Executive summary

India is in the grip of a severe water pollution crisis. A 2015 report from the Indian Government estimates that the number of contaminated waterways has more than doubled in the past five years and that half of the country’s rivers are now polluted. A variety of factors have contributed to this critical situation, notably the staggering quantities of untreated sewage generated in this country of nearly 1.3 billion people. Another major cause is industrial pollution, the dark side of India’s economic development.

In recent decades India’s pharmaceutical industry has scaled new heights in step with a steady rise in population and thanks to its reputation as a low-cost manufacturing destination for multinational drug companies. In particular, its bulk drug production sector, which has a major hub in the southern Indian city of Hyderabad and a more recent presence along the coastline of Andhra Pradesh, has experienced a rapid ascent since the 1970s. While this has yielded obvious economic benefits for both Indian and overseas-based firms, as well as dividends for shareholders, scant attention has been paid to the impact of increased pharmaceutical production on the environment and inhabitants living in proximity to factories and industrial parks.

The emergence of a globalised pharmaceutical sector, which accelerated in the wake of the World Trade Organisation’s agreement on trade-related aspects of intellectual property rights (TRIPs) in 1994, has given rise to a sophisticated and geographically dispersed industry reliant on a highly complex supply chain network comprising thousands of suppliers worldwide. Outsourcing of production to the emerging markets, where labour is cheap, workforces skilled, and environmental standards lax, has now become second nature for the pharmaceutical majors, many of which are based in the United States and Europe.

Indeed, the vast majority of the world’s drugs are now manufactured in India and China. While China has become the dominant supplier of the Active Pharmaceutical Ingredients (APIs) used to make medicines, India has a sizeable share of API production itself, and has also carved out a niche in processing drugs, which it ships to markets around the world as finished products.

Pharmaceutical supply chains are as opaque as they are complex and while it is relatively easy to describe broad trends, granular detail is hard to come by. Information about the origin of APIs and the finished products that end up on our pharmacy shelves is kept confidential by drug firms, which are unwilling to open up their supplier relationships to public scrutiny. Regulators, who could easily demand greater transparency from the pharmaceutical industry, have so far shied away from taking action.

There are several elements to consider when assessing the pharmaceutical sector’s environmental footprint. One is the energy used during production and processing. Another is the generation of waste-solid, liquid or airborne – from the manufacturing process. While pharmaceutical contamination of water has only recently permeated the public consciousness, it has been on the scientific community’s radar for decades. There is now a compelling body of research on the negative effects resulting from the accumulation of pharmaceuticals in the environment, which range from the near elimination of entire species3 to the feminisation of fish and the spread of antimicrobial resistance (AMR).

This report looks at the latter aspect, focussing on the major public health threat posed by pollution from antibiotics manufacturing plants in India, which is believed to be contributing to soaring drug resistance rates in the country and further afield. This has serious implications for global health as antibiotic resistance genes spread around the world through travel and trade with India.

Based on evidence from an on-the-ground investigation in the southern Indian states of Telangana and Andhra Pradesh in early 2016, as well as thorough analysis of industry data and the latest academic research, this report documents local impacts of drug pollution – including extreme contamination of waterways and agricultural lands – and identifies some of the key players at the root of the problem. It draws links between polluting manufacturers and some of the large multinational pharmaceutical companies they have dealings with, highlighting the need to establish and implement strong environmental standards at every stage of the supply chain.

As is explored at length in this report, people living in the vicinity of dirty pharmaceutical manufacturing sites, who are often poor and reliant on subsistence farming, are those whose health is at most immediate risk from the toxic effluents and API-laden waste being deposited in their rivers, lakes, groundwater and fields. However, because of the way in which antibiotic manufacturing discharges trigger resistance in bacteria present in the environment, spreading to human pathogens which then travel the world, antibiotic pollution puts everyone at risk, wherever they live. This is why AMR is often compared to climate change, given the scale of the challenge it poses, and the coordinated global response which is required to tackle it.