Executive summary

In recent years, scientific researchers have identified an additional cause of Antimicrobial resistance (AMR): environmental pollution from the production of antibiotics. Factories in China and India, which produce the lion’s share of the world’s antibiotics supply, have been found to be dumping manufacturing waste into their surroundings, resulting in the contamination of rivers and lakes and fuelling the proliferation of drug-resistant bugs.

Healthcare professionals everywhere are fighting a roundthe-clock battle to contain rising antimicrobial resistance rates. In Europe alone, around 25,000 people die every year as the result of contracting an infection which proves resistant to treatment. By 2050, that figure is expected to rise to 390,000, with the total death toll worldwide reaching 10 million.

AMR, and particularly the diminishing effectiveness of antibiotics to treat bacterial infections, strikes at the foundations of modern medical practice. Beyond the essential role antibiotics play in treating life-threatening conditions such as sepsis, countless medical procedures including hip replacements, caesarean sections and chemotherapy are reliant on their use. Nevertheless, many experts are now warning that we could be facing a future without antibiotics. This is a chilling prospect: without them, common illnesses, minor surgery and routine operations could become high risk procedures.

In the UK, where antibiotic consumption is on the rise and drug resistance rates are also increasing, considerable human and financial resources are being channelled into tackling AMR including through improved hygiene in clinical settings and better prescribing practices. Concern about drug resistance has reached the highest levels of government: in 2014 Prime Minister David Cameron commissioned a Review on Antimicrobial Resistance led by a renowned international economist, Lord Jim O’Neill, to establish the scale of the human and economic threat. Its conclusions were sobering, with Lord O’Neill, warning of the end of modern medicine as we know it.

Antibiotic resistance is a complex phenomenon with multiple interlinked causes. There is agreement across the board that the rampant misuse of anti-infectives in human medicine and farming is the major driver of AMR worldwide. In many countries, action is being taken to address these twin factors with varying degrees of success.

In its December 2015 report “Antimicrobials in Agriculture and the Environment: Reducing Unnecessary Use and Waste” the Review on Antimicrobial Resistance identified pollution in the pharmaceutical supply chain as a causational factor in the spread of AMR and called on the industry to take measures to tackle it, also noting that “Major buyers of generic antibiotics could factor appropriate management of environmental considerations, including the amount of APIs and antibiotics that the company or their suppliers generate as waste, into their procurement decisions”.

This briefing, which contains information from detailed reports and on-the-ground investigations into pharmaceutical pollution carried out in 2015 and 2016, shines a spotlight on the conditions in which some of the most commonly prescribed drugs in the UK are manufactured. It shows how dirty production and the dumping of inadequately treated antibiotic waste in China and India, where most of our drugs are produced, is fuelling the AMR crisis through the back door. Highlighting the astonishing lack of transparency in the pharmaceutical supply chain, it calls on the National Health Service (NHS) and other big purchasers to use their buying power to help bring about a sea change in drug manufacturing practices by blacklisting products manufactured by pharmaceutical companies at the heart of the antibiotics pollution scandal.