Environmental sustainability for post-COVID healthcare
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The COVID-19 pandemic has, in a short time, inflicted huge personal suffering and had a long-lasting economic and social impact in every country around the world. As our attention starts to shift to the future and to economic recovery, how can we begin to move forward?

This is the question at the heart of a new 10-point action plan published on June 4, created within the framework of the Sustainable Markets Initiative established by His Royal Highness, the Prince of Wales, in collaboration with the World Economic Forum, in September 2019. The Sustainable Markets Council (SMC) is the Initiative’s high-level, public-private advisory board, on which AstraZeneca CEO Pascal Soriot sits as a founding member.

The action plan highlights the exciting potential for a sustainable global circular bioeconomy and outlines the interdependent strategies necessary to shape a resilient, sustainable and healthy future for people and the planet.1

So, what is a circular bioeconomy and how do we get there? At its centre is a new framework to transform and manage our land, food, health and industrial systems – working in harmony with society and the natural environment to deliver sustainable and holistic wellbeing.1

As a global organisation committed to sustainability there are multiple ways in which we can all help contribute to the broader vision and actions set out in the paper, some of which are spotlighted below:1

  • Aim for sustainable wellbeing: investment in nature and biodiversity is critical if we are to benefit the climate and societal health. This means replacing solely economic measures with those that reflect sustainable wellbeing, including human health. Here, the United Nations (UN) Sustainable Development Goals2 provide the perfect foundation for establishing a framework to measure the positive impact of creating a circular bioeconomy.
  • Ensure an equitable distribution of prosperity: managing biological resources offers a credible opportunity to reimagine and co-create value chains that include local communities in all elements of decision-making and benefit-sharing – rather than only harvesting knowledge or resources.
  • Rethink holistically our land, food and water systems: from sustainable agriculture and smart forestry, to understanding the deep connections between land use, animal and human health, transforming systems to deliver sustainable practices could have a substantial impact on reducing greenhouse gases, contributing around 30% of the 2050 global mitigation target of 1.5º Celsius.3
  • Transform industrial sectors: with global industry a major contributor to greenhouse gases, it is essential that viable resource-efficient and low-carbon alternatives to current production methods, resourcing and recycling are identified, based on using renewable energy and sustainably sourced materials. This requires a multifaceted approach to maximise the use of environmental resources and minimise impact at every level.

This shift to a circular rather than linear approach will, inevitably, take time – and aligned with the paper there are several challenges for global sectors, such as the biopharmaceutical industry, to act upon in steering this change:1,4

  • intensifying research and education efforts across multiple disciplines to deliver whole-system solutions
  • developing co-creation innovation practices alongside local partners and communities
  • ensuring strategy and decision-making are guided by nature and our impact on the environment
  • establishing cohesive policies for climate, land/site management, waste, water and health
  • instilling robust ecopharmacovigilance and creating an enabling and transparent regulatory approach through engagement with global regulatory agencies
  • placing people and environmental prosperity front and centre of economic recovery and establishing new imperatives to measure success

The circular bioeconomy and the pharmaceutical industry

The world is waking up to the economic as well as environmental need for the shift from a linear to a circular approach for a sustainable future. Investors, governments and healthcare providers are setting their own greenhouse gas reduction targets and placing increased scrutiny on their Scope 3 indirect carbon emissions related to the goods and services they procure and the companies they invest in.5,6 The global seeds of green substitution and green procurement have been sown and are starting to germinate,7,8 as demonstrated by our lifecycle approach to product environmental stewardship (see Figure 1).

Figure 1: Our lifecycle approach to product environmental stewardship4

These shifting market demands are seeing healthcare systems take a holistic view of the complete care pathway; the environmental impact of the medicine itself, use of power and resources by the organisation and its supply chain, and the impacts of patients with poorly managed chronic disease.

For example, with 5.4 million people in the UK with asthma – and a single inhaler having the same carbon impact as a 180-mile car journey – the National Health Service (NHS) is working to halve the carbon impact of inhalers by 2028.9 Additionally, the organisation’s Sustainable Healthcare Coalition has developed guidance to evaluate the environmental impact of existing health and care pathways and consider sustainability when designing or re-designing models of care.10

Connecting healthy business, people and planet

A healthy planet is essential for promoting human health. All those with the power to make changes need to come together to act on an environmentally sustainable economic model to deliver global health.11

Communities don’t necessarily choose the quality of the air they breathe and the water they drink or the food they eat. There are more people globally with access to a mobile telephone than clean drinking water or basic sanitation12 – despite, and perhaps because of, the rapid pace of urbanisation. Now is the time to take integrated action to protect and support the current and future health of people and planet.

