Greek Pharmaceutical Students’ Federation (GPSF)
Greek Pharmaceutical Students’ Federation (GPSF) is a non-profit, nongovernmental, non-trade union organisation in which undergraduate and postgraduate students of Pharmacy and doctoral candidates participate. The vision of the association is to represent each student of Pharmacy in Greece and to promote cooperation, interdisciplinarity and awareness of students and the community. The mission of the association is to participate actively at the student and professional level, and its main purpose is to encourage students to act in their scientific and social interests but also to inform them about the latest medical and pharmaceutical achievements, new fields of research and applications of modern technology in science. At the same time, it aims to strengthen relations with other voluntary groups operating both in Greece and at the European level through communication and cooperation in matters of common scientific or social interest and noble rivalry in the scientific arena.
Finally, it gives great importance to the participation of Pharmacy students in programs aiming to inform the public on issues of hygiene, prevention, and treatment, with the aim of improving their quality of life.
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Climate change-associated health problems
For the past decades, anthropogenic impacts on the environment have caused longterm shifts in temperature and weather patterns1. These effects, defined as climate change, influence people's well-being in numerous ways. For instance, a changing climate can affect human health since many pre-existing illnesses are becoming more frequent and severe; rising air and water temperatures not only alter the geographic range and distribution of disease-carrying insects and pests, therefore, exposing more people to vector-borne diseases but also leads to increases in heat-related deaths and worsens respiratory conditions2. These climate-sensitive health risks are disproportionately felt by the most vulnerable and disadvantaged, including women, children, poor communities, older populations, and those with other health conditions3 .
Heat-related illnesses
First and foremost, extreme heat events can be dangerous to health and even fatal. According to Copernicus Climate Change Service, the summer of 2022 was Europe’s hottest on record by substantial margins of 0.8°C over 2018 for August and 0.4°C over 2021 for summer. This kind of exposure to abnormal or prolonged amounts of heat and humidity without relief or adequate fluid intake can trigger a variety of heat stress conditions4. Symptoms range from heat oedema and exercise-associated muscle cramps to collapse, heat exhaustion, and multiorgan failure with heat stroke5
Heat cramps are the mildest form of heat-related illnesses and consist of painful muscle cramps and spasms4. Heat exhaustion is more severe than heat cramps and occurs as the body’s response to a loss of water and salt, usually through excessive sweating. Symptoms may include headache, nausea, dizziness, irritability, or thirst and, if left untreated, can progress to heat stroke. More specifically, the term heat stroke typically implies an elevation in core body temperature (the temperature of internal organs) to at least 40°C and the presence of central nervous system (CNS) dysfunction6. CNS dysfunction can manifest as dizziness, confusion, dysmetria (the inability to coordinate the distance, speed, and range of motion), ataxia (poor muscle control that causes clumsy voluntary movements), and, eventually, coma. At high ambient temperatures and increased metabolic demands, sweating as the primary mechanism for heat dissipation fails, and the body turns unable to cool down. Therefore, the elderly, small children (relatively large ratio of skin surface area to body mass), those with medical comorbidities, as well as athletes, firefighters, and military personnel (occupational activities requiring strenuous exercise in hot environments) are at greatest risk6 .
Vector-borne diseases
One way climate change might additionally affect human health is by increasing the risk of vector-borne diseases. A vector is a living organism such as a flea, tick, or mosquito that transmits a pathogen, or infectious agent, from one organism to another7. Weather conditions, in particular temperature, precipitation, and humidity, affect the survival and reproduction rates, habitat stability, distribution, and abundance of vectors8. Additionally, climatic factors impact the intensity and temporal activity of vectors throughout the year and affect the rates of development, reproduction and survival of pathogens within the vectors9,10. Europeans are currently at risk of numerous vector-borne diseases, including Lyme, dengue fever, and West Nile virus disease. Some vector-borne pathogens that have not been a substantial concern within Europe are Chikungunya, Zika virus, and Malaria, which are also threats11
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1. West Nile virus (WNV)
WNV is a common cause of epidemic viral encephalitis in Europe, and it will likely remain an important cause of neurological diseases for the foreseeable future12. WNV is a positive-stranded RNA virus and belongs to the family of Flaviviridae (genus Flavivirus), which includes other human infecting viruses, such as dengue, yellow fever, and Japanese encephalitis viruses13. Most human WNV infections result from mosquito bites. WNV is maintained in nature in an enzootic transmission cycle between birds and mosquitoes through blood-meal feeding, which results in virus amplification. Species from the genus Culex mosquitoes are the primary amplification vectors and also act as bridge vectors. Humans and other mammals serve as “deadend” hosts, meaning they become infected, but they do not develop high levels of the virus in their blood, and they can pass the virus to mosquitoes8. Infection also has resulted from transfusion of WNV-infected blood products, although the risk remains extremely low14,15. WNV infection has resulted from transplacental foetal infection, infected organ transplants16, laboratory exposure, and possibly through infected breast milk.
