Antimicrobial resistance (AMR) and how standardization is driving change

Liz Girardi Schoen

Liz Girardi Schoen, Sustainability Executive

Liz owns GRNQUN Consulting Inc. and was the global environmental sustainability leader for Pfizer, which she retired from in 2022 with 30 years of service. Before returning to Pfizer, Liz was VP global environment and sustainability for Teva and director of global environment for First Solar. Liz has sustainability expertise in multiple topics including AMR, greenhouse gas management, climate change strategy, energy conservation, global water management, ecosystem services, responsible supply chain, human rights, traditional EHS management, and manufacturing and operations.

Liz has experience with many NGOs and governments, e.g., The UN Global Compact, UNEP, UNDP, WBCSD, GEMI, BSR, WRI, and Wildlife Habitat Council. She served on the board advising Mayor Bloomberg in creating PlaNYC, the original sustainability plan for New York City, and remains on the board of the Building Energy Exchange a non-profit seeking to advance energy efficiency in New York City.

What is AMR?

Antimicrobial resistance is the ability of a microorganism to prevent an antimicrobial from working against it. While AMR occurs naturally and has always occurred, its rate and spread is accelerating. The World Health Organization (WHO) has described AMR as one of the biggest threats to global public health today.1

Why should I care?

The impact on human health is enormous – a risk of developing resistance to life-saving antibiotic medicines, and the economic impact’s also extreme.2

Is there anything I can do?

Each individual can help themselves and the whole world by doing some pretty simple things:

  • Only take antibiotics when needed and as directed by your doctor
  • Discuss keeping vaccinations up to date with your doctor
  • Wash your hands regularly
  • When prescribed antibiotics, take all doses and finish the course of medication as directed by your doctor
  • Never take antibiotics prescribed for someone else or prescribed to you for a different infection.

How do medicines get into the environment?

There are a few ways medicines enter the environment:

  • Mostly through normal patient use, that is both human and animal use. Medicines are taken, some are metabolized and some are not, and then are excreted. There is some reduction in processing of wastewater, and then wastewater goes to the environment
  • A major portion comes from agriculture through the application of manure as a fertilizer to land and use of antimicrobials in aquaculture
  • Some is from the disposal of unused medicines
  • A small amount is lost when medicines are manufactured.

Even though manufacturing emissions is not the main source of antibiotics in the environment, companies which take a risk based approach to environmental impact reduction proactively manage waste and emissions.3 

What is the pharmaceutical industry doing?

Some pharmaceutical companies have been working together for many years to reduce the impact of manufacturing on AMR.4 Recently, in June 2022, the AMR Industry Alliance group published a private standard to describe how to responsibly manufacture antibiotics. This standard is called “Antibiotic Manufacturing Standard: Minimizing risk of developing antibiotic resistance and aquatic ecotoxicity in the environment resulting from the manufacturing of human antibiotics”.

I led the team which created this standard working with our colleagues from British Standards Institution (BSI).

So what, what will a voluntary standard do?

The standard by itself may not do much, but there is a bigger plan beyond the standard. The standard is required to create a certification scheme, whereby the manufacturing of products can be certified to meet [or not meet] the standard. This certification would be undertaken by an objective assessment body (BSI). This concept of certification is not new; similar schemes exist for other products such a forestry and palm oil. 

Customers (so far only some government buyers in Europe) are already asking for evidence that antibiotic products are made responsibly. Today they ask complex questions, which require much information from producers, and customers are hard pressed to discern the results from the answers. Certified products would streamline and simply the process for these customers. In addition, if all customers asked for this certification, it would drive all suppliers of medicines to manufacture responsibly in order to sell products, creating market incentive to do the right thing for the environment.

Is that it then?

There’s still more work underway to get the certification scheme completed, up and running. The target is early 2023. Eventually all products can be certified to responsible manufacturing. Antibiotics and all medicines actually. Really exciting!

There is a lot to know about the subject, so I have provided links for you to follow to learn more. Share your thoughts and keep an eye out for more developments and information.