In January 2023, the European Medicines Agency (EMA) sounded the alarm on a shortage of amoxicillin across several EU member states. This situation exposed the fragility of the global antibiotic supply chain, susceptible to interruptions that cause the lack of essential drugs. Post-COVID-19 efforts to secure EU medicine supplies, particularly antibiotics, have intensified. While these efforts have primarily focused on promoting European solidarity and enhancing domestic production, the environmental and human rights impact of early-stage pharmaceutical production demands urgent attention.

EU’s reliance on imported antibiotics

The EU's Pharmaceutical Strategy emphasises the need for resilience in the pharmaceutical supply chain, aiming to bring medicines production back to Europe. However, challenges such as limited profitability, buyer preferences, and the complexity of healthcare systems hinder this plan.

The EU's increasing reliance on cheap Active Pharmaceutical Ingredients (APIs) abroad has exacerbated import dependency, particularly from China and India where antibiotics drug manufacturing mainly occurs. For instance, China contributes to 80-90% of antibiotic API production, while Indian firms lead in manufacturing finished-dose antibiotics. In 2021, the European Commission conducted a thorough assessment revealing that 80% of API imports into Europe originate from five countries: China (which provides 45% of the APIs), India, Indonesia, the US, and the UK.

Sustainability initiatives in pharmaceuticals are underway, but urgent action is needed to address environmental pollution resulting from production, especially in countries with less strict environmental standards. In particular, antibiotics essential for treating life-threatening infections in both humans and animals are produced on a large scale globally, amounting to approximately 100,000 tons each year. 

Can sustainability reduce the acceleration of antibiotic resistance?

The acceleration of antibiotic resistance is closely linked to the discharge of pharmaceuticals and specific chemicals into the environment, especially at manufacturing sites. Pollution from antibiotics production has already contributed to the spread of antibiotic resistance, with downstream pollution observed in the EU and elsewhere. For instance, a study found dangerously high levels of antibiotic and antifungal residues in water near a major drug production hub in Hyderabad, India, along with widespread drug-resistant bacteria and fungi. Another report shows that the nearby community of these production sites has suffered from the death of livestock, reduced agricultural yields, skin diseases, and more. 

Positive steps are being taken towards a sustainable pharmaceutical supply chain, as shown by the AMR Industry Alliance's antibiotic standards and the recent EU directive on corporate due diligence. However, a crucial piece remains missing: a standardised approach not only across stakeholders but also embedded within national procurement policies. The existing frameworks and guidelines for assessing environmental and social risks in the pharmaceutical industry, while valuable, do not have a unified set of sustainability criteria. This makes it difficult to compare risk assessments and due diligence reports across companies, potentially affecting efforts to promote transparency and accountability.

Greening supply chains for a healthier future

By promoting green chemistry practices, improving pharmaceutical manufacturing sites, and calling for more collaboration among all the stakeholders, the EU can safeguard a healthier future for both people and the planet. Stakeholders, from policymakers to manufacturers and pharmacists, must come together to develop a shared vision for addressing sustainability challenges. This unified approach will establish clear and measurable benchmarks, driving a more significant impact on the industry's environmental and social footprint. 

Pharmacists, for instance, can contribute to greening the healthcare system by joining initiatives like our Pharmacists for Greener Healthcare network.

A blog post by Luna Dayekh
Pharma Supply Chain Assistant – HCWH Europe