2. Lyme disease
Lyme disease is an example of a tick-borne disease. The geographic distribution of ticks is related to climatic factors such as humidity, soil water, and air temperature. The effects climate change has on these variables have caused ticks to shift their seasonal activity and geographical range. This has resulted in an increase in Lyme disease infections20
Lyme disease is caused by the bacteria Borrelia burgdorferi and rarely Borrelia mayonii. It is transmitted to humans through the bite of infected black-legged ticks. Ticks can be come infected by feeding on infected wild animals. Symptoms typically include fever, headache, fatigue, and a characteristic skin rash called erythema migrans21 (Figure 1.1). Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics. For early Lyme disease, a short course of oral antibiotics, such as doxycycline or amoxicillin, cures most cases. In more complicated cases, Lyme disease can usually be successfully treated with three to four weeks of antibiotic therapy by intravenous (IV) administration of the previously mentioned antibiotics22 Some steps to prevent Lyme disease include using insect repellents, removing ticks promptly, applying pesticides, and reducing tick habitats21
Respiratory illnesses
Lastly, climate change is linked to diminished lung functions or increased hospital admissions and emergency room visits for asthma24 The increase in air pollutants causes an increase in the concentration of allergens and, subsequently, aggravates the effects caused by them25. For instance, poison ivy, a mildly toxic, allergenic plant, grows faster and becomes even more toxic because it produces a more potent form of urushiol, the allergenic substance when carbon dioxide levels are higher. Thus, people with existing pollen allergies may have an increased risk for acute respiratory effects.
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Figure 1.1 Erythema Migrans23
Chronic Obstructive Pulmonary Disease
Another respiratory illness which can be aggravated by air pollution is Chronic Obstructive Pulmonary Disease (COPD). COPD is a group of lung conditions that lead to breathing difficulties. It includes emphysema: damage to the alveoli in the lungs, and chronic bronchitis: a long-term inflammation of the lining of the bronchial tubes. COPD is a common condition that mainly affects middle-aged or older adults who smoke27. It has been reported to be associated with air pollution. Studies have found that climate-mediated air pollution leads to higher risks of decreasing FEV1 (Forced Expiratory Volume) and oxygen saturation and increases emphysema severity among COPD patients28. With this in mind, even though respiratory conditions such as allergies, asthma, and COPD already affect many people worldwide, it is still important to find ways to combat air pollution. Some examples are using less energy by choosing efficient appliances and heating systems, switching to electric or hand-powered lawn equipment, and planting and caring for trees29
Conclusion
To recapitulate, it is unequivocal that climate change poses many risks to human health. Impacts from environmental crises on extreme weather and climate-related events, air quality, and the transmission of disease through insects and pests, food, and water increasingly threaten people's well-being, particularly populations that are already vulnerable2. It is of the utmost importance to act, from changing to renewable sources of energy to limiting deforestation, to preserve a liveable climate.
Author: Elena Zoi, 4th year Pharmacy Student
Author: Rafaela Parthena Papadopoulou, 2nd year Pharmacy Department, Aristotle University of Thessaloniki
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Author: Athena Dimou, 2nd year Pharmacy Student
Author: Aikaterini Zafeiropoulou, 2nd year Pharmacy student
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The pharmaceutical industry and climate change - A reciprocal relationship
The pharmaceutical industry and environmental change are strongly linked together. By achieving a sustainable production-consumption balance and eco-friendly manufacturing technologies, the pharmaceutical industry’s impact on the environment will be diminished therefore protecting nature and human health. The goal of this article is to study the importance of nature in drug manufacturing and development, how the industry affects it and what is being done to lower the environmental impact.
