Alba Tiley, head of sustainability at Centrient Pharmaceuticals discusses why a sustainable approach to developing antibiotics is key to combatting antimicrobial resistance (AMR).
Sustainability
Antimicrobial resistance (AMR) is the biggest health crisis of this and the next generation.
By 2050 AMR is predicted to cause 10 million global deaths per year, more than obesity and all cancers combined and it is anticipated to cost the global economy more than 100 trillion USD per year in lost GDP. Without effective antimicrobials for the prevention and treatment of infections, the success of critical medical procedures such as organ transplantation, chemotherapy and major surgery will be severely compromised.
Antimicrobial resistance occurs naturally over time but the misuse and overuse are seen as the core problems accelerating the process of AMR. One area that is frequently overlooked is the environmental impact of antibiotics, including its production.
The production process of active pharmaceutical ingredients (APIs) and antibiotics naturally creates wastewater, which contains residual levels of antimicrobials. Sustainable production processes then see this wastewater treated, so that it is considered safe to release into the environment. However, this is not always the case and if not treated correctly or effectively, then antibiotics are released into the waterways, accelerating AMR through the environment.
This is a particular issue in Asia (China and India produce the vast majority of antibiotic APIs and finished dose antibiotics), where regulations of pollution and antibiotic effluents are not as advanced as in Europe. In the extreme, a study in Hyderabad, India, found concentrations of antibiotics in treated wastewater higher than those found in the blood of patients being treated with antibiotics. The concentration of the most abundant drug, ciprofloxacin (up to 31,000 μg/L) exceeded levels toxic to some bacteria by over 1000-fold.
Until recently, this contributor to AMR was severely overlooked. The World Health Organisation’s global action plan on AMR makes only brief reference to the issue of unsustainable antibiotic production. If we are, as a global community, going to tackle AMR and the devastating health impacts it will cause we must act collaboratively and decisively.
Simply put, this can be achieved in two key ways: MAKING antibiotics in a sustainable way by adopting emission targets and BUYING antibiotics and antibiotic ingredients only from responsible sources to ensure a clean supply chain.
When it comes to sustainable production, progress has been made by industry. The AMR Industry Alliance, one of the largest private sector alliances, formed of 100 life sciences companies and associations, have joined together to work towards a common goal of tackling AMR. The Alliance was crucial in the development of emissions targets outlined in the Antibiotic Manufacturing Framework which looks to reduce the amount of API content in wastewater. Similarly, efforts are being made to improve sustainability of supply chains, most notably through the Pharmaceutical Supply Chain Initiative (PSCI) which requires members to complete five supplier audits each year. This data is accessible in a shared database, exposing suppliers who are using unsustainable production methods, promoting sustainable practice.
As part of Centrient Pharmaceutical’s Sustainable Antibiotics Program, we've implemented methodologies to detect remaining antibiotic activity in our wastewater. This way, we are sure none of our operations add to the growing threat of AMR. We have developed a wastewater treatment and discharge test to detect the presence of antimicrobial activity in effluent and are updating our methods to reach the newest target limits.
Lastly, but perhaps most importantly, is the need for buyers of antibiotics to ensure they are procuring antibiotics that are sustainably produced. Because antibiotic production and usage is global, efforts to establish international regulations have been unsuccessful. Therefore, incentivising sustainability is a critical way forward and environmental criteria should be included in the procurement process.
Since 2010, for example, Swedish County Councils have been co-operating on a national level to use environmental criteria in the procurement of pharmaceuticals in an attempt to phase out products which are deemed to be environmentally hazardous. These environmental standards are setting the nation on its way to meeting national and international targets and it demonstrates the effective use of public purchasing power as a tool to reach non-economic targets. In Norway, a similar stance has been adopted with suppliers now rewarded for their environmental efforts. The preferred pharmaceutical procurement criteria in Norway includes the supplier’s environmental and supply chain policies, comprising 30% of the overall procurement score criteria.
More organisations are beginning to take similar responsibilities. Most notably, the United Nations aims to use environmental criteria on its decision making regarding the procurement of medicines, widely referred to as ‘green health procurement’, and believed to be a major contributor to the attainment of the UN Sustainable Development Goals. This good practice now needs to be adopted by nations and organisations worldwide.
Together, we can secure the future of antibiotics, but it requires a collaborative global effort, and sustainable production must be a key component in the fight against AMR.