Connecting Global Priorities Biodiversity and Human Health

widespread use (Boxall et al. 2012) and the
majority of these have not been tested for the
environmental effects. While new pharmaceutical
products are subjected to risk assessment,
it is unlikely that a significant proportion of
the existing APIs can be subjected to full risk
assessment in a timely manner. It is important
therefore that priority API pollutants are identified
for study.
5. Ways forward: reducing the
impact of APIs in the environment
In most developed countries with strong
regulatory systems for integrated prevention and
control of pollution, it has long been considered
that outputs of waste and wastewater from
the manufacture of APIs are well regulated and
controlled, so that fugitive emissions of APIs to
soil, groundwater and surface water would be
minimal – not least because any significant fugitive
loss of API from a manufacturing facility also
represents a potential loss of revenue. However,
research into the environmental burdens of APIs
from sewage treatment plants receiving effluent
from pharmaceutical factories has suggested
that manufacturing facilities are a potentially
significant source of API inputs to surface water
and sewage sludge (Philips et al. 2010; Cardoso
et al. 2014). In some developing countries,
environmental inputs from manufacturing sites
have been found to be very high, particularly in
areas with weak or no regulatory frameworks
or poor enforcement, and in areas with high
concentrations of API factories (Fick et al. 2009;
Larsson et al. 2007; Larsson 2010).
Therefore, it is important that greater efforts are
made to understand, regulate and minimize the
potential for API release from the manufacturing
sector, particularly in developing countries.
This should include advancement and uptake of
more environmentally friendly manufacturing
methods and of technologies to remove APIs from
wastewater streams, and greater focus on so-called
green chemistry – creating APIs that are “benign
by design” and inherently carry a low ecological
risk (Daughton 2014).
There is also a need to more effectively regulate
the use and disposal of APIs at the community
level. This includes tackling the overuse and
overprescription of APIs, and perhaps exploring
opportunities for reduced-dose prescribing,
and conducting information campaigns to
promote wise use through sustainable healthcare
campaigns. Health agencies that purchase
medicines for public use should be made aware
of the environmental issues associated with APIs,
and discuss these with their suppliers. Waste drug
take-back schemes should also be promoted, with
better education for customers from prescribers
and at the point of sale. Similarly, for veterinary
APIs, the risks of overuse and misuse of these
products must be effectively communicated to
farmers and larger food producers, food retailers
and relevant regulatory bodies; appropriate
restrictions and support mechanisms can be put in
place to limit the impact of veterinary APIs to the
intended target species. The use of veterinary APIs
to treat diseases in wild populations should also
be carefully controlled, and widespread baiting
of APIs should be avoided or carefully managed
to reduce non-target effects. In addition, while
recognizing that the causes of antimicrobial
resistance are complex, it is vital that greater
effort is made to understand the linkages between
veterinary and human use of APIs, environmental
exposure, and the development and transfer of
antimicrobial resistance genes in pathogens.
It is important also that scientists, practitioners
and policy-makers in both the health and
biodiversity sciences engage more closely with
food producers, pharmacologists, environmental
chemists and other relevant stakeholders to
better understand and address the potential risks
associated with APIs, and assist with identifying
cross-cutting indicators – including priority
species and ecosystems for future monitoring of
potential impacts – to better facilitate cooperation
and effective action. This should become an
integral part of wider efforts to mainstream a
sustainable development agenda into policies and
practice in the health-care sector (Vatovec et al.
2013; Schroeder et al. 2013; Morgon 2015). This
will become increasingly important in the face of
future social and environmental change.
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