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AMR’s environmental impact– the silent part of the story

One of today’s main public health threats, antimicrobial resistance (AMR) already claims 700,000 lives a year. The numbers are continuously increasing; 300 million premature deaths are expected by 2050. Quite a lot of countries have put in place strategic plans to tackle AMR, which represents a threat to national security, and are now calling for a global approach. Yet this global approach is missing an important part of the puzzle – the silent part of the story- namely the manufacturing of antibiotic substances and its environmental impact. Used correctly, antibiotics are miracle drugs that have saved millions of lives. But their presence in the environment can be problematic, being one of the key reasons for the spread of AMR.

Antibiotic waste

As a patient suffering from an infectious disease, you are confident that the antibiotic prescribed by your doctor is the safest cure for your sickness. But did you know that most of the world’s antibiotic drugs are manufactured in China and India? Currently, China alone produces 80-90% of antibiotic active pharmaceutical ingredients (APIs). Due to the incoherent environmental regulation in place, in China and India, antibiotic waste is discharged into local rivers and groundwater, harming local inhabitants and spreading AMR around the world through travel and trade. Forty-four kilos of the antibiotic ciprofloxacin are discarded every day in an effluent of the Godavari River in India. In comparison, the consumption of the entire Swedish population is 9 kilos per day of the same antibiotic.

As stated in the UK Government-funded Review on AMR (2015), pollution from the production of antibiotics “needs to be viewed as a straightforward issue of industrial pollution, and it is the responsibility of all actors in the supply chain to ensure that industrial waste is treated properly as a matter of good manufacturing practice.”  So doctors and pharmacists have a key role in supervising the access and use of antibiotics by patients. However, due to the lack of transparency in the production chain, health professionals have little access to relevant environmental information to inform their own recommendations.

Manufacturers held accountable

At present, the regulatory framework for Good Manufacturing Practice (GMP) in the US and Europe pays insufficient attention to environmental safety. Even though supply chains from India and China are regularly inspected, no sanctions can be applied for polluting practices, because verification of this parameter depends exclusively on local governments. To prevent pharmaceutical pollution that leads to AMR, manufacturers should be held accountable for the antibiotics they place on the market and their environmental consequences through the implementation of manufacturing standards. These standards should, at first, offer a coherent European solution to address this global issue; secondly, integrate all the steps of the supply chain and finally, be equally applied to medical products for both human and veterinary use that are sold in Europe, even when produced in China and India. The emergence of superbugs must be tackled from all perspectives to avoid an imminent health disaster.  

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