marie Laga, and Jean-Paul Moatti, “The Evaluation of the HIV/AIDS Drug Access Initiatives in Côte d'Ivoire, Senegal and Uganda: How Access to Antiretroviral Treatment Can Become Feasible in Africa,” AIDS 17 (July 2003): S1–S4.

64 Buse, Kent and Walt, Gill, “Global Public-Private Partnerships: Part 1—A New Development in Health?,” Bulletin of the World Health Organization 78, no. 4 (2000): 549–61Google Scholar.

65 Knight, UNAIDS, 69.

66 John A. Harrelson, “TRIPS, Pharmaceutical Patents, and the HIV/AIDS Crisis: Finding the Proper Balance between Intellectual Property Rights and Compassion,” Widener Law Symposium Journal 7 (2001).

67 Mbali, Mandisa, “AIDS Discourses and the South African State: Government Denialism and Post-Apartheid AIDS Policy-Making,” Transformation: Critical Perspectives on Southern Africa 54, no. 1 (2004): 104–22CrossRefGoogle Scholar.

68 Knight, UNAIDS.

69 Merson and Inrig, AIDS Pandemic, chap. 14; Sudhanshu Priyadarshi, “Indian Pharmaceuticals and Africa: A Case Study of Cipla,” in Brookings India, India and Africa: Forging a Strategic Partnership (New Delhi, Oct. 2015), https://www.brookings.edu/wp-content/uploads/2015/10/indiaafrica_priyadarshi.pdf.

70 Marseille, Elliot, Hofmann, Paul B., and Kahn, James G., “HIV Prevention before HAART in Sub-Saharan Africa,” Lancet 359, no. 9320 (2002): 1851–56CrossRefGoogle ScholarPubMed.

71 The topic was covered widely in the international press; see, for example, Donald G. McNeil, “Indian Company Offers to Supply AIDS Drugs at Low Cost in Africa,” New York Times, 7 Feb. 2001.

72 Jeffrey L. Sturchio, “Partnership for Action: The Experience of the Accelerating Access Initiative, 2000–04, and Lessons Learned,” in Delivering Essential Medicines: The Way Forward, ed. Amir Attaran and Brigitte Granville (London, 2004), 116–51.

73 Christian Laurent, Charles Kouanfack, Sinata Koulla-Shiro, Nathalie Nkoué, Anke Bourgeois, Alexandra Calmy, Bernadette Lactuock, et al., “Effectiveness and Safety of a Generic Fixed-Dose Combination of Nevirapine, Stavudine, and Lamivudine in HIV-1-Infected Adults in Cameroon: Open-Label Multicentre Trial,” Lancet 364, no. 9428 (2004): 29–34.

74 Carmen Perez-Casas, Cécile Mace, Daniel Berman, and Julia Double, “Accessing ARVs: Untangling the Web of Price Reductions for Developing Countries” (Médecins sans Frontieres, Geneva, 20 Sept. 2001),

https://www.msfaccess.org/sites/default/files/MSF_assets/HIV_AIDS/Docs/AIDS_report_UTW1_ENG_2001.pdf.

75 Stéphane Lucchini, Boubou Cisse, Ségolène Duran, Marie De Cenival, Caroline Comiti, Marion Gaudry, and Jean-Paul Moatti, “Decrease in Prices of Antiretroviral Drugs for Developing Countries: From Political ‘Philanthropy’ to Regulated Markets,” in Agence nationale de recherches sur le SIDA (ANRS), Economics of AIDS and Access to HIV/AIDS Care in Developing Countries: Issues and Challenges (France, 2003), 169–211.

76 ’t Hoen et al., “Driving a Decade of Change.”

77 For a detailed treatment of the topic, see Nattrass, Nicoli, The Moral Economy of AIDS in South Africa (Cambridge, U.K., 2004)Google Scholar.

