AKI Trial: MCA and Pharmacy Conflict of Interest a Threat to Public Health

AKI Bereaved Parents © Askanwi

By Fatoumata Jaiteh,

The Acute Kidney Injury (AKI) trial continued on 29th February 2026 at the High Court in Banjul before Justice Ebrima Jaiteh, with renewed cross-examination of the Director of Health Services, Dr Bittaye, shedding light on regulatory challenges within the country’s pharmaceutical system.

The lawsuit was filed by the Gambia Bar Association and the Female Lawyers Association of the Gambia on behalf of bereaved parents of 28 children who died during the 2022 AKI outbreak linked to contaminated cough syrups. The plaintiffs are seeking accountability and damages from authorities they say failed to prevent the tragedy.

The victims are represented by Counsel L. Farage, while Counsel J. O. Okete appeared for the state-linked defendants.

The defendants in the case are Maiden Pharmaceuticals Limited (1st Defendant), Atlantic Pharmaceuticals Company Limited (2nd Defendant), Medicines Control Agency (3rd Defendant), Ministry of Health (4th Defendant), and the Attorney General’s Chambers and Ministry of Justice (5th Defendant).

The case stems from the deaths of over 70 children following the consumption of contaminated paediatric syrups manufactured in India by Maiden Pharmaceuticals and imported into the country by Atlantic Pharmaceuticals.

During the hearing, the court continued the cross-examination of Dr Mustapha Bittaye, former Director of Health Services and currently Chief Medical Director of the Edward Francis Small Teaching Hospital.

The cross-examination had previously begun but was partially disrupted due to technical recording lapses during the earlier sitting. As a result, significant portions of the questioning were repeated during the February 29th session.

Under questioning by Counsel Farage, Dr Bittaye addressed concerns about conflicts of interest in drug registration and regulation within the country’s pharmaceutical oversight system.

Counsel Farage put it to the witness that concerns about conflicts of interest had already been raised in 2019, particularly regarding the drug registration process.

She referenced provisions under the Consumer Protection Act of The Gambia, which, among other consumer safeguards, encourages regulatory authorities to ensure transparency, accountability, and independence in systems responsible for approving and monitoring goods such as medicines. The Act emphasises that regulatory institutions must avoid situations where personal business interests could compromise public safety.

Responding to the line of questioning, Dr Bittaye acknowledged that conflict of interest issues had indeed existed.

He told the court that some staff members of the Medicines Control Agency owned licensed pharmacies, a situation that could potentially undermine regulatory oversight.

“That could pose a threat to public health,” Dr Bittaye admitted.

He told the court that reforms have since been introduced to address the problem, including stronger regulatory provisions and ethical safeguards.

“We were ready to go to jail for that, even if it meant saving just one child,” he said, emphasising the seriousness with which authorities now view the issue.

Dr Bittaye also testified about the early medical response when the unusual kidney injuries among children began to emerge.

He said that the health team at the Edward Francis Small Teaching Hospital initially hesitated to classify the situation as an outbreak.

According to him, clinicians at the hospital described the situation as “a pattern, not an outbreak".

Counsel Farage challenged this position, noting that The Gambia is a small country where unusual clusters of severe illness among children should quickly raise alarm.

In further testimony, Dr Bittaye highlighted structural challenges in the country’s health system.

He told the court that physicians in The Gambia make up only about 0.2 per cent of the population, underscoring the limited human resources available for healthcare delivery.

To address these gaps, he said several measures have been implemented since the AKI crisis. Among them, he stated, is the establishment of a pharmacy school in 2021 to train more pharmaceutical professionals, adding that “the law had to be changed for all listings to happen”.

However, Counsel Farage pushed back on the explanation, suggesting that the existing legal framework already required medicines to be properly registered, not merely listed.

“In all honesty, the law already provided for registration,” she told the witness during the exchange.

After the day’s proceedings, Justice Jaiteh adjourned the matter to 4th and 10th March 2026 for the continuation of the trial.

The AKI case remains one of the most significant public health litigations in Gambian history, as families of the victims continue to seek justice and accountability for the deaths of their children.