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Water and DevelopmentSIWI and Swedish Water House
Headlines
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
