The current pandemic reminds us (perhaps all too forcefully) that a basic tenet for life is good health. Advances in medicine have allowed us to make incredible progress in our life expectancy and quality, and will hopefully continue to do so. Much of this success we owe to the pharmaceutical industry, which, paradoxically, is taking a lead in undermining our planetary health, just as it tries to serve it. In this article, we share our journey into the core of the pharma industry’s practices, and will outline the steps we believe are necessary to remedy the harm caused by this sector worldwide.
This harm has two sides to it: the consumption and the production. The consumption is about the way we consume, the kind of drugs we get prescribed, and the way out water is treated. The production side is about manufacturing the drugs outside the West in large quantities and with little regulation, resulting in environmental degradation.
Consumption: Drug prescriptions and water treatment
Even a technologically advanced and environmentally conscious country like Sweden, one of the leaders in the sustainability agenda, proud of its water cleaning facilities, is not free from the pervasive water issues of our society. The current technology which delivers water to Swedish cities does not remove pharmaceutical residues. In fact, the testing for active pharmaceutical ingredients (API) is not even mandatory when the water quality question is raised.
There is some hope though, as Stockholm is currently building one of the world’s most modern water-treatment facilities. The facility will employ membrane technology, which is a promising solution for treating pharmaceutical residues. This is timely and critical, as researchers in Sweden and Denmark show that large doses of estrogen from pharmaceutical residues are entering the Baltic Sea and have a negative impact on the genetics and procreation of fish. These compounds found in our water are dangerous to human fertility, too. If you think of it purely technically, doesn’t drinking water with pharmaceutical residues of contraceptives in it daily mean taking those contraceptives in small doses?
This and other similar issues inspired us (Rishab, Ingrid and Gunnar) to start EnvirohealthMatters in 2010. One of our advisors, Dr. Åke Wennmalm, the former Environmental Director of Stockholm County Council, had warned his pregnant daughter-in-law against drinking unfiltered water in Stockholm. According to Åke however, this does not have to be the case, as there is a way to produce medicines which do not leave persistent residues. He published a book for doctors advising on how to prescribe drugs that were more eco-friendly without compromising the efficacy of the treatment (an online classification of drugs in English is available here). However, the reasons why this or the other drug is prescribed by the doctors or stocked by pharmacies usually have little to do with the environment, and much more with other factors, one of them being generic substitution obligation.
Production: Our fight with the pharma practices
Åke told us that the European pharmaceutical industry is mostly outsourcing their manufacturing of generic drugs in India, China and Brazil with very little regulation and monitoring.
Coincidentally, Rishab’s friend’s father was fighting a case on behalf of the farmers against the pharmaceutical industry and Pollution Control Board for their negligence of the catastrophic impacts of pharmaceutical pollution. Rishab went to meet advocate Niroop Reddy, an amazing lawyer who originally comes from the region of Hyderabad, where this pollution has affected some of the communities he knew.
When Rishab first met him in 2011, in his office full of books, and discussed the case with him, he told us the entire saga. The fight against the pollution started in the 1980s, when farmers filed a case against the manufacturers under criminal law, and the cluster in Hyderabad was shut down. It reopened again, when the lobbying from the industry changed the legislation which made it possible to defend the industry on the basis of its economic importance. As the law evolved further, it was possible to file a new case, this time under the Water Act, which again allowed the cluster to shut down. It reopened again. Green Peace filed a petition on the basis of research done by Osmani Medical College in the 1990s which showed high levels of dangerous substances in the environment. The cluster was shut and subsequently reopened as a result of a legislative change which shifted attention from pollution control to pollution management.
In the early 2000s the Swedish researcher Joakim Larsson found extremely high concentrations of antibiotics, high blood pressure drugs and antiallergens in the effluent of the pharmaceutical plants in Hyderabad. Some of these drugs were ones with extremely dangerous potential side effects. In 2009 they found high concentrations of such drugs in village wells and in lakes downstream (some of his findings are written about here). The drugs produced in this industrial cluster are sold, among other countries, in Sweden. Joakim Larsson had also pointed out that the pharmaceutical pollution greatly increases the risk of antibiotic resistance and creation of ‘superbugs’ – antibiotic resistant bacteria. Today, antibiotic resistance is considered one of the greatest threats to global threats, according to WHO.
By the time we met in 2011, Niroop had lost all hope in continuing to fight the case, but we convinced him to file a new case with the newly created Indian National Green Tribunal.
We told Niroop that we were willing to get more research from Sweden, as well as help advocate in Sweden for the issue of pharmaceutical pollution. He agreed to file a new petition in the Indian National Green Tribunal. We organised a seminar of environment and health issues with students at Uppsala University, where we discussed the environmental challenges of the pharmaceutical industry. One of the students wrote a paper on this issue, which led to organising a debate with the participation of Åke Wennmalm and Bengt Mattson (then working for CSR Pfizer). This debate showed us that industry could change if they were willing to. However, we perceived that the industry was full of fear, so much that some of them even warned Rishab against going to India and fighting the legal case.
