Pharmaceuticals in the Environment: a global problem

Iris.panorel@siwi.org PA Hazards 2019-12-11

Water and DevelopmentSIWI and Swedish Water House

Headlines

A hard pill to swallow

Occurence

Country survey on the number of pharmaceutical substances detected in surface waters, groundwater, or tap/drinking water. (Aus der Beeek et al, 2016)

Evidence-based effects

Most significant sources

Source: EMA Reflection paper on antimicrobial resistance in the environment

Human use

• Growing population

• Increased life expectancy

• Emerging diseases

• Increasing instances ofchronic diseases

• New strains of microbes

• Misuse

Livestock production

• Intensive animal production with respectto market demand

• Need for higherproductivity

• Disease prevention / growth promotion

• Emergence of animal diseases

• Animal care

Misuse and overuse!

Manufacturing of pharmaceuticals

• Advancing economy

• Improving access

• Changing demographics

https://www.pharmaceutical-technology.com/features/pharma-manufacturing-hotspots/

Pathways to the environment

Household/STP effluent

Hospital effluent

Agricultural runoff

Aquaculture

Landfill leachate

Drugmanufacturingeffluent

Improper disposal

(modified from Natalie Renier, WHOI Creative Studio)

Challenges

• Global occurence of the problem is increasing rapidly

• Antimicrobial resistance as a critical health threat

• Differences in emission pathways – no single solution fits all

• Lack of relevant water policies in some countries

• Global action plan?

• Willingness to pay or invest

• Detection capability

• Measurement inconsistencies

Knowledge gaps

• Impacts on quality of drinking water, ecosystem, human health

• Multiple mechanisms of action of medicinal products depending on considered species

• Multi-component mixture of different pharmaceuticals in the environment

• Global, comprehensive and up-to-date database of levels of known harmful pharmaceuticals in the environment

This Photo by Unknown Author is licensed under CC BY-SA

Initiatives

• Answers to the unknown• Focus on the upstream measures• How to address the challenges?• Stewardship?

Upstream measures

• Choose where there are choices without compromising patients’ health

• Require prescription due to environmental impact

• Reduce total consumption

• Point sources: additional treatment or avoidance of liquid discharge

• Proper disposal of unused medicines

• Benign by design pharmaceuticals

• Optimize doses

• Improve diagnostics

Downstream measures

Wastewater treatment between opposing environmental objectives and economic constraints:

• Available at significant cost and additional energy consumption

• Demand (and risk) is defined upstream

• Need for clear prioritization (high concentrations, sensitive recipient)

Monitoring

• Systematize the monitoring!

• Customize the watchlist for certain pharmaceutical substances

• Need for definition of maximum concentrations in wastewater recipients

• Look at biological effects, not just toxicity

• Take cocktail effects into account

Learnings from GrePPP & REAP

Initiatives in the global procurement scenario

2016 – UNDP SPHS came up with an environmental questionnaire to assess the performance of its suppliers and manufacturers in the health sector

2018 – During Cleanmed Europe conference, HCWH and SPHS hosted a brainstorming session for Identification of components and success factors for development of sustainable procurement index for health

2018 – MVO Netherlands - Procurement of medicines becoming an emerging issue driven by insurers.

2019 – The pharmaceutical division of the Norwegian Hospital Procurement Trust pilots a new procurement criteria for antibiotics allocating 30% weight for environmental impact during production

2019 – German commercial service provider for healthcare started sending a basic questionnaire to some suppliers indicating an interest in access to information and ultimately applying that as a criteria

2019 – Swedish Procurement Agency is finalizing the procurement criteria for antibiotics / pharmaceuticals

2019-2024 UK NAP - Work with other countries to ensure responsible antimicrobial procurement from manufacturers with transparent world class environmental stewardship in their supply chains. Set-up in UK is transitioning to a centralized procurement.

2019 – EU Procurers dialogue hosted by SIWI on sharing challenges and experiences and collaborating to harmonize the procurement criteria and promote to public procurers to implement

2019 – AEGIS Europe industry alliance (Medicines for Europe is a member of) calls for action to tackle abnormally low tenders, strengthen contract award criteria, address non-compliance with EU rules & standards

(2020) – UNDP SPHS to deliver on a universally adaptable criteria : Sustainable Procurement Index for Health

Increasing customer awareness and potential demand for access to a “green shelf” - Swedish Pharmacy chain Apotek Hjartat developed proxy criteria to evaluate their supply chain

SIWI activities on PiE

• GrePPP (Green Public Procurement of Pharmaceuticals) -concluded

• REAP (reduced emissions of antibiotics during production) project together with UNDP

• Development of a Responsible Antibiotics Manufacturing Platform

• Sustainable aquaculture supply chain as means to contain Antimicrobial Resistance

• Hospital-acquired resistances- the role of WASH as prevention tool

Thanks for your attention!Iris Panorel, iris.panorel@siwi.org

www.siwi.org | www.swedishwaterhouse.se