ReAct Policy Brief: Sustainable antibiotic production

2025-01-30

The increasing global crisis of antibiotic resistance demands urgent and multi-faceted solutions, yet a less recognised driver of resistance is pollution from antibiotic production. Waste from manufacturing sites can create hotspots of resistance, disproportionately affecting low- and middle-income countries. This policy brief addresses the intersection of environmental pollution, antibiotic resistance, and equitable access to antibiotics, offering practical recommendations for systemic change.

Click image to download the ReAct policy brief (PDF). Photo: Claudio Arnese, Istock.

Current initiatives and gaps

While global initiatives like the WHO’s guidelines on wastewater management and voluntary frameworks by the AMR Industry Alliance represent steps forward, significant gaps persist. Many initiatives lack enforcement, transparency, or scalability, particularly in low- and middle-income countries. The brief underscores the urgent need for harmonised global standards, robust surveillance systems, and funding mechanisms to address these gaps and drive transformative change in antibiotic production practices.

Barriers to sustainable antibiotic production

Lack of Transparency in Manufacturing Processes and Supply Chains

Companies are seldom required to disclose their production practices or environmental impacts, limiting accountability and enabling pollution, particularly in low- and middle-income countries, where many pharmaceutical companies outsource their production.

Weak regulatory frameworks and technology transfer

Many low- and middle-income countries lack robust regulations and enforcement for environmental and pharmaceutical practices. Insufficient technology transfer from high-income countries further hinders manufacturers’ ability to adopt sustainable solutions.

Inefficiencies in global surveillance of antibiotic residues

Global systems to monitor antibiotic residues are fragmented, with no standardized protocols for tracking environmental contamination, especially in low- and middle-income countries, where resources and infrastructure are limited.

Lack of awareness among key stakeholders

Policymakers, healthcare providers, and consumers often lack understanding of how antibiotic pollution drives resistance, leading to insufficient regulatory action and industry accountability.

Key takeaways

Sustainable antibiotic production is essential for mitigating antibiotic resistance while safeguarding environmental and public health. The brief highlights the critical need for transparent supply chains, stronger regulations, and global cooperation. Recommendations include the adoption of an “End-to-End” approach, integration of environmental standards into procurement policies, and incentivizing responsible manufacturing practices. These strategies not only reduce pollution but also promote equitable access to life-saving antibiotics.