Planetary health leadership to drive climate action across pharmaceutical supply chains: insights from qualitative research and a call to action

Introduction Pharmaceutical manufacture, delivery and use produces an estimated 10%–55% of national healthcare greenhouse gas emissions. Addressing pharmaceutical supply chain emissions is essential to mitigating healthcare’s climate impact. Our research aimed to explore the constraints to pharmaceutical supply chain climate action and how planetary health leadership can overcome these challenges. Methods We conducted 21 narrative interviews with representatives from pharmaceutical companies and industry and health system stakeholders. Interviews explored perspectives on climate action across pharmaceutical supply chains. Analysis was informed by argumentative discourse analysis, enabling the identification of key storylines. Results Climate action across pharmaceutical supply chains is sporadic and insufficient to achieve health system climate goals. Critical constraints to climate action include (a) structural constraints, particularly complex, fragmented, global supply chains as well as limited renewable energy infrastructure in some countries where supply chains operate and (b) conceptual constraints, the ‘patient-profit-planet dilemma’, where climate action is perceived to conflict with patient well-being and financial considerations. Planetary health leadership can help overcome these constraints in three key ways. First, planetary health leadership can help reconceptualise healthcare delivery, and the role of pharmaceuticals, to align patient and planetary well-being while meeting financial pressures. Second, planetary health leadership can mobilise collective climate action across pharmaceutical supply chains, reframing climate change as a shared problem and challenging issues of transparency, competition and blame. Third, planetary health leadership can challenge wider systems that constrain climate action, leveraging the economic and political power of pharmaceutical supply chains to drive global decarbonisation efforts. Conclusion Planetary health leadership must confront considerable constraints to embed planetary health considerations across pharmaceutical supply chains. Leaders in this space must be willing to go against the status quo and challenge entrenched norms and systems to enable wider spread and support for sustainable healthcare delivery.