Making medicines sustainable
There’s a new cross-healthcare initiative to cut medicines waste and lower carbon emissions while also improving healthcare equity and serving patients. Pharma will be a key player
Healthcare’s sustainability record to date leaves much to be desired. The sector contributes 4.4% of total global emissions, healthcare costs continue to rise, and waste is rife. At the same time, two billion people lack access to even basic healthcare.
These are big problems but there is one way to act on them at scale that will be a win for patients, care providers, taxpayers and pharma.
Medicines waste is the problem and cutting it is the aim of the Sustainable Medicines Partnership, a body which is about to launch a new four-year programme to find solutions that will work at scale.
Its director is Nazneen Rahman, who is also the founder of YewMaker, an innovation incubator with a mission to build, test and scale sustainable healthcare solutions, as well as a molecular genetics researcher and former professor of human genetics at the Institute of Cancer Research.
A big part of the challenge in tackling waste is that the issue lies across such a wide swath of the healthcare sector, says Rahman. Different bits of the healthcare system work in silos and so cannot effect the system-wide change needed.
Trying to drive change in this highly-complex, highly-regulated system replete with competing incentives and interlocking commercial and not-for-
profit organisations, therefore requires concerted, industry-wide action to drive change, she says. “The challenge of systemic change is hard but if you get in at the foundational levels the scale of the impact can be extraordinary.”
Rahman is convening experts from across pharma, healthcare, academic and related fields such as supply chain and even food to help build solutions to build a community of ‘change makers’ capable of meeting this challenge. “These are difficult, systemic problems that can only be solved if people work together,” she says. “There are pockets of people working on recycling or redistribution or inventory science but they are not connected.”
The four-year Sustainable Medicines programme will begin next year to explore evidence-based, scalable solutions that the wider sector will be able to adopt. As well as seeking to measure the environmental impact of medicines, the project seeks to find ways to make medicines more sustainable by:
Minimising waste via better quality assurance and agile supply chain processes
A big impact on waste can come from smarter supply chain approaches. For example $37 billion of medicines are lost annually due to failures in cold chain logistics alone. Another source of waste comes from the necessity to hold excess inventory in supply chains, says Rahman. “That excess is hundreds of billons of medicines a year and currently most of that excess is destroyed. We are asking: can you use inventory science to better optimise and use that supply?”
Exploring ways to improve medicines shelf life
Stability data sets medicine shelf lives typically at around two to three years, yet 90% of medicines are effective for five years longer on average, says Rahman. “That shelf-life date may not be when that medicine becomes ineffective but there are no systems to test that and allow you to extend their life at the moment.”
The SMP is helping to set up and monitor a series of pilots to test medicine effectiveness on expiry and allow better medicines allocation systems. One pilot, currently being trialled in California, should give the industry confidence that such initiatives can work well at scale.
Moving to digital-as-default provision of information
On top of the huge quantities of paper used in medicines information leaflets, comes other waste - millions of dollars-worth of medicines are discarded annually due to leaflet issues either because they need to be updated or because there are errors in them. On top of this the leaflets are far from patient-centred and consequently patients often don’t read them.
Decoupling patient information from medicine packs thus has many advantages, says Rahman. “It can provide ways of making things more patient centred and more efficient. You reduce that amount of-paper and also improve the patient experience in terms of accessing that information.”
The advantages of a digital-first approach may be obvious but getting there isn’t so easy, she adds. “This can seem quite a simple change but it is a big change to orchestrate and drive.”
Using every dose
It’s estimated that manufacturers destroy 3% of medicines, around 135 billion doses a year, often surplus doses. In the US and the UK around 10% prescriptions are not collected (US, UK) and smart, dynamic stock-control solutions are rarely used to help limit waste.
The SMP will explore the potential to use deep analytics to optimise inventories and it will also explore the potential for equitable access programs along with developing standardised reallocation processes.
Creating more sustainable packaging
A trillion medicines packets are thrown away every year, going for landfill or incineration, yet most medicines plastics could be recycled. Eliminating single-use plastics is a priority. The SMP is starting with blister packs as an exemplar of hard-to-recycle healthcare plastic.
Hundreds of billions of blisters are discarded each year. Technical, logistical, and regulatory constraints on composition, collection, sorting, and disposal have impeded progress but new collaborations, innovations and legislations are facilitating change that can be replicated for other plastics.
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The benefits of finding ways to cut waste at scale across healthcare in the ways listed above are not merely environmental, they will help reduce costs and increase efficiencies, cut energy and water waste and improve medicines access and equity.
But this requires a commitment to sustainability as a guiding principle, not an add on. Driving the deep cultural change inside the organisations that matter to effect this change will be key to success, says Rahman. “It must become who we are and how we operate, so we won’t need to talk about it as a separate issue anymore. As businesses, we have to move this issue from values and philanthropy to something that is simply good for business.”
For more information on the Yewmaker and the Sustainable Medicines Partnership visit https://www.yewmaker.com.