Water is essential in the fight against antimicrobial resistance

Responsible manufacturing of pharmaceuticals along with the provision of water and sanitation services are key to reducing the spread and impact of antimicrobial resistance.

Pharmaceuticals and water

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Andreas Karlsson

Director,

Communications

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Antimicrobial resistance (AMR) is one of the world’s greatest health threats, according to a recent study published in the Lancet. The analysis, which covered more than 200 countries and territories found an estimated 1.27 million deaths attributed to bacterial AMR in 2019.

Nicolai Schaaf who leads SIWI’s work on tackling AMR says “To fight antimicrobial resistance, antibiotics manufacturing must prioritize the prevention of pharmaceutical waste polluting water.”

SIWI’s Responsible Antibiotic Manufacturing Platform (RAMP) was set up to put an end to the unsustainable practices of antibiotics production which is leading to the degradation of both human and environmental health.

In a recent blog Rachael Kupka of the Global Alliance on Health and Pollution, called for a Science Policy Panel on Chemicals, Waste and Pollution which would bring visibility and focused attention to the critical issue of pollution such as water pollution. Tackling one of the key drivers of AMR – emissions from the production of antibiotics – through collaboration will be instrumental to tackling AMR on a global scale.

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“Water plays an essential role in the fight against AMR”

Nicolai Schaaf, RAMP Platform Manager, SIWI

The World Health Organization warns that antimicrobial resistance (AMR) could claim 10 million lives per year by 2050, jeopardizing the efficiency of the treasure that antibiotics are to human health and a century worth of medical progress. The use and misuse of antibiotics in human health care, livestock and crops are the major drivers of AMR. Pollution from pharmaceutical production must not add to this risk.

“Water plays an essential role in the fight against AMR” says Nicolai Schaaf. “Access to safe water is not only a key determinant for health, reducing the dependency on antibiotics and the vulnerability to AMR. Curbing emissions of antibiotics to waterbodies prevents these from turning into incubators for resistant bacteria.” SIWI and RAMP are now embarking on the journey to define holistic and globally applicable criteria for responsible manufacturing.

Responsible Antibiotic Manufacturing Platform

In 2007, researchers from the University of Gothenburg, Sweden, were the first to discover shockingly high levels of antibiotics in rivers downstream from a wastewater treatment plant in India’s pharmaceutical hub, Hyderabad. The concentration of antibiotics in the water was not only the highest ever recorded in the environment; it exceeded what can be found in the blood of patients undergoing treatment. To date, antibiotics have been detected in waterbodies around the globe, with the highest concentrations – and accordingly high risk of triggering AMR – often associated with pharmaceutical industry waste streams.

As these linkages between pharma production and antimicrobial resistance became increasingly clear, countries like Sweden and several UN agencies started to discuss stricter sustainability criteria in the procurement of medicine. In 2016, the UN called for concerted action from governments as well as the industry and the AMR Industry Alliance began to plan for a voluntary standard.

To date, these individual approaches have not proved sufficient to transform the industry or generate the required policy and market instruments. It is therefore very encouraging to see a new kind of commitments from regulators, procurers and the industry. The EU, various buying entities and the WHO are picking up the discussion of environmental criteria for how antibiotics are produced. And a growing number of companies seems willing to be transparent about their manufacturing, seeing responsible production as an increasingly competitive factor.

SIWI facilitates the harmonization between these initiatives and works for future standards, showcasing feasibility and verifiability of emission reductions through technical solutions and matched by corresponding incentives structures like public procurement. In 2020, this led to the launch of RAMP, building on earlier projects and collaborations.

The platform was first presented in India, a major manufacturing hub determined to reduce AMR-driving emissions from its production facilities.

These are all encouraging trends and through the Responsible Antibiotics Manufacturing Platform, different stakeholders can join forces to finally make antibiotics production sustainable.