Health Care Without Harm aims to transform global healthcare to reduce its environmental impact and promote sustainability. Lorna Rothery spoke to the team about the effects of pharmaceutical pollution and the need for the industry to adopt greener practices
How can pharmaceutical discharges during the manufacture, use and disposal of medicines affect ecosystems and human health? How has climate change affected it?
Medicines are essential tools to treat and relieve symptoms or to prevent diseases. However, every medicinal product used to treat a patient has the potential to harm the environment and human health, which should be carefully considered before purchase and use. Europe accounts for 24% of this total medicine use.
The nature of a pharmaceutical product’s impact on the environment depends on a number of different factors. Some pharmaceutical products require a large amount of energy for production, resulting in high carbon emissions. Other products have a high toxicity that, when entering the environment, can lead to harmful effects on human health, including accelerated antimicrobial resistance (AMR). Some produce significant amounts of waste that require treatment and processing. For example, in some EU countries, waste from unused medicines represents 10% of wastewater pollution.
Pharmaceutical residues have been detected worldwide in surface water, sewage waste, groundwater, drinking water, manure, soil and other environmental matrices. Although the environmental impacts of most active pharmaceutical ingredients (APIs) are not fully understood, several APIs are known to persist and accumulate in the environment, which can seriously affect animal and plant life and some essential biogeochemical processes such as nitrification or can affect denitrification.
In the coming decades, two major public health challenges will increase pharmaceutical pollution and its impact on the environment and human health. The first one is the demographic trend in Europe, where an increasing part of the aging population will create a greater demand for medicine and an increase in days of hospital stay. Only in Germany, pharmaceutical use is expected to increase by approximately 43-67% by 2045. The other is climate change. As the effects of climate change increase, non-communicable diseases (eg, cardiovascular disease and mental illness), as well as respiratory, waterborne, vectorborne and foodborne toxicants and infections, are increasing. As a result, there will be a greater need for medications to treat these health conditions.
Why should pharmaceutical companies target the entire value chain when introducing more sustainable practices?
Pharmaceutical pollution can occur at various stages of the supply chain, including manufacture, use and disposal. These steps pose significant environmental and public health risks if measures are not taken to reduce pharmaceutical pollution. Measures at the manufacturing sites to avoid pharmaceutical excretions, awareness campaigns to reduce pharmaceutical overuse and abuse among patients, or stronger regulations to analyze, for example, the environmental impact of medicines, are equally important and must be addressed together.
Including sustainability criteria only in some stages reduces the impact of those measures. This can distract from the big picture, which in some cases can end up in situations very similar to greenwashing.
The new and strengthened role of environmental risk assessments within the new pharmaceutical legislation of the EU will be an essential tool to address the impact of pharmaceutical pollution. By better understanding the impact of our medicines on the environment, we will be able to better plan our actions.
What are some barriers to greener pharmaceuticals, and how can they be addressed?
There are several barriers to achieving greener pharmaceuticals. One worth mentioning here is the complexity and fragmentation of pharmaceutical supply chains. This complexity often leads to reduced visibility of certain activities, especially in the downstream segments of the chain where production takes place. Transparency is a fundamental requirement for sustainable procurement, as it enables the assessment of risks and the development of relevant provisions. Unfortunately, the current lack of transparency in the pharmaceutical industry, together with the complex nature of the chain, makes it more difficult to carry out effective risk assessments. A more transparent supply chain is essential not only for assessing risks, but also for holding polluters accountable and promoting greater environmental responsibility.
Public procurement can be a useful tool to drive the transformation of pharmaceutical supply chains. It can support healthcare institutions to make sustainable choices and reward good practices when purchasing medicinal products, as in the EU, on average, 8% of national GDP is spent on healthcare.
Also, although existing private governance tools, such as due diligence and audits, are essential for the transition to greener pharmaceuticals, they are not sufficient. To ensure that targets are met, these instruments must be accompanied by national legislation and sustainable procurement practices. A collaborative effort is needed between stakeholders involved in various parts of the chain.
How does HCWH work with policymakers and health systems to advance progress toward building a greener pharmaceutical industry?
Our role at HCWH is to support the transition to greening pharmaceutical production, from manufacturing to disposal. To that end, we bring together relevant actors (including industry, policy makers, researchers…, etc.) to discuss and agree on actionable steps. Since pharmaceutical pollution comes from different streams, we work on different fronts to ensure an effective impact.
For example, regarding antibiotic contamination, we created the MEP Stakeholder Group on AMR with the European Public Health Alliance (EPHA). In this group, we work together with MEPs from across the political spectrum to address antibiotic resistance and, more broadly, AMR and develop actions that can be implemented at EU level to reduce the acceleration of this global threat.
To address supply chain transparency and sustainability, we organized a webinar with over 100 participants from industry, academia and policy, and came up with a series of recommendations for a green pharmaceutical supply chain. Based on this assessment by the European Commissiona large amount of APIs purchased in Europe come from producing countries in Asia. Thus, pressure from European buyers can be applied through private and public management equipment to address sustainability in the upstream segments of the chain, which is essential to mitigate risks and ensure the industry’s long-term environmental and social responsibility.
In the past few years, we have also created guidelines for healthcare institutions to leverage their purchasing power and reduce their pharmaceutical footprint. We launched the ‘Procuring for Greener Pharma’ report and compiled a set of criteria for purchasing hospital food with lower antibiotic use.