78 See S. S. Abdool Karim and Q. Abdool Karim, eds., HIV/AIDS in South Africa (Cambridge, U.K., 2010).

79 Naomi A. Bass, “Implications of the TRIPS Agreement for Developing Countries: Pharmaceutical Patent Laws in Brazil and South Africa in the 21st Century,” George Washington International Law Review 34 (2002): 191.

80 Attaran, Amir and Gillespie-White, Lee, “Do Patents for Antiretroviral Drugs Constrain Access to AIDS Treatment in Africa?,” JAMA 286, no. 15 (2001): 1886–92CrossRefGoogle ScholarPubMed.

81 There are numerous studies on TAC and its role in HIV drug access. See, for example, Mandisa Mbali, “The Treatment Action Campaign and the History of Rights-Based, Patient-Driven HIV/AIDS Activism in South Africa,” in Democratising Development: The Politics of Socio-Economic Rights in South Africa, ed. Peris Jones and Kristian Stokke (Leiden, 2005), 213–43; Mbali, “TAC in the History of Patient-Driven AIDS Activism: The Case for Historicizing South Africa's New Social Movements,” in Challenging Hegemony: Social Movements and the Quest for a New Humanism in Post-Apartheid South Africa, ed. Nigel C. Gibson (Trenton, NJ, 2006), 129–55; Robins, Steven, “From ‘Rights’ to ‘Ritual’: AIDS Activism in South Africa,” American Anthropologist 108, no. 2 (2006): 312–23CrossRefGoogle Scholar; and Karim and Karim, HIV/AIDS in South Africa.

82 For detailed notes on the case, see Heywood, Mark, “South Africa's Treatment Action Campaign: Combining Law and Social Mobilization to Realize the Right to Health,” Journal of Human Rights Practice 1, no. 1 (2009): 14–36CrossRefGoogle Scholar; Friedman, Steven and Mottiar, Shauna, “A Rewarding Engagement? The Treatment Action Campaign and the Politics of HIV/AIDS,” Politics & Society 33, no. 4 (2005): 511–65CrossRefGoogle Scholar; and Friedman and Mottiar, A Moral to the Tale: The Treatment Action Campaign and the Politics of HIV/AIDS (Durban, 2004).

83 Berger, Jonathan Michael, “Litigation Strategies to Gain Access to Treatment for HIV/AIDS: The Case of South Africa's Treatment Action Campaign,” Wisconsin International Law Journal 20, no. 3 (2002): 595–610Google Scholar.

84 For details, see “Cipla Tests South African Government with Compulsory License Request” (KHN Morning Briefing, Kaiser Health News, 12 Mar. 2001), https://khn.org/morning-breakout/dr00003332/.

85 The protests got worldwide attention, including newspaper coverage in the United States, the United Kingdom, Germany, and South Africa in the first week of March 2001. For an example, see Ravi Nessman and Andrea Babbington, “Protest in Britain as Drug Companies Sue South African Government,” Independent, 5 Mar. 2001.

86 Ashwin Vasan, David Hoos, Joia S. Mukherjee, Paul E. Farmer, Allan G. Rosenfield, and Joseph H. Perriëns, “The Pricing and Procurement of Antiretroviral Drugs: An Observational Study of Data from the Global Fund,” Bulletin of the World Health Organization 84 (2006): 393–98.

87 Wafaa M. El-Sadr, Charles B. Holmes, Peter Mugyenyi, Harsha Thirumurthy, Tedd Ellerbrock, Robert Ferris, Ian Sanne, et al., “Scale-Up of HIV Treatment through PEPFAR: A Historic Public Health Achievement,” Journal of Acquired Immune Deficiency Syndromes 60, no. S3 (2012): S96.

88 For the announcement, see Ramnath Subbu, “Cipla Wins $189 m Global Fund Tender for AIDS Drugs,” The Hindu, 13 Feb. 2015.

89 Cipla registered several of its HIV drugs in South Africa in September 2003. See “Cipla Registers Five Anti-AIDS Drugs in South Africa,” Economic Times (Mumbai), 22 Sept. 2003.

