What pharmaceutical companies and EU policy commit healthcare to
The largest pharmaceutical companies have committed to cutting their emissions, and the emissions of their supply chains are harder to tackle than those of their own operations. Their targets answer to societal values, industry guidance and government legislation, and the European Green Deal carries climate and environmental goals into EU law for healthcare.
Company targets and the steps towards them
Although progress on tackling climate change is slow, the pharmaceutical industry is taking it seriously. In recent years pharmaceutical companies have set targets for reducing their greenhouse gas emissions, and these targets are regularly reviewed and often become more ambitious over time. Novo Nordisk, for example, committed to "net zero emissions in operations and transport by 2030, with net zero emissions across the entire value chain by 2045, at the latest". To meet such targets, companies are changing their business practices, for example by switching to renewable energy providers, optimising building design, reducing business travel, choosing lower-carbon transport for raw materials and goods, reducing waste, monitoring patients in clinical trials remotely, implementing vendor selection criteria, and offsetting carbon emissions.
A review of the company reports of the 20 largest pharmaceutical companies by prescription revenue, reported in a conference paper in 2022, found that 19 had committed to reducing carbon emissions, with half committing to carbon neutrality and 40% to net zero emissions by a range of target years. Ninety percent had committed to improving reporting and reducing emissions across their supply chain. One of the review's authors found their commitments difficult to compare, because the companies had different baseline emissions and baseline reporting years, ran different operations, had different product scopes and employee numbers, and made different kinds of commitment: to carbon neutrality, to net zero, or to a percentage cut by a certain year. Some commitments were vague about whether they covered scopes 1 and 2 only or scopes 1, 2 and 3. Where companies had reported emissions, most of the 20 had reduced scope 1 emissions and all had reduced scope 2 emissions from their baseline years of reporting.
Initiatives included renewable energy sources such as solar panels or wind farms, and many companies planned to switch to more energy-efficient equipment, optimise manufacturing processes through green chemistry principles, and switch their vehicles from petrol or diesel to hybrid or electric. GSK, for example, was working towards a target of net zero by 2030, and intended to install two new wind turbines (8 MW) and a 56-acre, 20 MW solar farm at its manufacturing facility in Irvine, Scotland. It was also redesigning its rescue metered-dose asthma inhalers to use a lower greenhouse gas propellant that, the company said, had the potential to cut its inhalers' greenhouse gas emissions by 90%. Other companies were beginning to move from batch manufacturing, in which materials are made in large bundles and are sometimes shipped to different locations between steps, to continuous manufacturing, a more efficient process in which drugs are made in a single location in an uninterrupted flow. Eli Lilly, Vertex Pharmaceuticals and Pfizer had adopted continuous manufacturing for part of their drug production. About three years before 2022, Sanofi opened a continuous manufacturing plant in Massachusetts that emits 80% less carbon dioxide than its first-generation facility and reduces water and chemical use by 91% and 94% respectively.
Why the supply chain is the hard part
Tackling scope 3 emissions was a tougher challenge than scopes 1 and 2, where companies were taking positive steps. A company's supply chain is quite diverse, taking in not only raw-material suppliers and waste management companies but also IT, lawyers, and marketing and communications companies. Finding a standardised method for measuring and reporting emissions from so diverse a supply base is far from straightforward.
Perhaps the biggest challenge is standardising the reporting of emissions, especially scope 3 emissions. Most of the companies reviewed used the Greenhouse Gas Protocol reporting method, but inconsistently: not all reported scope 3 emissions, and not all reported every category of scope 3. In the view of one of the review's authors, improving reporting and transparency is needed, and getting data from suppliers is also going to be a challenge.
Some companies had begun engaging their supply chains by building sustainability criteria into their vendor selection processes and by committing to programmes that help suppliers buy more renewable energy. Measures companies could require of suppliers include sourcing raw materials, water and energy sustainably and using recycled materials in packaging. Companies need to think both about how to bring suppliers on board and about how to measure what suppliers are doing. One of the review's authors suggests that one way could be to encourage suppliers to report their emissions and targets through EcoVadis, which provides a common platform, scorecard, benchmarks and performance improvement tools, or through the similar Carbon Disclosure Project. Requiring suppliers to report to such platforms lets a company determine how far they engage with sustainability principles.
