Testing the Water
Environmental campaigning organization Changing Markets recently published a report uncovering widespread antibiotic resistance in wastewater from pharmaceutical plants in India (1). We spoke to the group about why – and how – the industry should address this important environmental issue.
Why focus on antibiotic pollution?
Pollution from antibiotic manufacture is known to be a factor in the global spread of drug resistance, alongside excessive consumption of antibiotics in human medicine and their profligate use in livestock rearing. This is still a relatively unexplored issue, despite a substantial and growing body of scientific evidence highlighting the negative environmental and human health impact of antibiotic residues.
In 2007, a team of Swedish scientists analyzed pharmaceuticals in the effluent from the Patancheru Common Effluent Treatment Plant (CETP), a plant serving about 90 pharmaceutical manufacturers on the outskirts of Hyderabad. The pharmaceutical concentrations in some of the water samples were higher than those found in the blood of patients taking medicine. The concentration of ciprofloxacin, a fluoroquinolone antibiotic, was approximately one million times greater than the levels found in treated municipal sewage effluent (2).
What did your investigation reveal?
Our report exposes the occurrence of resistant bacteria surrounding pharmaceutical manufacturing plants in India, which supply European and US markets. An on-the-ground investigation by the investigative agency Ecostorm and subsequent analysis of water samples under the supervision of Mark Holmes from the University of Cambridge found high levels of drug-resistant bacteria at sites in three Indian cities: Hyderabad, New Delhi and Chennai. In total, out of 34 sites tested, 16 were found to be harboring bacteria resistant to antibiotics (see below for breakdown).
Ecostorm Investigation: Results
34 sites were tested in Hyderabad, Visakhapatnam, Delhi and Chenna, India.
16 sites harbored antibiotic-resistant E. coli bacteria:
- 4 with resistance to cephalosporins, carbapenems and fluoroquinolone
- 8 with resistance to cephalosporins and fluoroquinolones
- 4 with resistance to fluoroquinolones or cephalosporins
How widespread is the problem?
We believe this is just the tip of the iceberg. Our research is the equivalent of a pilot study, with more extensive research required to establish the full scale of the problem. Pharmaceutical pollution is an emerging issue and even developed regions, such as Europe, could make considerable improvements to their regulatory framework. The European Commission’s Strategic Approach to pharmaceuticals in the environment is already more than a year late, which is concerning.
What can be done?
The Review on Antimicrobial Resistance characterizes pharmaceutical manufacturing pollution as “a supply chain problem that pharmaceutical companies and their suppliers need to solve together” (3). We couldn’t agree more. Pharmaceutical companies have a duty to stamp out pollution throughout the supply chain by implementing clean production and appropriate waste management at their own factories and those of their suppliers, integrating environmental criteria in all their contracts, ensuring technology transfer to companies in their supplier base, and ensuring appropriate audits and follow-up actions take place. Regulators must act to include environmental criteria in the Good Manufacturing Practice (GMP) framework, and GMP inspections should be significantly strengthened. In addition, regulators should demand more transparency in the pharmaceutical supply chain.
When it comes to addressing the global AMR challenge, tackling drug resistance due to irresponsible production and opaque supply chains is low-hanging fruit. This is an issue that must be addressed head-on across the board – failure to act will negatively impact the reputation of the industry as a whole.
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- “Superbugs in the Supply Chain: How pollution from antibiotics factories in India and China is fueling the global rise of drug-resistant infections” Changing Markets (2016)
- DGJ Larsson et al., 2007. Op. Cit. (2007) and RH Lindberg et al., Op. Cit. (2005)