90 On the issues associated with Ranbaxy, see Fleck, Fiona, “Ranbaxy Withdraws All Its AIDS Drugs from WHO List,” BMJ 329, no. 7476 (2004): 1205Google Scholar; and Eban, Katherine, Bottle of Lies: The Inside Story of the Generic Drug Boom (New York, 2019)Google Scholar.

91 Cipla Limited, Cipla Sixty-Seventh Annual Report 2002–2003, https://www.cipla.com/sites/default/files/1442820175_Sixty-Seventh-Annual-Report-2002-2003_0.pdf.

92 Hamied interview.

93 Cipla Quality Chemical Industries Limited (CQCIL) started in 2004. See Mulumba, Moses and Machemedze, Rangarirai, “Addressing Bottlenecks to Local Production of Medicines: Issues for International Cooperation in East and Southern Africa,” Journal of Health Diplomacy 1, no. 3 (2015)Google Scholar. On quality management at CQCIL see Christian Murungi, “Total Quality Management and Competitive Advantage of Pharmaceutical Industries in Uganda: A Case Study of Cipla Quality Chemical Industries Limited” (MBA dissertation, Nkumba University, 2018); for Hamied's keynote, see Y. K. Hamied, “Address by Dr. Y. K. Hamied, Chairman,” Eighty-First Annual General Meeting, Cipla, 11 Aug. 2017, https://www.cipla.com/sites/default/files/2019-01/Address%20by%20Dr.%20Y.K.%20Hamied%2C%20Chairman%20-%2081st%20AGM_0.pdf.

94 See “Quality Chemicals Marks 10 Years in Uganda,” New Vision Uganda, 11 Oct. 2017, https://www.newvision.co.ug/new_vision/news/1463399/quality-chemicals-marks-uganda.

95 For details on Cipla's activity in East Africa, see Company Profile of Cipla Quality Chemicals Ltd. Uganda “https://africanfinancials.com/company/ug-cipla/”]. For company information, see “Mission, Vision & Values,” Cipla website, accessed 7 Dec. 2020, https://ciplaqcil.co.ug/about-us#mission. See also W. O. Wanyanga, Sarah Vugigi, and Frankline Keter, “Improving Access to Essential Medicines through Public-Private Partnerships in East Africa” (Policy Brief No. 10, Scinnovent Center, Nairobi, 2020).

96 Pathak interview.

97 For information see Cipla, Health Care with a Purpose: Cipla Limited Annual Report 2018–19 (Mumbai, n.d.), https://www.cipla.com/sites/default/files/Cipla%20AR%202018-19-2.pdf.

98 Pathak interview.

99 Cipla acquired 100 percent of InvaGen in 2015.

100 Anant Atal (head of Cipla Latin America, based in Colombia), interview by Muhammed H. Zaman, May 2017.

101 In 2017, Cipla and Pfizer agreed on a plan to improve access to sixteen chemotherapeutic drugs for cancer. See Donald G. McNeil, “As Cancer Tears through Africa, Drug Makers Draw Up a Battle Plan,” New York Times, 7 Oct. 2017; and “American Cancer Society and Clinton Health Access Initiative Announce Collaborations with Pfizer and Cipla to Increase Access to Lifesaving Cancer Treatment in Africa,” press release, 20 June 2017, American Cancer Society Pressroom, http://pressroom.cancer.org/2017-06-20-American-Cancer-Society-and-Clinton-Health-Access-Initiative-Announce-Collaborations-with-Pfizer-and-Cipla-to-Increase-Access-to-Lifesaving-Cancer-Treatment-in-Africa.

102 In general, Cipla has maintained a strong reputation of quality among Indian pharmaceutical manufacturers (e.g., Eban's book Bottle of Lies discusses this in detail); however, there have been some reports of warnings by Indian regulators. See Prabha Raghavan, “Bad Medicine! Pfizer, Cipla, DRL, Other 63 Drug Firms Fail Quality Test,” Economic Times (Mumbai), 21 July 2017.