At AstraZeneca we’re united by our desire to push the boundaries of science to deliver life-changing medicines. We know it’s how we will continue to transform the lives of millions of patients around the world while delivering value to our employees, our communities, and the environment. We believe there is a strong connection between the health of our business, our patients, our workforce, and the planet and that each of these impacts the others.

Despite the complexity of the challenges ahead, we are confident of a sustainable future. We are working hard to address these challenges with ambitious actions, operating in a way that recognises this interconnection.

From sourcing renewable power through to solvent recovery, water reuse and understanding and minimising the environmental footprint of our medicines, the ambition is to be part of the global transition from a brown to green economy that best serves patient, societal and environmental priorities.

With the Lancet Commission citing climate change as the century’s greatest global health opportunity,13 we are taking action across all our activities to contribute toward a healthy planet and healthy people:

Greenhouse gas reduction

Greenhouse gases from human activity represent the major contributor to climate change in the past 50 years. We recognise there is a plethora of opportunities to improve global health through greenhouse gas reduction,14 so addressing decarbonisation in our own organisation and throughout our value chain is a business imperative. Our Ambition Zero Carbon, unveiled in January 2020, brings our plans for complete decarbonisation forward by more than a decade through a raft of initiatives, delivering a carbon negative value chain across all sites and suppliers by 2030. Our targets are verified in line with the science of climate change, working alongside internationally recognised bodies such as Science Based Targets Initiative and the Sustainable Markets Council to accelerate the transition to a global decarbonised economy.

Product environmental stewardship

Society deserves products with minimal environmental impact, without sacrificing safety or efficacy. Consequently, we evaluate all materials and processes used throughout product development, from discovery to end of life. In addition, we also address other areas including responsible R&D, supply chain, water and waste. A key priority contributing to our climate agenda is switching to next-generation propellants with near-zero global warming potential in our asthma and COPD devices.

Water stewardship

With almost one third of people globally without access to clean drinking water,15 we are taking a broad approach to water stewardship, reducing the water used at our sites and ensuring the quality of the water we put back into the environment. We’re also looking at the impact of climate change in water-stressed areas – where the need for responsible water management is even more important – to understand the local risks in the places and communities where we operate and to future-proof our response. Together with experts from the global water stewardship team at World Wide Fund for Nature (WWF) Sweden, we have initiated a project to analyse the physical, reputational and regulatory water risks within WWF’s Water Risk Filter across our global operations, to establish how we can strengthen our water stewardship programme.

Pharmaceuticals in the environment (PIE)

Pharmaceuticals primarily enter the environment through human excretion and improper drug disposal, which has a negative impact on wildlife and human health. To help determine the risks and ensure safety throughout the product lifecycle, we've made environmental data transparent for all our products, we keep these risk assessments up to date through ecopharmacovigilance, and we are the only company to have safe discharge targets in our annual report for our own production sites and those of our suppliers. Our PIE statement outlines our industry-leading approach to ensuring the environmental safety of our medicines.

Waste management

Waste can pollute and have a negative impact on the planet and people’s health. We look at waste not only in its end state, but also how it was produced – focusing first on prevention and reduction. Our approach makes sure that where waste cannot be avoided, we explore every option to ensure it can be repurposed and reused by others. Reducing waste lowers the risks to people and the environment and maximises resource efficiency, balancing the use of natural resources with what can be sustainably regenerated. In 2019, initiatives across our sites replaced over two million pieces of plastic cutlery with compostable or reusable alternatives. We signed the UK National Health Service (NHS) Plastics Pledge across all our R&D and operations sites to remove specific items of plastics.

The need to connect the health of people with the planet’s health on the global agenda is key to driving more sustainable solutions for healthcare, given the vast cost to our health of air, water and soil pollution as reflected by an estimated nine million premature deaths globally.16 By supporting healthy environments, we contribute to a healthier ecosystem and could slow – even prevent – the incidence of disease on a global scale.