Thanks to Niroop, we did manage to go to Patancheru and make a short video about the problem. We used it to raise awareness, and started a petition in Avaaz to the Swedish Medical Procurement Agency. The legal case in India gained momentum, and we continued to show growing evidence of the global research being done on the catastrophic implications of the effluent being discharged by one of the biggest industrial clusters in the world.
Towards the end of 2013, we got to learn more about Pauline Göthberg’s work at Sveriges kommuner och regioner (Swedish Association of Local Authorities and Regions), and others at the Swedish Läkemedelsverket (Medical Products Agency). We helped them to visit the polluted areas of Patancheru, and they became more aware about the legal proceedings against the industry.
Åke Wennmalm took Rishab to see the factory of Astrazeneca in Södertjäle, and he learned that they were one of the first companies to have environmental standards from drug discovery to production and secondary discharge. Together with Rishab’s Indian colleagues we were lobbying the Central Pollution Control Board (CPCB) of India for getting such environmental standards implemented in India, however it still has not happened.
The interest for influencing the pharmaceutical industry has grown exponentially since 2014; there have been several reports, films and lobby groups within the EU. In 2015, an international NGO Initiatives of Change organized a workshop in their Dutch centre, where several groups learned about the situation in Patancheru. A similar interest in tackling pollution was shown in Germany and in the UK, resulting in a campaign by European Environmental Bureau and a few other organisations to change legislation.
These efforts have led to higher awareness among investors. In 2015, Nordea, a large investor toPfizer, expressed serious concerns about the situation. In 2016 Nordea sponsored an assessment done by Changing Market on the situation in Patancheru. However, according to the latest data we could find, Nordea is still investing more than five hundred million dollars in Pfizer (as of the beginning of 2020).
A partial victory
In 2017 we had a victory at the Southern Bench of the National Green Tribunal in India. The court found the state guilty of negligence and not holding the industry accountable for the pharmaceutical pollution. A series of measures were ordered by the Court, such as:
- a superspeciality hospital to be built to treat the population who have suffered from the pollution, with seventy five percent of the cost to be borne by the industry and twenty five by the state government;
- environment relief fund to be created by the industry, where one percent of annual sales would be deposited;
- the state government to create a committee to study bacterial resistance in the Manjira river basin;
- compensation fund to be created for the victims of the environmental pollution.
We know that, as of the present date (May 2020), the compensation has not been received by the farmers whose lands were polluted. We also know that the other rulings of the Court have not been implemented by the industry and the government. Additionally, we had placed certain demands in the case, which were not honoured by the Court and which include, for example, such urgent acts as remediation of the lakes polluted in the are of the cluster, and the removal of the eighteen-kilometre pipeline allowing the industry to mix their effluent with municipal wastewater and therefore not comply with the Basel convention of treating at source.
It is good news that we won the case. It helps show that environmental pollution is a crime, and it can be successfully fought in court. But what use is it without the reinforcement of the rulings, and without the full honouring by the Court of the most critical demands?
Our offer: Towards the transformation of the pharma industry
As the world is grappling with a global pandemic and economic crisis, the pharmaceutical industry remains largely unregulated. Large doses of API continue to pollute our water, soil and air. Antibiotic resistance continues to be a severe threat to the current and future generations. To address this situation, we desperately need a transformation to the sector which would make it fit for the future and bring it within the planetary boundaries.
We at EnvirohealthMatters have worked at the intersection of environmental health and societal issues for more than a decade. We have a large network of societal actors and access to knowledge, methods and tools for transformation towards sustainability, which allows us to design processes ad hoc, depending on the situation and the needs of the industry we are working with. These are the steps we envision as part of the transformation path for the pharmaceutical industry:
- Visioning a future scenario: Give the industry the perspective on the dangers of business as usual, and show the positive stories of companies that bring change. This could help them realign their operations with their vision.
- Life cycle analysis with ecopharmacovigilance: We can offer a systemic perspective on the social and ecological impact of drugs and API. We can screen the API from the inception stage, so that the industry can avoid the use of ingredients harmful to the ecology.
- Stakeholder consultation: We can facilitate complex discussions with diverse stakeholders, and use the diverse perspectives shared and transform it into actionable research.
- Circular economy: Treating the effluent, recovering and reusing the solvent. Industries and economies are trying to reduce, reuse and recycle materials, to create a zero-waste society, in which one person’s waste is another person’s resource.
- Bioremediation and regeneration: We have partners who can enable treatment of soil and water through biological means.
- Real-time monitoring of effluent: Release of effluent in the water is a major challenge. We can provide the technology to monitor the effluent in real time, so that treatment of the water can be more effective.
We know that the current economic practices of pharmaceutical production are a structural issue. However, we cannot change the structure overnight. We can only advocate, educate, lobby and build awareness. Only if consumers, local and national governments, doctors, and the industry unite, will we see any transformative change. We know that people within the industry want change. Our offer is there, and we are working with the industry in the hope that an environmentally friendly and ethical pharmaceutical industry which truly serves humanity is not a fairy-tale – it is a possibility, an inevitability, a question of time.
By Rishab Khanna, Tatiana Sokolova and Ingrid Franzon, EnvirohealthMatters