World Health Organization have urged all countries to develop national antibiotic resistance strategies. Joakim Larsson, professor and director of CARe (Centre for Antibiotic Resistance Research) at the University of Gothenburg, Sweden has read India’s draft for National Action Plan on Antibiotic Resistance. He welcomes the section focusing on emissions from antibiotics production.
What are the greatest environmental and public health problems regarding release of antibiotics from the pharmaceutical industry?
– Discharges of antibiotics from manufacturing sites can be very substantial, leading to massive selection of antibiotic resistance in the receiving waters.
– The pollution thereby creates environments where new resistance factors can evolve and eventually be transferred to pathogens. Hence, in my view, the greatest risk is that such environments can be spawning grounds for resistance, with potential future health consequences for everyone, regardless where the pollution takes place.
How important is the Indian address of emission problems in their National Action Plan on AMR?
– India is one of the major manufacturing countries of antibiotics for the world market. It is also a country where large industrial emissions of antibiotics have been documented repeatedly. In the past years, many have pointed out the need for taking control over environmental discharges of antibiotics, but still, after 10 years of discussions, there are no specific regulations and relatively little concrete action overall.
– It is therefore very important and encouraging that the government of India, who has the power to make a difference, shows a clear intention to monitor and regulate antibiotic discharges within a relatively short period of time. This also sends a signal to pharmaceutical industries that the rules are about to change, which will likely spawn voluntary actions as well. Finally, it provides support to those who are pushing for similar demands through other routes, for example via public procurement and via a revised generic substitution system for drugs that take into account not only price of the drugs but also pollution control during manufacturing.
What would India and their pharmaceutical industry need to do to overcome the problem?
– The first challenge is to defining emission standards and establish a system for living up to them. There are proposed discharge limits in the public literature that could be applied already. Corruption is unfortunately still widespread in India, which puts additional demands on how to bring environmental regulations into practice.
– Technically, there are existing solutions that are able to radically reduce discharges of antibiotics and resistant bacteria that may arise during the waste-water treatment process. Implementing such solutions will, however, likely come with a cost for the companies, and this may, at least on the marginal, affect the prices of the final products. It is therefore also important for buyers to acknowledge such risk-reducing investments and not stare blindly on the price of the products.