Since Alexander Fleming discovered penicillin in 1928, antibiotics have saved billions of lives. Modern healthcare is unthinkable without them.
Ironically, however, we are now moving towards a post-antibiotic era due to widespread misuse and irresponsible behaviour. Unless we take immediate action
to save them, society will pay a heavy price in the form of antimicrobial resistance (AMR).
AMR, a global problem
In its concluding report, the Review on AMR estimated that drug-resistant infections will kill more people than cancer by 2050, resulting in a staggering 10 million deaths and a cost to the world economy of $100 trillion every year. The crisis is already underway. Some estimates indicate that AMR causes 700,000 deaths globally annually, others refer to the 410,000 children under five years old who die from pneumonia in India, and the 56,000 newborns who regrettably pass away there every year because of infections that are resistant to first-line antibiotics. All personal tragedies. Meanwhile isolation treatments are driving up healthcare costs everywhere in the world.
AMR is a natural phenomenon, but it is accelerated and spread by human behaviour such as poor sanitation, low infection prevention and control, antibiotics misuse and pollution of the environment, and international travel and food trade.
In 2014, a drug-resistant bacterium was found in India that has since then been identified in more than 70 countries worldwide – global proliferation in just two years – while reports indicate that increasing numbers of travellers frequently return home with superbugs in their digestive systems.
To prevent these chilling scenarios from becoming an unstoppable epidemic, we need to act fast to curb all causes of AMR and develop strong alternatives.
Recent research on antibiotics pollution
The areas surrounding pharmaceutical-ingredient manufacturers have repeatedly been identified as a source for resistance, in particular in India but also in the People’s Republic of China. This does not come as a surprise, since 80 to 90% of all antimicrobials are made in these countries.
Pollution – especially of watercourses downstream from production facilities – and insufficient wastewater management facilities lead to high concentrations of various antibiotic drugs in the environment. These not only contaminate surface, ground and drinking water, but also create perfect hotspots for multiple drug-resistant bacteria to develop.
The Review on AMR mentions an estimated amount of 30,000 to 70,000 tonnes of antimicrobial activity waste that is generated by the supply chain. Scientific studies on industrial antibiotics pollution report concentrations of antibiotics in the close proximity of some pharmaceutical plants that are hundreds, thousands, and even 10,000 times higher than in clean water. A recent study even measured levels of fluconazole (an anti-fungal) approximately 950,000 times higher than suggested environmental limits.
“We must all take, use and make antibiotics responsibly”
The industry as a whole must take leadership in safeguarding the future of antibiotics and battle antibiotics pollution from manufacturing. In fact, it
is in the interest of the industry – together with third-party stakeholders – to secure business continuity and stop irresponsible manufacturing practices
that are associated with the selection and spread of multiple drug-resistant bacteria.
We should stop buying, using and selling irresponsibly made antibiotics and we need mechanisms to increase transparency for pharmacists, physicians, payors and patients.
Saving existing antibiotics
Of course we must develop new antibiotics, treatments, vaccines and diagnostics to secure modern healthcare and stay ahead of the increasing prevalence of AMR. These new alternatives and tools must be made available for those who need them. No one argues about that, although it will take time and development remains uncertain while we still need to define models to make them economically sustainable. But it has to be done.
However, to preserve the effectiveness of existing antibiotics for patients today and in the future, we must all ‘take, use and make antibiotics responsibly’ and stop relying on irresponsibly made antibiotics. This requires behavioural change and cleaning up our supply chains by defining mechanisms to stop antibiotics pollution associated with drug manufacturing, which is a significant cause of concern.
Public-private collaboration is vital
For all of the above, public-private engagement is imperative if we want to stand a chance against the rapid emergence of multiple drug-resistant bacteria. The private sector cannot do without the public sector, and vice versa.
A single company can only do so much, just as a single country cannot keep out multiple drug-resistant bacteria. Concerted industry-wide efforts are essential, just as concerted inter-agency alignment is imperative.
An encouraging beginning has been made. Many countries have shared their National Actions Plans on AMR, including India – which recently published an ambitious plan covering all the relevant angles. In addition, an Inter-Agency Coordination Group on AMR has been established, and the AMR Industry Alliance has been announced, representing signatories of the Davos Industry Declaration (Jan, 2016) and the UNGA Industry Roadmap on combating AMR (Sept, 2016). Established this May, the AMR Industry Alliance will govern progress on the commitments made, and will report the industry’s progress in the fight against AMR. It is essential that both initiatives find each other soon.
While these are important and encouraging initiatives, it is vital that other stakeholders in the supply chain take leadership too, including healthcare suppliers and professionals, physicians, pharmacists and payers – such as wholesalers, health insurance companies and hospitals.
We all must take responsibility to curb the misuse of antibiotics and stop irresponsible manufacturing through, among other measures, the inclusion of environmental criteria in purchasing decisions and allowing labelling for safe antibiotics.
We all must take leadership, and no one is exempted.
DSM Sinochem Pharmaceuticals is a leading generic manufacturer of sustainable antibiotics with manufacturing sites in Europe, Mexico,
India and China. We have basic measures in place to make antibiotics responsibly: we implemented enzymatic biotechnology in the 1990s; we operate dedicated wastewater treatment plants 24/7 and 365 days a year as an integral part of our manufacturing process at all our sites; and we frequently test our effluent on antimicrobial activity before discharge.
We are a signatory company to the Davos Industry Declaration, the UNGA Industry Roadmap on combating AMR, and the AMR Industry Alliance.
DSM Sinochem Pharmaceuticals
30 Pasir Panjang Road, Singapore 117400