Bridging waters – a One Health Partnership to tackle societal challenges around Sustainable Use of Drugs

Pharmaceuticals are essential for modern healthcare, but their increasing global consumption poses significant environmental risks. More than 100,000 tons of pharmaceuticals are used annually in the world. Since most medicines cannot be effectively eliminated in wastewater treatment plants, they end up in rivers, lakes and groundwater where they can harm aquatic life, disrupt ecosystems, and contribute to antimicrobial resistance (AMR). In response, the EU is revising its Urban Wastewater Treatment Directive and Environmental Quality Standards, mandating advanced treatment technologies and holding pharmaceutical companies accountable under the "polluter pays principle”. Additionally, the EU's endorsement of the One Health approach promotes interdisciplinary policies to mitigate pharmaceutical pollution and AMR. Sustainable practices throughout the medicine lifecycle, from responsible production and use to proper treatment and disposal, are crucial for minimizing the environmental impact without compromising patient safety. Although welcomed by many stakeholders, representatives from pharmaceutical industry claim that bearing the costs of treating urban wastewater is intrinsically unfair. Others are stressing that although the revisions are necessary, forcing the pharmaceutical industry to bear the costs could lead to some companies choosing to withdraw from the European market and thus increasing the problems faced with availability of medicines.

Awareness, policies and measures to addressing this issue differs between the countries. There are large opportunities for exchange of learning and best practices between Gotland and the Scottish Highlands, which share similar challenges. These are for example coupled to social cohesion (e.g., quality of care within limited resources), environment (e.g., environmental impact and water supply), demographic development (e.g., ageing and declining working age population), globalization and digitalization. Both regions have a special situation coupled to geography, environment and demography, including small populations with large seasonal variations placing a large stress on infrastructure including healthcare and water services. In light of current and future climate changes, many of these conflicts are expected to worsen.

This project aims to establish a long-term collaboration between Uppsala University (UU) (Gotland & Uppsala), and the University of Highlands and Islands (UHI) in Scotland, to develop sustainable practices in use of medicines. By fostering interdisciplinary research and education, this partnership seeks to address goal conflicts linked to pharmaceutical pollution, water quality, climate change and the interconnected health of humans, animals, and ecosystems.