The UN published its report, ‘Bracing for Superbugs: Strengthening environmental action in the One Health response to antimicrobial resistance’, to find solutions to the rise of antimicrobial resistance (AMR).
The organization explained that the report is necessary as AMR is considered one of the top global public health problems, which poses a threat to animal and plant health, food security and economic development.
Within the report, the UN states that there are effectively two reasons why pharmaceutical manufacturing poses a significant issue for the environment and for the rise of AMR.
“Implementing measures to prevent and control pharmaceuticals such as antimicrobials in effluent is crucial to minimize the selection and spread of AMR in the environment but also to minimize the ecotoxicity effects on aquatic organisms,” the report authors state.
Further, the authors add that less than a tenth of antimicrobials have been tested for in wastewater and environmental samples, with no environmental toxicity being available for most medicines. In terms of why the untreated discharge of pharmaceutical waste is a key issue, this is due to the products acting to select for resistant microorganisms and antimicrobial-resistance genes (ARGs).
The complexity in effectively tackling the issue is due to the economic environment in which the antimicrobials are created. Currently, it is not particularly lucrative to produce antimicrobials and therefore cost-efficiency is a significant priority.
Any action to minimize waste would need to not ensure more costly production, which could then result in lowered affordable access to important antimicrobials.
As outlined in the report, “Concerns about the supply chain resilience and drug prices have so far prevented the demand for specific discharge limits as part of their procurements of medicines... Contributing to this problem is the price pressure for inexpensive drugs, particularly antibiotics, which have made environmental concerns and AMR development and spread a lower priority to cost cuts.”
The pharma industry is taking action through internal measures, with the report noting that voluntary initiatives have been established for a common frame for managing discharge of antimicrobial compounds and applying it across manufacturing and supply chains of relevant members. Further, the industry has developed an antibiotic manufacturing standard.
However, the authors outlined that ‘more action is still needed’, which they conclude should arrive from environmental regulators being ‘empowered’ and funded to enforce regulations and legislation related to pharmaceutical releases – though they note that these activities should be implemented so as not to add additional cost to the consumers.