Bangladesh's endeavour to establish a comprehensive drug policy dates back to 1972, when a committee of experts, lead by the renowned physician Dr Nurul Islam, first proposed the banning of hazardous and useless drugs. However, the committee lacked support from key sectors of the government and was soon dismantled. This was not surprising, given that in the 1970s through the early 1980s, the pharmaceutical market in Bangladesh was dominated by just a few multinational companies, including Squibb, Wyeth Laboratories, SmithKline, Pfizer and Eli Lilly. Together, the foreign companies controlled more than 75 percent of the market, and supplied most of the essential drugs to the government, at very high prices. Additional ramifications of this industry composition included the flooding of the market with dangerous and unnecessary drugs, including vitamins, tonics, enzymes, gripe waters, cough mixtures, restoratives and digestants. A market survey in 1978 reported that harmful and pointless drugs accounted for a full third of the total drug consumption in the country.
After a decade of disquiet over this toxic situation, pushed by academics, regulatory experts and health activists, Bangladesh implemented the National Drug Policy (NDP) in 1982. It aimed to ensure quality and, importantly, to expand the domestic drugs industry. Yet the new policy received an immediate and hostile response from domestic and multinational pharmaceutical companies alike, as well as associations of local health professionals and certain foreign governments, including the US, Britain, West Germany and the Netherlands. These parties argued that the new policy would discourage foreign investors, would result in more harm than good for public health, and would not achieve the goal of increased availability of medicines. For their part, the multinationals further warned that the policy could result in a decision to halt all pharmaceutical production by foreign companies, with devastating impact. Within two months, although the Dhaka government persisted with the main thrust of its drug policy, some changes were introduced in response to this pressure. These included permitting some banned products back on the market, extending the time period for implementation of regulation, introducing an appeals process, and altering the list of permitted products.
Despite the mild watering-down, the NDP policy did articulate a vision of self-reliance, giving priority to the country's basic drugs needs, coupled with a proud defiance of the multinationals. The policy was essentially people-oriented, which may be why the government was able to sustain its tough stance against the huge pressure from powerful opponents. At the same time, it is important to note that the new policy came up within a very particular political context, at the time when the military government led by General Hussain Muhammad Ershad had just come to power. By immediately choosing to focus on an issue as sensitive as the drugs industry, the government was able to give itself the option of achieving both domestic political goals and international recognition. The domestic goals included objectives that were populist and political (providing drugs at lower prices for the poor) and politico-economic (winning support from part of the local pharmaceutical industry through protectionism). In order to achieve these, the government had to risk antagonising the multinationals and foreign governments.
Second, in order to achieve international recognition, the government engaged respected and internationally known figures with close relations with influential international agencies such as the World Health Organisation (WHO), Oxfam, the Danish government's development programme (DANIDA) and others. The choice of a national essential-drugs policy gave the military government high visibility at the WHO, where the topic was much discussed, and a dynamic leader to implement the policy was being sought in developing countries. Indeed, Bangladesh soon emerged a regional leader on the drugs issue, while its neighbours lagged behind.