The central Asian nation last week put 21 people on trial – 20 of whom are Uzbeks and one Indian – over the deaths, making public for the first time a much higher death toll than previously reported.

Three of the defendants (an Indian and two Uzbekistan nationals) are executives of Quramax Medical, a company that sold medicines produced by India’s Marion Biotech, in Uzbekistan.

According to state prosecutor Saidkarim Akilov, Quramax CEO Singh Raghvendra Pratar allegedly paid officials $33,000 at the state centre for expertise and standardisation of medicinal products so that they would skip a mandatory inspection of its products.

It was unclear from the prosecutor’s statement whether the inspection was supposed to involve tests in Uzbekistan, or a request for tests to be carried out by the producer in India.

Pratar, who spoke in court, denied the charges but admitted to handing over the sum to officials through an intermediary as a “token of appreciation”. He said he had no idea how and by whom that money was used later.

Seven of the 21 defendants pleaded guilty to at least some of the charges against them, which included tax evasion, sale of substandard or counterfeit medicines, abuse of office, negligence, forgery, and bribery.

Officials have not said why 45 deaths had remained unreported since last year.

State prosecutors also said on Wednesday that Quramax had imported Marion Biotech medicines at an inflated price via two Singapore-based intermediary companies, which prompted tax evasion charges.

(Reporting by Mukhammadsharif Mamatkulov; Writing by Olzhas Auyezov; Editing by Sharon Singleton.)