Global OTC Medicine Restrictions

Delivered July 20th, 2019. Contributors: Ezeonye J., Emmad, Sese, Emmanuel A. and

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Global OTC Medicine Restrictions: India

The requested information on the number of US travelers who visited India, the required and recommended vaccinations / immunizations for US visitors, and the banned OTC drugs in India has been provided in rows 2-75, column C of the attached spreadsheet.

KEY FINDINGSAccording to the Indian Ministry of Tourism, 1.38 million American tourist arrivals visited India in 2017.
Vaccination against yellow fever is required by the Indian Health Agency, especially those coming from yellow-fever areas. Although the US is free from yellow fever, Indian health regulations require an evidence of vaccination against yellow fever.
According to CDC, some recommended vaccinations for Americans who want to travel to India include measles, cholera, malaria, and others.
RESEARCH STRATEGYWhile we could pull data from the CDC and the US National Travel & Tourism Office (NTTO) to provide the list of required vaccinations/immunizations US travelers must have before visiting India, as well as data from the Indian Central Drugs Standard Control Organization of the Ministry of Health & Family Welfare to determine the banned the OTC drugs in India, information on the total number of US travelers to India was a bit challenging.

To address this, we began by searching through US government sources, especially NTTO on the total number of US travelers to India. While NTTO publishes the information on outbound travelers, it only does that on a regional basis. Hence, it only provides the total number of US travelers to Asia. Switching to the other side, we searched Indian government websites, especially the ministry, as they are the only government body we recognized that tracks inbound and outbound visitors in India. While the Indian Ministry of Tourism published the number of inbound US travelers, it only does so for foreign tourist arrivals, which may not account for business travelers.

Next, we expanded our approach to specifically cover industry reports and media articles, both from the US and India. From these sources in the US, we were not able to find any relevant information apart from except from a source that provided the total number of US travelers to India in 2012, which we deemed too old. From these Indian sources, we found lots of information (such as this report) on the number of American travelers who visited India, however, we found that a majority of these sources cited the same data published by the Indian Ministry of Tourism — the number of foreign tourist arrivals including the US. We also tried to find the number of American business travelers into the US so that we could add it to the number of American tourist but found no information, as it seemed that the Indian government isn't tracking such information.

Since, there were no direct sources, we attempted to triangulate this data from the number of US travelers to Asia, as published by the NTTO. However, this method was feasible because we could not get any supporting data that could be used to obtain the share of American travelers who traveled to India from the number of those who traveled to Asia. We also tried to triangulate the requested data from the total number of US travelers to India for the year 2012. But again, it was not possible because we could not find any growth figure that could be used to determine a more recent figure by factoring the growth.

Since there was no way of triangulating this figure, we provided the total number of foreign tourist arrivals who visited India in the 2017, as published by the Indian Ministry of Tourism. We did this because this was the only data on American travelers tracked by the Indian government and the fact that multiple third-party sources report the data (foreign tourist arrivals) as the number of visitors.

Lastly, for the determination of banned OTC drugs in India, we found the most recent (2019) list of all the banned drugs, as published by the Indian Central Drugs Standard Control Organization of the Ministry of Health & Family Welfare. We used the list to corroborate the listed OTC drugs in the spreadsheet. While none of the drugs are banned in India, we found some uncertainties around Acetaminophen, Antacid, Ibuprofen, and Electrolyte Mix. This was because while they were not listed individually as banned drugs, they were shown to be banned when in combination other drugs, some in fixed doses, while the dose description was provided for some. For Antibiotic Ointment, while it was directly listed, Penicillin Ointment is banned in India, of which Penicillin is an antibiotic.

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Global OTC Medicine Restrictions: Brazil

In 2017, 475,200 US visitors traveled to Brazil. Of the medications listed only emergency contraception is banned as an over the counter drug. The requested information has been entered into the attached spreadsheet.
VACCINATIONSThe United States Government's official travel organization does not have any vaccinations that are required to visit Brazil, but recommends following the suggestions of the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization.
The recommendations are that all routine vaccines are up to date and that additional vaccines Hepatitis A, Typhoid, Hepatitis B, Malaria, Rabies, and Yellow Fever are considered.
OVER THE COUNTER MEDICATIONSWe were unable to determine if the following OTC medications are banned in Brazil; Delsym Children's Cough, Day & Night, Genexa, Sambucol, Airborne, Emergen-C, Medi-Lyte, Diphenhydramine, Urinary Tract Defense, Charcoal Capsules, and Drip drop.
 Emergency contraception is not banned in Brazil, however it is not an over the counter medication in Brazil. Emergency contraception can only be obtained with a prescription.
RESEARCH STRATEGYWe began our research by looking for information on over the counter medications banned by the government in Brazil. We were unable to identify a list of medications so we reviewed each medication individually. We began our research by searching for the OTC drugs on Droga Raia's website. Droga Raia is a pharmacy in Brazil. If we were unable to find the medication on the pharmacy's website we did a press search for news articles, if a medication was banned we assumed there would be a news article about it. We then utilized Pill In Trip, ScienceDirect, Drugs.com and research papers to find information on the OTC drugs. If we were unable to locate the drug using these methods we have listed them as maybe on the spreadsheet.