Heavy regulation restricts some of the measures companies can take. Green chemistry principles are largely about optimising the manufacturing process, but once a drug is manufactured in a particular manner, significant changes to that process have to be submitted to regulatory bodies, which can limit optimisation. Likewise, a change that makes a drug's packaging more sustainable has to take account of the regulations on packaging. In many cases these regulations exist for good reasons, such as keeping a drug from changing its composition or from being consumed by children, but they can be an obstacle to sustainability. In the view of one of the review's authors, that is why collaboration with policy makers and regulators is needed.
Cooperation across the sector
Any single pharmaceutical company has relationships with other pharmaceutical companies, with suppliers, with regulators and with policy makers, and in the view of one of the review's authors this web of relationships means that progress on sustainability depends on cooperation. Agreement on how to implement sustainability throughout the supply chain and how to standardise measurement and reporting can only be achieved through cooperation. The same author points out that some suppliers are small or medium-sized enterprises that might not have the capital to engage with many of these sustainability issues, and holds that both pharmaceutical companies and governments should therefore be prepared to help suppliers as far as they can to meet sustainability targets, so that no one is left behind.
There were already encouraging examples of companies working together. The International Pharmaceutical Aerosol Consortium was coordinating a programme among large pharmaceutical companies to encourage patients to return inhaler devices to pharmacies for green disposal. The Pharmaceutical Supply Chain Initiative, which promotes responsible practice in the supply chain and is committed to improving environmental sustainability, created a Topic Team at the end of 2021 to focus on the measurement, management and reduction of scope 3 greenhouse gas emissions in the pharmaceutical sector. She also holds that there are many gaps in innovative solutions to the problem, so finding those solutions, collaborating with academics who research them and sharing the ideas will be important. In her view, competition between companies has to be put aside on this, because the planet is at stake.
What drives a company's targets
The leadership of pharmaceutical companies recognises the importance of moving in step with societal values and expectations on corporate responsibility, and there is an appreciation of the need to act now to address climate change. There are also commercial drivers of change, such as industry guidance and government legislation. Many governments have committed to reducing greenhouse gas emissions, and companies gain an advantage by adopting sustainable working practices ahead of deadlines to maintain access to global markets.
NHS England was the first healthcare system to embed net zero emissions in legislation, through the Health and Care Act 2022, with a target date of 2040. At COP27 in November 2022, the US Department of Health and Human Services announced its sustainability plans for the healthcare sector, including a plan, joint with NHS England, to align procurement requirements for emissions and energy use that will also cover pharmaceuticals.
The European Green Deal
The European Green Deal is a road map towards sustainable development, meant to guide EU policymakers through the policymaking process and to ensure that all policy initiatives steer the EU towards the efficient use of resources and a clean, circular economy. Its adoption on 11 December 2019 marked the moment that climate change and environmental issues moved from the fringes into the heart of EU policymaking. The deal aligns with the EU's commitment to the Paris Agreement and with the UN's 17 Sustainable Development Goals, which are at the heart of the UN's 2030 Agenda for Sustainable Development; both were adopted in 2015. As of 2021, the deal was set to drive changes to EU laws in all economic sectors, including healthcare, and to form the basis for all policies in the healthcare, pharmaceutical and medical technology sectors.
Its goals are to become climate neutral, with no net greenhouse gas emissions, by 2050; to invest in economic growth decoupled from resource use; to ensure that no person or place is left behind; to protect, conserve and enhance the EU's natural capital; and to protect citizens' health and wellbeing from environmental risks such as air, water and chemical pollution. Eight transformative policy areas drive the changes: becoming climate neutral; supplying clean, affordable and secure energy; mobilising industries for a clean, circular economy; building and renovating in an energy- and resource-efficient way; striving for zero pollution and a toxic-free environment; preserving and restoring ecosystems and biodiversity; implementing a farm-to-fork strategy; and accelerating the shift to sustainable and smart mobility. Enabling pillars make them possible, among them dedicated investments and financial tools to keep the transition fair and inclusive across all member states, mobilising research and innovation, building capacity for the transition by engaging the public actively through education and training, and a new pact for accountability between all citizens, national, regional and local authorities, civil society, industry, and the EU's institutions and consultative bodies.