Natural resources such as plants, minerals, and animal fats, among others, have been used as treatments for thousands of years, with the earliest records of plant medicine use dating from around 2600 BCE in Mesopotamia. In 1985 World Health Organisation (WHO) estimated that approximately 65% of the population of the world relied on plantderived traditional medicine as their primary healthcare1. Moreover, as of September 2019 over 50% of the FDA-approved drugs are either directly or indirectly derived from natural products. Although lots of the sold drugs are now manufactured using chemical synthesis, crude extractions from different natural sources have been the main strategy for thousands of years. For example, khellin extracted from Ammi visnaga led to the development of the bronchodilator cromolyn in the form of sodium cromoglycate. Papaver somniferum was the basis for verapamil synthesis but also morphine and codeine. Galgega officinalis served as a model for the most known first-line antidiabetic drug, metformin. Antibiotics are derived from fungi and bacteria, or if they are chemically synthesized, their structure was originally inspired by nature2. These are just a few examples of nature’s contribution to drug development and human health. Sadly, during the 1990s and 2000s, many large companies with natural products programs such as Merck, Bristol Myers-Squibb, AstraZeneca, GlaxoSmithKline and Monsanto have closed them due to the challenges related to working with natural products (time and material consuming, ineffective separations, lack of predictability of the pharmacological actions and toxicity etc.). The revitalisation of the natural drugs came after the 2015 Nobel Prize when Tu Youyou and her teammates used ancient Chinese medical texts and found that artemisinin, a compound found in Artemisia absinthium, and its derivatives had antimalarial properties2,3
Although natural products or nature-inspired molecules make up the majority of today’s drugs, many companies shy away from trying to discover them because the identification and isolation processes are quite laborious. The advances in analytical techniques, genome mining and engineering and microbial culturing systems have the potential to revitalise natural product drug discovery. For example, instead of isolating one compound through several steps and studying it separately, using liquid chromatography-high resolution mass spectrometry (LC-HRMS) combined with nuclear magnetic resonance (NMR) allows for the separation and structural characterisation of numerous isomers at once4
Pharmaceutical impact on natural life
Unfortunately, while nature proved to be so valuable for human health, the pharmaceutical industry continues to be a key contributor to its destruction. There is no mystery that greenhouse gas emissions cause global warming resulting in increased temperature, extreme weather patterns, droughts, and destruction of plant and animal habitats. According to the WHO, outdoor air pollution causes 4.2 million
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premature deaths worldwide every year. People living in low- and middle-income countries are the most affected, accounting for 89% of the approximately 4.2 million premature deaths. Out of those cases, 23% were caused by lower respiratory infections, and 11% were due to respiratory tract cancer5 .
In recent years, there is an increased pressure on businesses to measure, manage and reduce their contribution to climate change. A comparative analysis of the top 15 global pharmaceutical companies found that greenhouse gas (GHG) emissions were 55% higher than that of the top 10 automotive companies. The study included neither emissions coming from the production, transportation or distribution of purchased materials nor emissions generated by the disposal of waste done by third-party companies. Still, an average of 48.55 tonnes of GHG per million of dollars of revenue were produced annually between 2012 and 20156
Global warming is linked to an increase in several infections, bringing pathogens closer to people. Warmer high latitudes allowed pathogens to survive winters generating higher outbreak rates in viruses such as Zika. Drought facilitated West Nile virus transmission. Floods and storms lead to direct and foodborne transmissions of noroviruses, hantaviruses and hepatitis7. This year, respiratory syncytial virus (RSV) circulation in the EU/EEA (European Union/European Economic Area) has intensified, with increasing transmission rates in all population groups and an earlier-than-usual start of the season8. Water-borne infections will become much more prevalent, and that could result in a higher demand for the development of antimicrobial drugs such as antibiotics. Apart from the potential increased demand for anti-infectious treatments, the pharma industry will be struck by a higher need for energy in order to maintain optimal drug manufacturing conditions (temperature, air flow, water quality etc). For example, floods and raised sea levels can contaminate water resources with salts and faecal matter, therefore, needing a more thorough cleansing and sanitising process resulting in higher energy consumption Moreover, all sources of energy require water in their production processes. Water scarcity will raise its value Therefore, energy production costs and prices will rise9,10. It is estimated that by 2050, climate change will stimulate a 25-58% increase in global energy demand, and inevitably the cost of living including drug prices and production costs will rise11 Pharmaceutical companies raised their concerns publicly in a series of open letters stating their inability to keep up with the elevated prices of fuel, resulting in shortfalls of drugs deemed as nonprofitable12
