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MANAGING POLLUTION FROM ANTIBIOTICS MANUFACTURING: charting actors, incentives and counterincentives

Authors:
Christian Munthe at University of Gothenburg
Christian Munthe
Niels Nijsingh at Ludwig-Maximilians-Universität in Munich
Niels Nijsingh
Joakim Larsson at University of Gothenburg
Joakim Larsson
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Abstract

Question Emissions 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 stakes and interests, incentives that can motivate them to act to improve the situation, as well as counterincentives that may undermine such motivation. Method The actor types and their respective interests have been identified using research literature, publicly available documents, websites, and the knowledge of the authors. Result Thirty-three different types of actor-types were identified, representing e.g. commercial actors, public agencies, states and international institutions. These are in complex ways connected by differing and partly similar interests that sometimes may conflict, sometimes pull in the same direction. Some actor types can act to create incentives and counterincentives for others in this area. Conclusions The 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 suggest 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.
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MANAGING POLLUTION FROM ANTIBIOTICS MANUFACTURING
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... The pollution is directly caused by API producers, but these respond to a demand from buyers, in particular, health systems in highincome countries. While the precise role of specific actors within these system in causing the pollution is difficult to conclusively determine, the priorities they make, particularly their effort to control costs, clearly generate a systematic demand for unsustainably produced antibiotics Nijsingh et al. 2019). In this way, these actors actively abet the serious harming of others without their consent, generating a strong reason to reduce their involvement in causing the harm and instead act to mitigate it. ...
... In contexts where this mechanism is harmonized across national jurisdictions, e.g. the EU, this power does not lie with the national agency, but with the institution in charge of the harmonized authorization framework, in this case the EMA. Several opportunities for including production-related environmental considerations in the European approval process exist (Ågerstrand et al. 2015;Nijsingh et al. 2019), leaving room for national agencies to act within that remit. While the feasibility and consequences of an environmental incentivizing mechanism may depend on whether it is implemented at a national or a multinational level, the impact of actions taken at these levels is potentially high compared to actions taken at local or regional levels. ...
... Since antibiotic use and meat consumption create an externality in the form of increased resistance, fees or taxes that require consumers to internalize this cost may be defended on analogous grounds(Anomaly 2009(Anomaly , 2013Giubilini et al. 2017;Giubilini 2019).3 For further details and additional actors, seeNijsingh et al. 2019. ...
What high-income states should do to address industrial antibiotic pollution
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Full-text available
  • May 2020
Antibiotic resistance is widely recognized as a major threat to public health and healthcare systems worldwide. Recent research suggests that pollution from antibiotics manufacturing is an important driver of resistance development. Using Sweden as an example, this paper considers how industrial antibiotic pollution might be addressed by public actors who are in a position to influence the distribution and use of antibiotics in high-income countries with publicly funded health systems. We identify a number of opportunities for these actors to incentivize industry to increase sustainability in antibiotics production. However, we also show that each alternative would create tensions with other significant policy goals, necessitating trade-offs. Since justifiable trade-offs require ethical consideration, we identify and explore the main underlying normative issues, namely, the weighing of local versus global health interests, the weighing of present versus future health interests, and the role of individualistic constraints on the pursuit of collective goals. Based on this analysis, we conclude that the actors have weighty principled reasons for prioritizing the goal of addressing pollution, but that translating this stance into concrete policy requires accommodating significant pragmatic challenges.
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