At a local and national level, proactive disease prevention takes precedence as we help to broaden access to healthcare, with screening and early diagnosis programmes to tackle high-burden non-communicable health conditions, particularly in low- and middle-income countries that currently lack the necessary healthcare infrastructure and have been further impacted by Covid-19. We are working towards a future where all people have access to sustainable healthcare solutions for life-changing treatment and prevention, through awareness and education programmes, training healthcare professionals and activating health facilities.4 To achieve this, all stakeholders in global health will need to review processes and resources to identify where we can innovate, where we can remove, reduce, reuse and recycle materials, and where we can ensure that need is matched to resources.

For us as a company, this means adopting an end-to-end approach to sustainable medicines development, from discovery to end of life, with circularity at every stage.

Working with others to drive societal change

It’s also why we’ve connected our company targets to the 17 Sustainable Development Goals laid down by the United Nations (UN) 2030 Agenda for Sustainable Development and to contribute directly at that level.2

In practice, this means understanding the biggest issues we face as a global community and measuring business success through our contribution to healthy people and a healthy planet, whether that is sustainable management and efficient use of natural resources, reducing waste generation and promoting sustainable procurement practices, or cutting premature death from non-communicable diseases (see Figure 2).

Figure 2: Our company approach to sustainability4


It’s also why we – and other leading enterprises – are setting ambitious targets that go beyond the aim set by governments around the world to be carbon zero by 2050. Our pledge is to be carbon zero by 2025 and carbon negative across our value chain by 2030, using our voice as a purpose for good with governments and in the communities in which we operate.4

Our 10-year strategy and targets for carbon, energy, water and waste, was set in 2015: decoupling economic growth from natural resource depletion for the first time. Now, Ambition Zero Carbon takes this to the next level – innovating, redesigning and rethinking our operations and our supply chain and taking those learnings to the broader community.4

Currently, pharmaceuticals are the only class of compounds that are approved irrespective of environmental hazard and risk where the societal benefit is assumed to always outweigh any environmental impact. It’s essential we identify any environmental concerns as early as possible, so we can mitigate these risks and ensure patient access to medicines does not compromise environmental protection. It’s why we are leading efforts to prioritise which legacy pharmaceuticals authorised before the current environmental testing requirements need to be evaluated for their environmental impact. We are also developing innovative approaches where environmental considerations can be integrated alongside traditional measures of safety and efficacy.
 

Currently, pharmaceuticals are the only class of compounds that are approved irrespective of environmental hazard and risk and this is under increased scrutiny given that drug targets are highly conserved across wildlife.

The enormity of the task at hand is without question. And the financial and regulatory hurdles can feel prohibitive. Collectively, we must collaborate and co-create to deliver the innovation, interconnectivity and infrastructure that will put societal and environmental health at the forefront of economic prosperity.

The shift to a more sustainable future requires a systems-level holistic view. We must collaborate beyond our own industries, co-invest rather than compete for natural resources to meet business demand, and work with governments to ensure the right infrastructure, fiscal environment and long-term vision is in place to enable transformational change.

 

Putting a biocircular economy into action at AstraZeneca

  • Sustainable Markets Council:17 AstraZeneca is a voice for the healthcare and biopharmaceutical industries on this high-level advisory board, created by His Royal Highness, The Prince of Wales, which brings together public-private-philanthropic leaders with the purpose of accelerating the potential for sustainable market creation and a decarbonised global economy.
  • United Nations Global Compact: As patron sponsor of UNGC the United Nations Global Compact (UNGC) action platform: Business Ambition for Climate and Health, we set climate targets across our operations and value chains aligned with limiting global temperature rise to 1.5°C above pre-industrial levels and reaching net-zero emissions by no later than 2050.
  • Ambition Zero Carbon: Our targets for climate change have been verified by the Science Based Targets initiative, which specifies how much and how quickly organisations need to reduce their greenhouse gas emissions, and we aim to go even further with our Ambition Zero Carbon strategy. Since 2015, we have reduced our carbon emissions from operations by almost a third and our water consumption by almost one fifth. Our AZC initiative, unveiled early 2020, will see 100% conversion of heat and power to renewable sources by 2025 and an ambition to be carbon negative across our entire value chain by 2030.
  • AZ Forest: Our AZ Forest initiative is a global commitment to plant 50 million trees over the next five years in partnership with local governments and the not-for-profit organisation One Tree Planted, with the first of 25 million being planted in Australia in February 2020 to reflect the devastating losses bushfires have caused in that country.
  • Nagoya Protocol: AstraZeneca operates under the terms of the internationally binding Nagoya Protocol to ensure equitable access and sharing of benefits; working in partnership with local communities in a fair and transparent way to preserve genetic resources and local biodiversity.

