For those dealing with cancer, the pain and trauma of the illness and treatment, including the steep costs, are all too familiar.

Add to this the possibility that the cancer medicine being administered is an ineffective substance peddled in the original packaging.

This was alleged by the International Consortium of Investigative Journalists (along with 47 media partners), putting the spotlight on Merck & Co’s (MSD) cancer drug Keytruda. (Merck & Co Inc is known as MSD outside the United States and Canada). The investigative report involving this drug in India further raises questions on supply chain sanctity, safe disposal of medical waste (vials) and accountability.

Questions remain on who has end-to-end visibility on the supply chain of critical medicines and who will be held responsible when that chain is diverted or manipulated?

There has to be a standard operating procedure (SOP) for the movement of drugs (vials, in this case) from the manufacturers to the distributors, pharmacies, hospitals, doctors, patients and waste management agencies, says R Uday Bhaskar, Honorary Director General, All India Drugs Control Officers’ Confederation. There should be criminal action against those found guilty of diversion and repackaging, among other malpractices, he said.

Cancer patients are often directed by people in the healthcare ecosystem to collect their expensive medicines from the chemist at the hospital or recommended distributors — to secure some reprieve on the cost, say multiple healthcare voices.

Faced with mounting bills, the patients do as told. And since the drug is packed and sealed, they have no reason to suspect something may be amiss, they add.

Cancer medicines are expensive, and leaks in the supply chain bring in “rogue” elements that look to exploit desperate patients and their families, observes KM Gopakumar, Co-convenor, Working Group on Access to Medicines and Treatment. The price of a 4 ml vial is about ₹1.8 lakh, according to industry data.

Companies are required to have a track-and-trace system for medicines, says an industry insider. So a stock check on vials supplied and the number used and disposed of should show up discrepancies in the supply chain, he adds.

MSD’s pembrolizumab (brand name Keytruda) is approved in India for over 14 indications, across eight different types of tumours. It works with the body’s immune system to help detect and fight cancer cells and is different from chemotherapy or radiation therapy, according to company data. The company also runs a patient assistance programme for this drug.

An email query was sent by businessline to MSD (Merck & Co Inc) on the alleged misuse of Keytruda vials in India. A response is awaited.

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Published on April 20, 2026