Biopharmaceuticals
Due to lots of patent expiration dates closing in, companies are moving their focus to producing biosimilars. In 2022, there are nearly 1.100 biosimilars in development worldwide13. They include vaccines, monoclonal antibodies, blood components, allergenic, gene therapy, tissue and proteins. On average, an impressive 94% of the materials used in their manufacturing consist of water14. The key to making biosimilars more sustainable than generics stands in the increase of process efficiency. Instead of using bioreactors of thousands of liters of water, a continuous approach seems to shorten the production cycle and reduce the carbon footprint. Similarly, switching from a traditional chromatography process (which accounted for approximately 62% of the water consumption) to multi-column chromatography showed to consume less buffer and therefore be more sustainable15. Recently, single-use technologies have been evaluated as a way to reduce costs and increase the efficacy of manufacturing processes. Studies have shown that switching the currently multi-use equipment to
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single-use plastic is less energy-consuming, it allows for a more efficient scale-up process, and it reduces capital costs16. Unfortunately, the overall environmental impact starts from acquiring the raw materials for plastic production to the manufacturing process, and finally, the disposal method is unknown. Based on the analysis that has been done so far, the single-use plastic technology seems to reduce the water consumption of the drug manufacturing process17. However, plastic contamination of the land is a very serious problem and needs to be taken into consideration. There are no clear regulations in regard to the best way to dispose of plastic. Recycling seems to be the best option, although it has some limitations, such as the presence of hazardous substances preventing the plastic from being recycled. Incineration releases dangerous particles in the air. Landfill contributes to soil pollution due to microplastic particles and other chemicals that are being released into the earth16
How is the pharmaceutical industry is taking action
Top biopharmaceutical companies are trying to cut down the environmental footprint as much as possible, constantly innovating and applying new technologies of manufacturing. For example, Amgen, a company that prides itself for receiving the Green chemistry award, successfully increased their purchased renewable energy from 41% to 79% and bought renewable energy certificates to make 6 of their facilities use 100% renewable energy. Not only that, but they are taking action towards gathering information and making advanced incident reports analysis, measuring performance and reviewing trends to determine areas for improvement.
Using engineered enzymes instead precious metal catalysis, innovating the synthesis process, and diverting 80% of landfill waste to the waste-to-energy facility are just some of the improvements to the company’s sustainability18. AstraZeneca has a plan to achieve 90% fewer carbon emissions by 2045 and will spend 1 billion dollars in order to achieve this goal. Their approach focuses on transitioning to 100% renewable energy sources, either bought or produced on-site, while engaging their suppliers to reduce emissions, increasing the usage of clean heating and cooling sources, transitioning to next-generation respiratory inhalers with environmentally friendly propellants, and so on19. Biopharmaceuticals and biosimilars are a very important part of the future pharmaceutical industry, with high specificity and efficacy against lifethreatening diseases. Therefore, much attention should be given to making them more environmentally healthy.
Conclusion
As climate change gets worse, more and more attention is given to the pharma industry as a great contributor to global warming and the increase of health-related problems, polluting the air and water with GHG and waste products and affecting biodiversity. If action is not taken properly drug shortfalls, elevated prices and heightened, disease rates are awaiting. The good news is that several Big Pharma companies are on the run towards drastically cutting down their environmental footprint and becoming more sustainable through programmes such as Energise, AstraZeneca’s Ambition zero carbon plan, Biogen’s Healthy planet, healthy life, and so on20,21 .
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Author: Alina-Ioana Stan, 4th year pharmacy student from Bucharest. Apart from pharmacy, she loves spending time with her family, friends and her sweet dog, reading and partying.