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Global OTC Medicine Restrictions: China

11.2 million travelers from the continent of America visited China in 2018. The required vaccines for United States' travelers to china are measles-mumps-rubella (MMR) vaccine, diphtheria-tetanus-pertussis vaccine, varicella (chickenpox) vaccine, polio vaccine, and your yearly flu shot. The recommended vaccines are hepatitis A vaccine, hepatitis B vaccine, typhoid vaccine, polio vaccine, rabies vaccine, and Japanese encephalitis vaccine.
KEY FINDINGSIn the year of 2018, China inbound tourist arrivals reached 141.2 million and 7.9% of that was from the continent of America. 7.9%x141.2 million =11.2million. Therefore, 11.2 million travelers from the continent of America visited China in the year 2018.
The required vaccines for United States' travelers to China are measles-mumps-rubella (MMR) vaccine, diphtheria-tetanus-pertussis vaccine, varicella (chickenpox) vaccine, polio vaccine, and your yearly flu shot.
The recommended vaccines for United States' travelers to China include hepatitis A vaccine, hepatitis B vaccine, typhoid vaccine, polio vaccine, rabies vaccine, and Japanese encephalitis vaccine.
Some OTC medicines that are permitted in China are antacid
s, diarrhea medicine
 like loperamide [Imodium] or bismuth subsalicylate [Pepto-Bismol], antihistamine, motion sickness medicine, cough drops, cough suppression/expectorant, decongestant, and medicine for pain and fever
 such as acetaminophen, aspirin or ibuprofen, mild laxative, mild sedative or other sleep aid, and saline nose spray.
China also allows incoming foreign travelers to carry items like are earplugs, latex condoms, sunscreen, hand sanitizer or wipes, water purification tablets, insect repellent, permethrin. 
China doesn't allow incoming foreign travelers to possess drugs like opium, morphine, heroin, marijuana, and other addictive drugs and psychotropic substances.
The number of United States' travelers to China in 2015 was 2,085,800. 
RESEARCH STRATEGYOur search on the government of China tourism site and the United States department of state bureau of consular affairs wasn't successful in revealing the number of United States' travelers to China in the year 2017 or 2018. All that was available was the total number of foreign travelers who came to China and a percentage of this total (7.9%) was also provided as those who came from the continent of America. We multiplied the given percentage with the total number of tourists (7.9% X 141.2 million) to get the number of persons who traveled from the continent of America to China in 2018 and we got the figure to be 11.2 million. The last exact figure given by the government of China tourism site was from 2015 and the number of United States' travelers to China in this year was 2,085,800. See more details in the attached spreadsheet.

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Global OTC Medicine Restrictions: Thailand

The requested information on the number of US travelers who visited Thailand, the required and recommended vaccinations/immunizations for US visitors, and the banned OTC drugs in Thailand has been provided in rows 2-75, column F of the attached spreadsheet.

KEY FINDINGSIn 2017, 1,056,423 American tourist arrivals visited Thailand.
According to the US Department of State, yellow fever vaccination check may be required in Thailand, especially if the travelers are from certain countries with yellow fever. However, the US is yellow fever-free, according to the US CDC.
For Americans who want to travel to Thailand, the US CDC recommends the vaccination against the following diseases: measles-mumps-rubella (MMM), diphtheria-tetanus-pertussis, varicella, polio, flu, hepatitis A, typhoid, hepatitis B, Japanese encephalitis, and rabies.
Thailand appears not to have any law on OTC drugs, instead it has on narcotics and psychotropics.

RESEARCH STRATEGYTo address this request, we pulled data from the Thai's Ministry of Tourism and Sports, the US CDC, and the US Department of State — Bureau of Consular Affairs. The Thai database provided the number of foreign tourist arrivals from the US in 2017 while the US sources provided information on the required vaccinations and the recommended vaccinations. Note that we have used the number of foreign tourist arrivals because that is the only relevant statistics provided by Thailand through its Ministry of Tourism and Sports. On the side of the coin, the US, through its National Travel & Tourism Office (NTTO), publishes this information in terms of the number of travelers. However, it only publishes this on a regional basis. Therefore, what we could find was the total number of US travelers who traveled to Asia.

In determining if any of the OTC drugs in the provided list was banned in Thailand, we searched through its FDA website of the Ministry of Public Health and found that Thailand appears to have no laws or guidelines on OTC drugs. We could only find its laws on narcotics and psychotropic drugs. According to these acts/laws, drugs or substances classified as category 1 are prohibited except with the permission of the Ministry of Public Health. This is the same for category 2 drugs albeit there are other clauses which offer some level of flexibility around its use. Thus, we obtained the list of restricted narcotics and psychotropic drugs and used them to review the provided OTC drugs to ensure that there are no listed drugs. We also checked if Thailand publishes the list of banned drugs but it appeared that it doesn't. Lastly, we found the product permission database provided by the FDA of Thailand, where it documents all licensed products, canceled licenses or expired licenses of products, including food, drugs, cosmetics, etc. We used this database to ensure that none of the listed OTC drugs are canceled or have expired licenses.

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Global OTC Medicine Restrictions: Singapore

We have entered the requested details regarding US travelers to Singapore on rows 2-76, column G (Singapore) of the attached spreadsheet.

The total number of US travelers to Singapore in 2018 is 643,243.
US travelers visiting Singapore are required to make sure that they are up-to-date with the following routine vaccines: measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis, varicella (chickenpox), polio, and annual flu vaccine. Hence, they are required vaccines.
The recommended vaccines for US travelers visiting Singapore include hepatitis A, typhoid, hepatitis B, rabies, and yellow fever.
None of the listed OTC drugs is banned in Singapore.

 