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Eco-labelling and climate requirements – will medicines also be sustainable?

Should medicine be assessed on how sustainably it is produced, packaged and transported? Can we even expect to make the choice at the pharmacy: Do you want a sustainable variant? Or should the authorities make the demands long before the medicine is on the pharmacy or hospital shelves? Sustainability requirements are rumbling on the pharmaceutical industry – but how is this challenge approached in such a complex and regulated industry? 

By Camille Aulkær Andersen

Power and safety. Two of the most important bricks on the scales of the clinical evaluation of all medications. And, of course, when it comes to shopping for health care, price and security of supply are also taken into account. But now an additional parameter has emerged: Sustainability. And how do you think such a complex size enters the already complex pharmaceutical sector?

The patient who consumes

From a consumer perspective, the medicines available to us in Denmark can be roughly divided into two piles: what ends up in hospitals that the patient does not choose, and what is dispensed or purchased at the pharmacy, where the patient has some influence on the choice. We are increasingly seeing patients acting as consumers, and countless studies show that consumers' shopping habits are becoming more and more sustainable. And this is where labelling schemes come in. For example, an analysis from the Confederation of Danish Industry from 2019 shows that two out of three Danes emphasize eco-labels when shopping. So should the medicines we buy be eco-labelled in the future, just like food?

Tamira Snell, senior adviser at the Institute for Foresight, says.

-Labelling schemes help, among other things, to guide the consumer in their decision-making processes, by clearly communicating a message. At the same time, they can help drive behavioural changes in consumption, such as the green keyhole label, which quickly shows when an item in the supermarket is healthier than others without the consumer having to read long nutrition declarations. Research has shown that we have a lot of cognitive biases, or thought processes, when making decisions. By making complex information transparent, the labelling system makes it easier to choose a particular product. It is an excellent way to filter in complexity.

Eco-label - is there room on the package?

However, if you ask the Danish Pharmaceutical Industry Association (LIF), it is not so straightforward to transfer a method such as eco-labelling to medicine:

-Something that speaks against outright labelling is that on pharmaceutical packages there are some rather strict requirements for what should be said – and the focus is rightly solely on quality and safety. If you put on an extra label, it fills up and may take the focus off something else that may have an impact on the safety of the use of the drug. Because is it appropriate for people to focus on an eco-label rather than, for example, describing the method of use and any warnings? It is a dilemma and perhaps a major discussion in society. What is most important for public health? Says Jakob Bjerg Larsen, Policy Head of Clinical Trials and Drug Production at LIF, and his colleague Louise Broe, Chief Consultant for Patient Access in LIF, adds:

-We are, after all, a global industry that is subject to international rules including EU regulations. So a Danish labeling will be a challenge. But I think it's something that actually matters to patients. That pharmaceutical production does not pollute its sustainable development, that packaging can be recycled. But it's hard because how does it affect patients' choices - the extent to which they can choose - and SHOULD it? There must be popular pressure, but I think it must be the hospital system and the state that must guarantee such criteria when they act in and award grants.

Environmental requirements have become natural

Criteria for sustainability in medicine should therefore be specified when buying large. Such purchases are made, for example, through the company Amgros, whose task is to ensure the supply of medicines to the public hospitals in Denmark. And there we are already in the process of the sustainable agenda:

-The time is over when the supply was all about quality, price and delivery. Therefore, earlier this year we published the first joint Nordic tenders together with Norway and Iceland, where the environment is one of three important criteria together with price and security of supply. And shortly afterwards we published the first national tender, where the environment is included as a criterion together with price. So it has become natural that we now look at both price and environment, says Flemming Sonne, CEO of Amgros and continues:

-For new medicines, the European regulation requires a number of
environmental requirements in relation to manufacturing. However, many of the old medicines, which amount to around 50-60%, come from suppliers where the raw material is produced in, for example, Asia, and we do not know under what conditions. It's a very complex area. Therefore, our demands have initially gone on the transport and packaging. Because that is something that can be done about. This has been done in close cooperation with both DTU and the suppliers.
In addition to introducing environmental criteria into the national supply of medicines, we are raising expectations in the framework agreement for the suppliers who win the tender. And as far as the joint Nordic tenders are concerned, they will be weighted according to the three environmental and sustainability criteria: Certified environmental management, e.g. ISO 14001, good environmental practice within zero emission and treatment plants, and transport of the medicines.

Growth and green transition can be reconciled

But what do the producers say about this development? Jakob Bjerg Larsen from LIF says:

-As a trade association, we would love to help support the purchase of greenery. So when companies make an effort and make green solutions, we would like to see it taken into account when the public sector buys in. Our members think the development is positive. I think they are aware that if you as a company do not work with green solutions, then it becomes harder and harder to attract labour. And with the demands of amgros, for example, you will also be able to read it on the bottom line if you are not green. However, the green initiatives must be much broader than just a label. It's about how companies generally handle climate and sustainability, how it's thought into their business. It must be a holistic consideration. The label must not become an easy solution.

At the same time, he stresses that sustainability has long since proven to be a good business, also for the pharmaceutical industry:
-From 1990 to 2017, the pharmaceutical industry in Denmark has managed to reduceCO2emissions by 55%. At the same time, the added value of the pharmaceutical products we export has increased by 12fold. So it has been possible to decoupling growth andCO2emissions, initially because it produced more efficiently. And it has the positive consequence that it is more green. So growth and green transition can go hand in hand.

More demands, yes please!

So should we expect the medicines we get in hospital or buy to be sustainable in the future? If you ask for the future, there is some evidence to suggest this:

"We see sustainability as a megatrend that has evolved significantly over the last 10-15 years – and where consumer awareness has increased. As a general societal flow, sustainability will only grow. Here, industries that are not automatically associated with sustainability can have a huge advantage in acting proactively. In many cases, the end user of the pharmaceutical industry will behave and expect the same as they do in relation to all other brands, says Tamira Snell of the Institute for Future Research.

Amgros also predicts more of the same drawer. Flemming Sonne says:

-It is a transitional period until it is natural for all companies to think environment into production. If the whole of Europe made these demands, then the change would probably take place quickly, but just making a change request in the registration of a product can take months or years. Companies are increasingly receiving sustainability certifications and ISO-certified environmental management systems, but sustainability is also about the use of medicines, such as what ends up in our wastewater. And that's why Amgros can't do this alone. But it must be clear to everyone that this area is only going in one direction. And that's ahead. Therefore, we will continue to develop our requirements for the environment and sustainability in close cooperation with partners. So if you ask me if we are going to make more demands on the environment, then the answer is yes!