As extreme weather events increasingly threaten each point in the pharmaceutical supply chain—from production facilities to hospitals to home medicine cabinets—Canadian practitioners are amongst those urging changes for greater resilience.
When wildfires ravaged the Northwest Territories last August, thousands of residents were forced to flee south into Alberta, displaced from their homes and essential services.
One of these essentials was access to a pharmacy, the Alberta College of Pharmacy (ACP) wrote to its members, offering them guidance on assisting evacuees who may arrive without health records and prescriptions.
The College also reminded members to notify it “as soon as possible” should a natural disaster force an Alberta pharmacy to temporarily close. On reopening, a pharmacy must “exercise caution and professional judgement in using drugs that may have been impacted by smoke/fire damage” or power disruptions. For drugs or vaccines that require refrigeration, “if there is no evidence that temperatures were maintained, you must assume they were not,” the ACP warned.
Just weeks before the ACP issued this wildfire advice, a major drug supplier in the United States faced a different natural disaster. A tornado spurring 240-kilometres-per-hour winds tore large sections of roof off a Pfizer facility in North Carolina.
“I’ve got reports of 50,000 pallets of medicine that are strewn across the facility and damaged through the rain and the wind,” Nash County Sheriff Keith Stone told The Associated Press at the time.
It would be 10 weeks before the facility—which makes anesthesia and nearly 25% of the sterile injectable medications that Pfizer supplies to U.S. hospitals—could restart production of 13 medications that had been “prioritized based on patient need and inventory levels,” AP said in a follow-up report. A return to full production capacity was not expected till well into 2024.
Six years earlier, AstraZeneca, a top global producer of cardiac, renal, and metabolic medications, as well as cancer drugs, was forced [pdf] by Hurricane María into a three-week hiatus at its manufacturing plant in Canóvanas, Puerto Rico.
Then once again in September 2018, the pharmaceutical titan had to dial back production for two weeks at its facility in Södertälje, 30 kilometres west of Stockholm, when excessive heat and humidity endangered the manufacturing process. One year later, AstraZeneca’s production line would be halted once more, this time at its processing plant in drought-stricken Chennai, India, in another example of how the climate crisis increasingly threatens the security of local, national, and international drug supply chains.
An Unhealthy Carbon Footprint
The outsized carbon footprint of pharmaceuticals implicates the industry in the climate-related challenges its supply chain faces. An exact accounting of emissions remains elusive due to a lack of reliable data, but one 2019 study out of McMaster University pegged the industry’s Scope 1 and 2 emissions intensity at 55% higher than the auto industry’s.
In 2023, a literature review estimated [pdf] that the healthcare sector contributes roughly 4.4% of global carbon emissions, with approximately 71% of those emissions stemming from the supply chain, including production and transport of pharmaceuticals and medical devices. “Within Scope 3, pharmaceuticals and chemicals are the largest contributors of carbon emissions, accounting for 18% of total healthcare sector carbon emissions.”
In 2020-2021, analysis of the reported emissions and climate strategies of the world’s 20 largest pharmaceutical companies found some signs of progress. Nineteen of the 20 companies had “committed to reducing greenhouse gas emissions (GHGs), 10 to carbon neutrality, and eight to net zero emissions between 2025 and 2050.”
The companies “showed largely favourable reductions in Scope 1 (in-house) and Scope 2 (purchased energy), with variable results in Scope 3 (supply chain) emissions,” wrote the authors led by the Nuffield Department of Primary Care Health Sciences at Oxford University. “Strategies to reduce emissions included optimizing manufacturing and distribution, and responsible sourcing of energy, water, and raw materials.”
The need for green chemistry is also urgent, given the astonishing carbon footprint of anesthetic gases and inhalers. The climate impact of an hour of surgery using the anaesthetic desflurane is equal to driving 200 to 400 kilometres in a fossil-fuelled car, while a standard hydrofluorocarbon-enabled inhaler can have the same footprint as driving 170 kilometres, according to the Canadian Association of Pharmacists for the Environment (CAPhE).
Prescribing Pharma-Resilience
Incidents like Pfizer’s turbulent encounter with the North Carolina tornado last July are exactly what pharmaceutical companies need to be preparing for as the planet warms, said Ivan Lugovoi, an assistant professor of medical and pharmaceutical supply chain management at Kühne Logistics University in Hamburg.
He told trade magazine Pharmaceutical Technology (PT) the industry’s business model could be an obstacle, noting that efforts to increase resilience by sourcing raw materials from multiple suppliers may run aground on supplier resistance to sharing profits. Lugovoi added that moves to build redundancy into manufacturing by having more plants “may only be viable for larger companies who can afford the financial investment needed, and withstand additional costs,” writes PT. Given these and other obstacles, Lugovoi says the need for a climate resilient pharmaceutical chain must become a “public issue.”
Canadian public health professionals are addressing the issue—at home and on a global scale. “Working to ensure the security of pharmaceutical supply in the midst of various climate-amplified disasters is very much on my mind, and is part of our discussions,” Yellowknife emergency physician Courtenay Howard told The Energy Mix, citing her work with Health Canada to help medical schools deliver on their commitments under the Declaration on Planetary Health—now signed by the “vast majority” of academic health institutions.
A member of the World Health Organization-Civil Society Working Group on Climate Change and Health, Howard said moves to pressure pharmaceutical companies into reducing their sizable emissions are a large part of the mandate of the Alliance for Transformative Action on Climate and Health pharmaceutical working group.
Meanwhile, CAPhE is raising awareness about the climate perils affecting the security of drug supply chains.
“While formal, standardized protocols at a national level are in development, CAPhE is actively working to bridge the gap through dialogue and collaboration,” CAPhE co-director Shellyza Moledina Sajwani told The Mix in an email. “We engage with pharmacy regulatory colleges and pharmacy professionals nationwide, emphasizing the critical need for robust disaster planning and management protocols to advocate for the continuous availability of essential medications during environmental crises.”
Sajwani gave a shout-out to CASCADES, a sustainable pharmacy and prescribing practices initiative in Canada that is working with professional associations to share knowledge and resources for sustainable inhaler practices.
At the international level, a 2022 brief issued by the World Economic Forum urged the pharma industry to take all steps to reduce emissions, noting GlaxoSmithKline’s (GSK) effort to develop a lower-emission propellent for its inhalers—devices that currently account for a whopping 45% of GSK’s emissions.
The WEF also urges investments in “heat-stable products” for hot countries that cannot afford cold chain supply networks. Here, the organization cites efforts to develop a heat-stable version of oxytocin, a drug whose administration “largely prevents” post-partum haemorrhage, the leading cause of maternal mortality.
