What role does the pharmaceutical industry play in driving sustainable health care?
Oxford’s Sustainable Health Care short course, now in its second year, explores how health systems can become more environmentally sustainable. This blog highlights a recent panel discussion on the pharmaceutical industry’s role in sustainability, focusing on the challenges and opportunities for decarbonising supply chains and driving systemic change.
Now in its second year, Oxford’s Sustainable Health Care short course is leading the way in thinking about how health systems can become more environmentally sustainable. It forms part of the MSc in Translational Health Sciences, a programme focused on the key topics and methods underpinning how we get health-related innovations into practice. Sustainability features across the programme but this dedicated course dives head first into the detail and urgency for change that can support sustainable health systems alongside good outcomes for our planet and patients. It is a complex field, requiring interdisciplinary discussions across a breadth of topics ranging from carbon foot printing of medical devices through to increasing use of AI and sustainability. Students come from across the world, representing different backgrounds and disciplinary perspectives. The level of engagement and learning is inspiring.
This year, we worked in collaboration with Green Templeton College to host a panel discussion looking specifically at the role of the pharmaceutical industry in supporting more sustainable health care. With a diverse audience across research, practice and industry, discussion was lively and with an immediate focus on the work that the pharmaceutical industry is, and isn’t, doing around decarbonisation. Five key themes emerged.
Panellists (from left to right) Mark Wilson, Chris Winchester, Samantha Holmes, and Liz Breen
Understanding the Pharmaceutical Industry's Impact on Sustainability
Firstly, the panel and audience focused on awareness of what is happening with medicines and the pharmaceutical industry’s role in relation to this. Key questions here related to whether people really understand what is happening with their medicines – where they come from, how they are processed, the waste that is generated (eg in manufacturing, packaging and dispensing) and what people can do to stop waste? While some people do recycle unused medicines, many do not. And yet there are opportunities for reuse and recycling, which can reduce waste and potential risks (eg of poisoning). We have pilots that are beginning to address these issues (eg eco-directed sustainable prescribing) and an appetite in industry and health systems to do more. However, it is not currently sufficient to make this happen at scale. The message from the panel is that we must do better. Industry needs to find the time and resources to make this happen.
The Need for Collaboration and Transparency Across Sectors
This need for change at scale is not only the responsibility of industry. The second theme which came across strongly was about the need for collaboration and transparency. Given the impact of pharmaceuticals across the world – contributing up to 55% of health care greenhouse gas emissions – panellists argued strongly for urgent and close engagement across industry, policy and research. Two key areas were deemed relevant. There were calls for national level policymakers, health system leaders and those working in NGOs to more fully engage with the private sector on environmental sustainability – to engage companies and work with them at every level – from water usage to waste to emissions and carbon footprints. And then a focus on working closely across research and industry to develop sustainable research systems (eg life cycle assessment of clinical trials and a push for ‘greener trials’). Collaboration across the board is key.
Learning from Global Leaders in Sustainable Procurement
Thirdly and unanimously, everyone agreed that we need to learn from those who are already doing this well. The example cited was Scandinavia, where environmental and sustainability criteria have been integrated into procurement with, for instance, the price only accounting for 25% of the criteria which must be met when purchasing in Norway. This gives enormous leverage to purchasing sustainably and can help to shape the ways we address and purchase pharmaceuticals. While the exact policy may not work for other nations, getting national ministries and system level decision makers to integrate criteria into procurement is key.
Audience members played an active part in the debate.
Progress in Pharmaceutical Company Efforts to Decarbonise
Fourthly, the panel focused on what pharmaceutical companies are doing in this space. Drawing on recent research, one panellist flagged that the top 20 companies have reported what they are doing to decarbonise, particularly around scope one and two (ie direct emissions from sources owned or controlled by pharmaceutical companies and indirect emissions from the generation of purchased electricity, steam, heating and cooling), with big sustainability gains through focusing on energy and manufacturing. With 80% of pharmaceutical company emissions coming from their supply chain (scope three emissions), the panel – and audience – unanimously agreed that there is significant work still to be done. This is challenging: the pharmaceutical industry is heavily outsourced (eg contract manufacturing) with thousands of suppliers across supply chains over which companies have limited leverage in terms of reducing emissions. But pharmaceutical companies do have both the money and human resource to address this. While rapid change at scale across supply chains may not be feasible or possible, as one of our panellists put it, 'sometimes a small step is better than no step at all'.
Integrating Profitability with Sustainability for Future Success
Finally, and now turning to think about how pharmaceutical companies might do more, the audience flagged the need to better merge profitability and sustainability. With pharmaceutical companies inevitably motivated by their bottom line, merging sustainability and profitability was seen as critical in incentivising companies to make the right choices and ensure leadership for sustainability.
Moving forwards, the panel pointed to key things that pharmaceutical companies and their collaborators need to do to drive sustainability efforts. While pharmaceutical companies are making choices for sustainability, we need to encourage them more and to demonstrate that profit can continue to be achieved, alongside patient and planetary benefits. Key here was prevention and routes to appropriate deprescribing, with one panel member emphasising the need to shift away from our current focus on ‘every pill for every ill’. Formularies need to be greener and we need measurement and data to support decision-making that can shift to more sustainable pharmaceuticals, supply chains and health systems. And finally we need transparency at all levels to incentivise and motivate good practice. With progress being made, albeit slower than many hope, the panel and audience were optimistic about the future and the role that the pharmaceutical industry can play in driving more sustainable health systems.
We are grateful to Green Templeton College for their support in running the panel on ‘Greening the Pharmaceutical Sector: Rhetoric or Reality’. The panel ran during the week of the Sustainable Health Care course, which is part of the MSc in Translational Health Sciences. The course runs on an annual basis and is open to both MSc and standalone students - further information can be found on the course web page.