Investigators have found drug-resistant bacteria – or superbugs – in antibiotic factories in India that supply major U.S. and European distributors, a report revealed for the first time today.
The report by Changing Markets implicates the factories and their suppliers in China in the rampant spread of antimicrobial resistance (AMR). “Dirty production processes” and improper discharge disposal provide ideal breeding conditions for antibiotic-resistant bacteria, according to the report.
Antibiotic-resistant bacteria is a global threat expected to take 10 million lives each year by 2050 and cost $100 trillion. Already health experts attribute nearly 1 million deaths each year to AMR, and its rapid rise could soon make even routine procedures or common illnesses a “life-or-death gamble.”
Although over- and misuse of antibiotics in human medicine and farming are the leading causes of AMR, manufacturing pollution is the third major interlinked cause.
Changing Markets published a similar report in September that traced AMR to pollution from factories in India and China, where the vast majority of the world’s antibiotics are manufactured. But for today’s report, they went deeper, actually testing for superbugs in water samples from sites, including factories, local bodies of water and a sewage treatment plant.
Of the 34 sites tested in Hyderabad, New Delhi and Chennai, investigators found superbugs in 16. Four of the sites hosted bacteria resistant to the three major classes of antibiotics, including those of “last resort” – prescribed when all other medications fail.
Analysis found three factories in particular to be hotbeds of resistance: Aurobindo Pharma, Orchid Chemicals and Asiatic Drugs and Pharmaceuticals. Investigators followed antibiotics from these manufacturers through supply chain data and Freedom of Information requests to major distributors in the West, including the U.K.’s National Health Service (NHS), French hospitals, German insurances and pharma giants Teva, Pfizer and McKesson, whose largest buyer is CVS Health.
Antibiotics supplied to CVS can actually be traced directly to Aurobindo Unit 7, where 70 percent of all bacteria were found to be resistant to the three main classes of antibiotics.
But Western patients aren’t the only ones at risk.
A 2013 study published in the Lancet medical journal estimated that 58,000 babies die each year from superbugs in India, where one-fifth of the world’s supply of generic drugs originates. Another report from last year showed the rate of AMR on the rise there, with a jump of 29 percent resistance in 2008 to antibiotics for a certain pathogen to 57 percent in 2014 for example. Even India’s livestock are increasingly falling victim to AMR.
China, too, is suffering from high and rising rates of AMR. A 2012 study reported a 22 percent increase in AMR in China over six years, compared to a 6 percent increase in the U.S. within a similar time frame.
Because these factories in India and China are in many cases improperly dumping waste into their surroundings, concentrations of antibiotics in rivers in the Hyderabad area, for example, are 1,000 times higher than what’s typical in developed countries.
The burden of change, the report says, ultimately lies with major buyers, who should commit to supply chain transparency.
“Major buyers of antibiotics, such as the NHS, must immediately blacklist suppliers that are contributing to the spread of AMR through industrial pollution and ensure that all drug companies take action to clean up their supply chains,” Natasha Hurley, campaign manager at Changing Markets, said in a press release.
Thirteen global pharmaceutical companies pledged at the recent U.N. antibiotic resistance summit to review supply chains for proper disposal of waste.
“[It] is a good step in the right direction, but all the other producers of antibiotics have to join this initiative, and the implementation of environmental audits has to be accelerated in light of the threat that AMR represents,” Nusa Urbancic, Changing Markets’ campaigns director, wrote in an email to Humanosphere. “Our findings represent only the tip of the iceberg.”
Nongovernmental organizations and journalists reached out to buyers with supply-chain links to polluting factories in China and India following the findings of Changing Markets’ reports. Some, like the U.K. Department of Health responded positively. Teva, Pfizer, McKesson never did, said Urbancic. Aurobindo and their U.K. subsidiary, Milpharm, refused to comment.
If only they would, Urbancic thinks a solution is not far off. “We believe that pharmaceutical pollution should be easy to fix – it is a supply chain problem that pharmaceutical companies should address with their suppliers,” she wrote.
With AMR rising to the ranks of the HIV/AIDS crisis, committing to eliminate one of the three major causes should not even be a question.