The antibiotic challenge

Written by Robin N Koenig

We observe International Earth Day on April 22 every year to demonstrate support and raise awareness about environmental concerns such as pollution, climate change, and resource depletion, among others, and their implications on our day-to-day lives. This also lends an opportunity to remind each actor in this ecosystem that we are all somewhat responsible for this gross mistreatment of the planet, and its resultant impact on our growth and well-being.

Undoubtedly, humans and businesses have contributed immensely to the overall development through inventions that have transformed our lives. However, those very discoveries and businesses have disrupted the environment due to its overuse or negligence. At an individual level, people need to acknowledge their responsibility and shift their behaviour towards environmentally conscious living. On the business side, while it is encouraging to see that organisations are now being called-out for unsustainable practices more than ever before, many of them have not truly understood their responsibility and attitudes towards sustainability.

Today, there is a pressing need for businesses to look at sustainability as something that is at the very core of their operations and not just as a nice-to-have checklist for improving their brand image. It has become crucial for companies to consider the wider working environment of their business when it comes to sustainability.

Talking of inventions and businesses which tread a precarious path on sustainability, antibiotics come to mind. Antibiotics are important life-saving medicines. Many of the treatments and medical procedures that we take for granted today would not have been possible without them. But, unfortunately, the unsustainable manufacturing processes deployed by the pharmaceutical companies to produce these antibiotics have contaminated the water and food sources and created one of the biggest challenges for this century: The global threat of Anti-Microbial Resistance (AMR).

TB, HIV, and malaria are among the diseases associated with a growing incidence of AMR. If not given due attention, our ability to treat infectious diseases will decrease and the number of deaths linked to AMR will increase to 10 million per year by 2050. Therefore, both businesses and individuals must work in tandem to tackle this threat responsibly. The drug manufacturers should switch to cleaner production technologies, have dedicated wastewater treatment plants, monitor antimicrobial activity in their effluents, engage in sustainable procurement practices and run sensitisation campaigns for stakeholders across the value chain. On the other hand, consumers should play an active role in being more informed about the medicines they consume, refrain from self-medication, and call out the physicians or pharmacists who recklessly prescribe antibiotics.

The Antibiotic-Resistant Genes (ARGs) reside within three sectors — humans, animals, and the environment. These sectors are closely interlinked, providing a free passage to the ARGs to travel between them. While the focus has largely remained on addressing the human and animal aspects, the focus on environmental contamination by antibiotics has been limited.

Among various factors, the main cause of antibiotics in the environment is the effluent discharge of Active Pharmaceutical Ingredient (API) from manufacturing units. This wastewater contains high concentrations of antibiotic residues that can lead to hotspots of resistant bacteria further contributing to AMR. A study conducted by IIT Madras in and around Chennai indicated a high concentration of antimicrobial agents in the rivers and lakes in the vicinity of pharmaceutical plants and outlets of wastewater treatment plants. Therefore, curtailing the release of antibiotic residues in the environment is the way to gradually mitigate AMR.

Currently, there are no global standards for antibiotic discharge limits in the environment from pharmaceutical industries. India is the only country to have issued the Draft Environment Protection Amendment Rules in January 2020 to limit the amount of antibiotic residue permitted in wastewater released by drug factories. If notified, it will shift the paradigm from a focus on the quality of medicine to the impact, manufacturing has on workers and the environment. As of now, companies across the globe are adopting good manufacturing practices and practicing self-regulation as part of AMR Industry Alliance, one of the largest coalitions set up to provide sustainable solutions to curb antimicrobial resistance.

While concerted efforts are undertaken by companies as a first step towards tackling the AMR menace, the fact cannot be overlooked that none of the world’s 17 biggest antibiotic producers publishes particulars of the levels of antibiotic residue discharged in wastewater, as per the 2020 AMR Benchmark report by the Access to Medicines Foundation, which monitors whether pharmaceutical companies are taking action to tackle superbugs.

According to the World Health Organisation, AMR is one of the top ten threats to global health. As a start, the drug manufacturing companies must recognise the impact of antibiotic production on the environment and deploy responsible procurement, operational, and waste management processes to control antibiotic discharge at the source along with innovating and adopting strategies to combat AMR sustainably. The government should bring together multiple stakeholders across the medical community, animal-rearing, agricultural world, departments of health, environment, water, agriculture, and science and technology, civil society organisations, academic experts among others, to brainstorm solutions along with strict monitoring and enforcement.

The problem is indeed complex and poses a major challenge for the ecosystem, however, a collaborative effort from the industry as well as policymakers towards continuous work on containing AMR will result in averting an antibiotic crisis and ensuring sustainability for both the environment and the industry. As we observe International Earth day, let’s all take a pledge to undertake conscious efforts and act responsibly for a safer, healthier, AMR-free future.

The writer is Regional Business Director South Asia & APAC at Centrient Pharmaceuticals