Burgeoning AMR burden is detrimental to the long-term prosperity of nations. A recent Lancet study argues that AMR was directly responsible for 1.2 million deaths in 2019. The World Health Organization had already dubbed it as one of the top ten global public health threats facing humanity, an assertion other UN and multilateral organizations have endorsed many times since 2016. Thus, it’s important to plug every gap that directly or indirectly contributes to AMR. All of it begins with where the drugs are manufactured, and how responsibly they are dealt with across the supply chain. Here, India has a critical role to play in setting standards and behaving responsibly when it comes to manufacturing drugs, as well as managing supply chains.
India is called the ‘pharmacy of the world’ for being the largest provider of generic drugs globally. Its domestic market is expected to grow approximately three times over the next decade from $42 billion at present to around $120-130 billion by 2030. With thousands of drug companies and manufacturing units in the country, the domestic pharmaceutical industry is highly fragmented. However, it remains a key sector that contributes to the economic growth of the country. Keeping that in view, the Indian government is planning a slow of measures to give a further boost to the sector.
With a renewed focus on “Atmanirbhar” or self-reliance, the government approved a scheme to set up three new bulk drug parks to make active pharmaceutical ingredients (APIs) for medicines. This is being done to reduce imports of raw materials of pharmaceuticals from China. The second important policy support by the government is the Production Linked Incentive Scheme (PLI) with a goal to enhance investment and production of high-value goods such as complex generic drugs and patented drugs, among others. It would also ensure continued support to domestic production of APIs to help increase the resilience of the domestic pharmaceutical industry to shocks. With these initiatives, the goal is to achieve greater affordable healthcare and develop a sustainable system.
While these are important measures to boost the pharmaceutical sector and make the Indian pharma industry even more competitive globally, it is important to understand that for these to become sustainable, we must assess their impact on health and the environment, particularly on issues like AMR. More manufacturing of drugs means more capability of the industry to pollute the environment around, and a higher chance of spreading AMR, unless manufacturing and supply chain is planned holistically right from the start of setting up these units.
In the recent past, surveys have highlighted how inadequate wastewater management in pharmaceutical manufacturing have increased water pollution across Hyderabad and Visakhapatnam, both pharma hubs in the country. Poor effluent treatment systems and systematic dumping of large volumes of chemical effluents into rivers and lands by pharmaceutical units have severely impacted the lives of communities surrounding these areas. Similar reports have emerged from other parts of the country, reiterating how important it is to curb the spread of AMR at the sources of manufacturing.
Bringing in sustainable investments and financing mechanisms that can help measures against AMR is thus the need of the hour. The World Bank has highlighted that funding AMR is an important economic and health investment for countries. Investing in building capacities, raising awareness and knowledge sharing, and ensuring improvements across sectors such as health, environment, water, and sanitation are key to comprehensively address AMR. India’s has readied a National Action Plan on AMR that identifies the need for greater investments for AMR activities, and to continue research and innovations in this space. The national green tribunal in the country and the Central Pollution Control Board of India (CPCB) housed in the ministry of environment, forest and climate change, are important institutions which have the capacity and the awareness to set standards and provide governance structure for manufacturing units to restrict the spread of AMR. In fact, before Covid-19 struck, the CPCB had taken crucial strides in this direction.
Besides, the pharma industry is itself undergoing a transition in the country. Industry stakeholders, right from investors to pharmaceutical manufacturers, are keen to find solutions to AMR for long-term sustainability. For example, Nordea Asset Management, a leading Nordic Universal Bank, started a dialogue with the pharma industry in India on the impact of pharma manufacturing on the environment and health. Such initiatives are slowly but steadily highlighting the importance of sustainable sourcing and managing pollution from pharmaceutical industries, including adopting measures limiting API effluents to levels where they don’t lead to environmental AMR. Such initiatives are slowly yet steadily enabling stakeholders to have an open conversation on the issue of AMR. Over the past few years, more and more suppliers have been candidly sharing their experiences around practices and challenges in following standards to curb AMR. This step is critical because only when AMR is acknowledged as an issue can the industry move forward to solve the problems linked to it.
This is not to say that all companies in India are shying away from compliance standards to curb AMR. Some pharmaceutical companies in India have strong aspirations to ensure sustainability and their supply chains reflect that ambition. Their pharmaceutical plants are equipped with advance treatment facilities; they recycle wastewater; reuse it inhouse to ensure no wastewater enters surrounding water bodies; and work to address AMR challenges by protecting the environment through responsible practices. However, the number of such companies which fully understand and act on AMR curbing practices is still few. For the remaining to grasp and act, a lot of other factors must fall in place.
What we need to curb AMR across pharma supply chains is investments, technologies, and transparency. For expanding on such cleaner practices, more long-term investment is needed by the industry. Moreover, at present, technology is primarily available for wastewater treatment and to address water pollution. Bringing in investments to develop smart technologies to address AMR is needed. It is also crucial to ensure greater transparency in R&D across companies. Continuing to work closely with companies and manufacturing units to ensure greater transparency in the ecosystem would be important to direct investments to address key gaps across pharmaceutical supply chains and develop sustainable outcomes.
AMR is a multi-faceted challenge and requires a multi-secoral approach to contain it. Of the 10 million deaths projected to be caused by AMR globally by 2050, a fifth is expected to be in this country. Even today, over 50,000 newborns die in India from sepsis because of pathogen resistant to first-line antibiotics. That’s a quarter of global neonatal sepsis deaths annually attributable to resistant pathogens. Moreover, by 2030, AMR could push 24 million people into extreme poverty. No one really knows how much worse the situation has become with the interference of Covid-19, when the misuse of antibiotics has become rampant. Therefore, all key players from investors, governments, and pharmaceutical companies, must pause and honestly assess where we stand on AMR one and half years into the pandemic. Further, active ownership among investors and companies is imperative to start setting clear goals, making commitments, and acting now to respond to the threat of AMR post pandemic, before there is irreversible consequences from it.
- Manjit Singh, Associate Director- Corporate Sustainability at Centrient Pharmaceuticals and Chair, Pharmaceutical Supply Chain Initiative (PSCI)
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