Health Care Without Harm aims to transform global healthcare to minimize its environmental impact and promote sustainability. Lorna Rothery spoke to the team about the effects of pharmaceutical pollution and the necessity for the industry to adopt greener practices
How can pharmaceutical discharges during drug production, use, and disposal impact ecosystems and human health? How has climate change affected this?
Medicines are essential tools for treating and alleviating symptoms or preventing disease. However, every medicinal product used to treat a patient has the potential to harm environmental and human health, which should be carefully considered before its 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 pharmaceuticals need a large amount of energy for production, which results in high carbon emissions. Other products have a high toxicity that, when entering the environment, could lead to harmful effects on human health, including accelerating antimicrobial resistance (AMR). Some produce considerable amounts of waste requiring treatment and processing. For instance, In some EU countries, waste from unused medicines represents 10% of wastewater pollution.
Pharmaceutical residues have been detected in surface water, sewage effluents, groundwater, drinking water, manure, soil, and other environmental matrices globally. While 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 severely affect animal and plant life and affect some essential biogeochemical processes such as nitrification or denitrification.
In the next decades, two major public health challenges will increase pharmaceutical pollution and its impacts on the environment and human health. The first one is the demographic trend in Europe, where an increasing share of the ageing population will create a higher demand for medicines and an increase in days of hospital stay. Only in Germany, pharmaceutical use is projected to increase by around 43-67% by 2045. The other one is climate change. As the effects of climate change intensify, non-communicable diseases (e.g., cardiovascular diseases and mental illnesses), as well as respiratory, water-borne, vector-borne, and food-borne toxicants and infections, are increasing. Consequently, there will be an increased need for medications to treat these health conditions.
Why do pharmaceutical companies need to target the entire value chain when introducing more sustainable practices?
Pharmaceutical pollution can occur at various stages of the supply chain, including manufacturing, 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 discharges, raising awareness campaigns to reduce pharmaceutical overuse and misuse among patients, or stronger regulations to analyse the environmental impact of medicines, for example, are equally important and must be addressed together.
Incorporating sustainability criteria only in some stages reduces the impact of those measures. It can divert attention from the big picture, which in some cases may end up in situations very similar to greenwashing.
The new and strengthened role of Environmental Risk Assessments within the new EU pharmaceutical legislation 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 results in reduced visibility of certain activities, especially in the downstream segments of the chain where production occurs. 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, coupled with the complex nature of the chain, makes it more difficult to conduct effective risk assessments. A more transparent supply chain is crucial 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 in making sustainable choices and reward good practices when purchasing medicinal products, considering that in the EU, an average of 8% of national GDP is spent on healthcare.
Also, although existing private governance tools, such as environmental due diligence and audits, are essential to the transition towards greener pharmaceuticals, they are not enough. To ensure targets are achieved, these tools should be accompanied by national legislation and sustainable procurement practices. A collaborative effort is needed between stakeholders involved in various parts of the chain.
How is HCWH working with the policymakers and health systems to drive progress toward building a greener pharmaceutical industry?
Our role at HCWH is to support the transition towards greening pharmaceutical production, from manufacturing to disposal. For that purpose, we bring together relevant actors (including industry, policymakers, researchers…, etc.) to discuss and agree on actionable steps. As pharmaceutical pollution comes from different streams, we work on different fronts to ensure an effective impact.
For example, regarding antibiotic pollution, we created the MEP Interest Group on AMR together with the European Public Health Alliance (EPHA). In this group, we work with MEPs from across the political spectrum to address antibiotic resistance and, more broadly, AMR and develop actions that could be implemented at the EU level to reduce the acceleration of this global threat.
To address the transparency and sustainability of the supply chain, we organised a webinar with over 100 participants from industry, academia, and policy, and we came up with a series of recommendations for a green pharmaceutical supply chain. Based on this assessment by the European Commission, a large quantity of APIs purchased in Europe comes from producing countries located in Asia. So, pressure can be applied from European purchasers through private and public governance tools 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 produced guidelines for healthcare institutions to leverage their purchasing power and reduce their pharmaceutical footprint. We launched the ‘Procuring for Greener Pharma’ report and produced a series of criteria for purchasing hospital food with lower antibiotic use.