The Green Deal's strategies for healthcare
Human health relies on the protection of communities and their environments. Within the Green Deal, the global healthcare principle of "do no harm" is imperative. Through new policies and regulations, the deal paves the way for a sustainable healthcare industry. Its strategies for healthcare focus on replacing harmful chemicals with safer and greener alternatives, managing healthcare waste sustainably, addressing pollution caused by the pharmaceutical industry and developing green medicines, transitioning to climate-smart healthcare, and enabling sustainable food practices.
The healthcare sector still uses a substantial amount of chemicals, including some with well-documented adverse effects on health and the environment, and solutions that address the additive effects of different chemicals, non-biodegradable chemicals, endocrine disruptors and hazardous chemicals in all consumer products are acutely needed. The Green Deal therefore includes plans for a Chemicals Strategy for Sustainability, which will be one of the steps towards a toxic-free environment and contribute to the Zero Pollution Action Plan, adopted by the EU in 2021.
The WHO and non-governmental organisations such as Health Care Without Harm and Practice Greenhealth aim to transform healthcare worldwide so that it reduces its environmental footprint and becomes an anchor for sustainability, and their efforts made healthcare waste management one of the focus points within the Green Deal. Under the EU Waste Framework Directive (2008/98/EC), a resource-efficient and circular economy will be promoted and an order of preference for waste management, the waste hierarchy, introduced. The waste hierarchy is based on reduce, reuse and recycle, and it categorises healthcare waste in four major types: general, infectious, hazardous and radioactive medical waste. The Green Deal bases its approach to healthcare waste management on the WHO guideline "Safe management of wastes from healthcare activities".
The healthcare sector's carbon dioxide emissions putatively hinder the EU from reaching its 2050 net-zero target, which Europe's first legally binding Climate Law proposal documents. Initiatives such as the European Health Care Climate Council and the Health Care Climate Challenge report that healthcare providers across Europe have committed to decarbonisation actions, green construction (such as antimicrobial wall coatings, prevention of overcrowding and anti-viral ventilation systems), purchasing from circular economies, reducing hospital water consumption, using clean energy, and improving sustainable mobility options for patients and staff. By promoting green construction and operation, green healthcare systems will in future contribute to the health of patients, workers and visitors both within healthcare facilities and outside them.
The Green Deal informed the European Commission's Farm to Fork Strategy, which is meant to balance the impact of fair, healthy and environment-friendly food systems and farming. The strategy aims to achieve a 50% reduction in the use and risk of chemical and hazardous pesticides, at least a 50% reduction in nutrient losses while ensuring that soil fertility is not decreased, at least a 20% reduction in fertiliser use, a 50% reduction in the sale of antimicrobials for use in farmed animals and aquaculture, and the use of 25% of total farmland for organic plant and animal farming by 2030. According to Health Care Without Harm, the healthcare sector, including many hospitals in Europe, has already transitioned to sustainable food systems. Balancing sustainable food systems against the ever-increasing climate crisis, with challenges such as water shortages, land and energy restrictions and environmental pollution, is difficult. To overcome these hurdles, the EU aims to restructure food environments so that consumers can make healthy and sustainable choices easily, add food labels so that consumers can choose healthy and sustainable foods, cut food waste by half, promote research and innovation, and improve animal welfare to improve animal health, which reduces the need for medication and preserves biodiversity. Under the Horizon Europe Programme 2021–2027, the EU has earmarked €10 billion for projects that aim to create innovative and secure ecosystems for plants and animals that make food healthier and greener while ensuring food security. The EU also aims to intertwine the strategy with other healthcare initiatives, such as Europe's Beating Cancer Plan, to reduce the incidence of non-communicable diseases through accessible and affordable healthier food.