Managing pollution from antibiotics manufacturing: charting actors, incentives and disincentives

Abstract

BackgroundEmissions of high concentrations of antibiotics from manufacturing sites select for resistant bacteria and may contribute to the emergence of new forms of resistance in pathogens. Many scientists, industry, policy makers and other stakeholders recognize such pollution as an unnecessary and unacceptable risk to global public health. An attempt to assess and reduce such discharges, however, quickly meets with complex realities that need to be understood to identify effective ways to move forward. This paper charts relevant key actor-types, their main stakes and interests, incentives that can motivate them to act to improve the situation, as well as disincentives that may undermine such motivation.MethodsThe actor types and their respective interests have been identified using research literature, publicly available documents, websites, and the knowledge of the authors.ResultsThirty-three different actor-types were identified, representing e.g. commercial actors, public agencies, states and international institutions. These are in complex ways connected by interests that sometimes may conflict and sometimes pull in the same direction. Some actor types can act to create incentives and disincentives for others in this area.ConclusionsThe analysis demonstrates and clarifies the challenges in addressing industrial emissions of antibiotics, notably the complexity of the relations between different types of actors, their international dependency and the need for transparency. The analysis however also suggests possible ways of initiating incentive-chains to eventually improve the prospects of motivating industry to reduce emissions. High-resource consumer states, especially in multinational cooperation, hold a key position to initiate such chains.

Moving towards sustainable dermatological practice

“…For example, wastewater emissions from manufacturing plants can be harmful to the local environment and require coordinated action. 6 Similarly, there have been calls for changing the ways in which medications are disposed, including take-back programs. 7 Figure 1 Practical interventions for reference of clinicians, either affecting their own behavior or advocating for change at higher and lower levels in the care system…”

What High-Income States Should Do to Address Industrial Antibiotic Pollution

“…The need to address industrial pollution to curb ABR is recognized by scholars, non-governmental organizations, governments and the pharmaceutical industry itself, and different strategies for accomplishing this goal have been proposed ( Laxminarayan et al , 2013 ; Ågerstrand et al , 2015 ; AMF, 2017 ; AMR Industry Alliance, 2018 ; Bengtsson-Palme et al , 2018 ; Nijsingh et al , 2019; WHO/FAO/OIE, 2020 ). However, all management approaches face significant challenges.…”

“…However, all management approaches face significant challenges. For instance, legal hurdles, financial costs and reputational risks constitute powerful disincentives for pharmaceutical companies to increase supply chain transparency and exert control over subcontracted API producers ( Nijsingh et al , 2019 ). Moreover, API discharges are unregulated in most countries ( Larsson, 2014 ) and governments in major API producer countries often have limited ability to enforce regulations due to e.g.…”

“…More generally, the chain from API production to final antibiotics consumption involves many different public and private actors with widely diverging interests, creating uncertainty about how positive change could be incentivized. Nevertheless, a recent analysis has argued that responsibility and opportunities for action can be found in high-income states, where institutional systems surrounding pharmaceutical markets may be used to incentivize industry to move toward cleaner antibiotics production ( Nijsingh et al , 2019 ). In this article, we explore these opportunities from an ethical perspective in order to analyze what is required to design justifiable and feasible action.…”

Correction to: Managing pollution from antibiotics manufacturing: charting actors, incentives and disincentives

“…Following publication of the original article [1], the author explained that there are multiple errors in the original article;…”