 

References

1. Palahí, M, Pantsar, M, Costanza R, et al. Investing in nature to transform the post COVID-19 economy: A 10-point action plan to create a circular bioeconomy devoted to sustainable wellbeing. The Solutions Journal 11: 2. Available at: https://www.thesolutionsjournal.com/文章/investing-nature-transform-post-covid-19-economy-10-point-action-plan-create-circular-bioeconomy-devoted-sustainable-wellbeing/. Last accessed June 2020.

2. United Nations Sustainable Development Goals. Available at: https://www.un.org/sustainabledevelopment/sustainable-development-goals/. Last accessed June 2020

3. Roe, S, Streck, C, Obersteiner, M, et al, 2019. Contribution of the land sector to a 1.5 °C world. Nat. Clim. Chang. 9, 817–828. doi:10.1038/ s41558-019-0591-9

4. AstraZeneca Sustainability Report 2019. Available at: https://www.astrazeneca.com/content/dam/az/Sustainability/2020/pdf/Sustainability_Report_2019.pdf. Last accessed June 2020

5. Carbon Trust. What are Scope 3 emissions? Available at: https://www.carbontrust.com/resources/what-are-scope-3-emissions. Last accessed June 2020.

6. Investor AB. Climate and resource efficiency. Available at: https://www.investorab.com/sustainability/climate-resource-efficiency/. Last accessed June 2020

7. Global Efficiency Intelligence. Curbing carbon from consumption: the role of green public procurement. Available at: https://www.climateworks.org/wp-content/uploads/2019/09/Green-Public-Procurement-Final-28Aug2019.pdf. Last accessed June 2020

8. Healthcare Without Harm. Strategic procurement in European healthcare. Available at: https://noharm-europe.org/sites/default/files/documents-files/6171/2019-12-17_HCWHEurope_Strategic_Procurement_Web.pdf. Last accessed June 2020

9. NHS Sustainable Development Unit. Anaesthetics and inhalers. Available at: https://www.sduhealth.org.uk/nhs%20long%20term%20plan/carbon-reduction/anaesthetics-and-inhalers.aspx. Last accessed June 2020

10. NHS Sustainable Development Unit. Sustainable care pathways and guidance. Available at: https://www.sduhealth.org.uk/areas-of-focus/carbon-hotspots/pharmaceuticals/cspm/sustainable-care-pathways-guidance.aspx. Last accessed June 2020

11. United Nations Global Compact. Business leadership brief for healthy planet, healthy people. Available at: https://d306pr3pise04h.cloudfront.net/docs/publications%2F2019_HealthReport_Web.pdf. Last accessed June 2020

12. Medium. The world’s poor people have mobile phones. Why can’t they get clean water and sanitation? Available at: https://medium.com/@marcgunther/the-world-s-poor-people-have-mobile-phones-why-can-t-they-get-clean-water-20ef9686a850. Last accessed June 2020

13. Watts, N, Adger, WN, Agnolucci, P, et al, June 2015. Health and climate change: policy responses to protect public health. Lancet 386: 10006; 1861–914. doi:10.1016/ S0140-6736(15)60854-6

14. Watts, N, Amann, M, Arnell, N, et al, November 2019. The 2019 report of the Lancet Countdown on health and climate change. Lancet 394: 10211; 1836-78. doi.org/10.1016/S0140-6736(19)32596-6

15. WHO / UNICEF. 1 in 3 people globally do not have access to safe drinking water. Available at: https://www.who.int/新闻-room/详细/18-06-2019-1-in-3-people-globally-do-not-have-access-to-safe-drinking-water-unicef-who. Last accessed June 2020

16. Landrigan, PJ, Fuller, R, Acosta, NJR, February 2018. The Lancet Commission on pollution and health. Lancet 391: 10119; 462-512. doi.org/10.1016/S0140-6736(17)32345-0

17. World Economic Forum. Championing sustainable markets. Available at: https://www.weforum.org/sustainable-markets/smc. Last accessed June 2020

 

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