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Multiple Choice Questions:
1. What does ataxia mean?
A. Losing muscle control
B. Speaking difficulties
C. Alteration in the sense of smell
D. None of the above
2. All of the following are vector-borne diseases, except:
A. West Nile virus disease
B. Lyme diseases
C. Malaria
D. COPD
3. Which of the phrases below applies to Lyme disease?
A. A mosquito-borne disease
B. Is caused by the Bacteria E-Coli
C. Erythema migrans is its main symptom
D. Goes away with an intestine course of antivirals
4. The basis for the synthesis of cromolyn, a bronchodilator, is:
A. Khellin extracted from Ammi visnaga
B. Papaver somniferum
C. Galgega officinalis
D. Artemisinin from Artemisia absinthium
5. Pharmaceutical companies try to reduce their investment in natural products in order to:
A. Save nature
B. Hard extraction, isolation, and identification
C. Synthetic molecules are more effective
D. All of the above
6. Climate change impacts on the pharmaceutical industry could be:
A. Increasing drug prices
B. Lack of natural resources and raw materials
C. Lack of energy
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D. All of the above
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Answers: 1-A, 2-D, 3-C, 4-A, 5-B, 6-D
References:
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Disease. Emerging Infectious Diseases, 11(8), 1174–1179.10.3201/eid1108.050289b
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Article 2:
1. Dias, D. A., Urban, S., & Roessner, U. (2012). A Historical Overview of Natural Products in Drug Discovery. Metabolites, 2(2), 303–336.
https://doi.org/10.3390/metabo2020303
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2. Cragg, G. M., & Newman, D. J. (2013). Natural products: A continuing source of novel drug leads. Biochimica Et Biophysica Acta, 1830(6), 3670–3695.
https://doi.org/10.1016/j.bbagen.2013.02.008
3. Liu, W., & Liu, Y. (2016). Youyou Tu: Significance of winning the 2015 Nobel Prize in Physiology or Medicine. Cardiovascular Diagnosis and Therapy, 6(1), 1–2.
https://doi.org/10.3978/j.issn.2223-3652.2015.12.11
4. Atanasov, A. G., Zotchev, S. B., Dirsch, V. M., International Natural Product Sciences Taskforce, & Supuran, C. T. (2021). Natural products in drug discovery: Advances and opportunities. Nature Reviews. Drug Discovery, 20(3), 200–216.
https://doi.org/10.1038/s41573-020-00114-z
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https://doi.org/10.1038/s41558-022-01426-1
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https://www.unwater.org/waterfacts/water-and-climate-change
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https://www.un.org/waterforlifedecade/water_and_energy.shtml
11. Romitti, Y., & Sue Wing, I. (2022). Heterogeneous climate change impacts on electricity demand in world cities circa mid-century. Scientific Reports, 12(1), Article 1.
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12. Hawkins, L. (2022, October 3). The impact of the energy crisis on pharma. Pharma IQ.
https://www.pharma-iq.com/business-development/news/the-impact-of-theenergy-crisis-on-pharma
13. Newton, E. (n.d.) The Top 4 Biopharmaceutical Manufacturing Trends in 2022
Retrieved March 26, 2023, from https://blog.isa.org/the-top-4-biopharmaceuticalmanufacturing-trends-in-2022
14. Cataldo, A., Sissolak, B., Metzger, K., Budzinski, K., Shirokizawa, O., Markus, L., Jungbauer, A., & Satzer, P. (2020). Water related impact of energy: Cost and carbon footprint analysis of water for biopharmaceuticals from tap to waste. Chemical Engineering Science, 8 https://doi.org/10.1016/j.cesx.2020.100083
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17. Lopes, A. G. (2015). Single-use in the biopharmaceutical industry: A review of current technology impact, challenges and limitations. Food and Bioproducts Processing, 93, 98–114. https://doi.org/10.1016/j.fbp.2013.12.002
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19. Ambition Zero Carbon. (2022, November 18). https://www.astrazeneca.com/sustainability/environmental-protection/ambitionzero-carbon.html
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Infographic 2:
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32. Mora, C., McKenzie, T., Gaw, I. M., Dean, J. M., von Hammerstein, H., Knudson, T. A., Setter, R. O., Smith, C. Z., Webster, K. M., Patz, J. A., & Franklin, E. C. (2022). Over half of known human pathogenic diseases can be aggravated by climate change. Nature Climate Change, 12(9), 869–875. https://doi.org/10.1038/s41558-022-01426-1
33. Thangamma Monnappa. (n.d.). (rep.). State of Community Health at MEDAK DISTRICT. Retrieved from http://www.environmentportal.in/files/state-ofcommunity-health-at-m.pdf.
EPSA – European Pharmaceutical Students’ Association 17
