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Managing pollution from antibiotics manufacturing: charting actors, incentives and counterincentives

Authors Christian Munthe
Niels Nijsingh
D. G. Joakim Larsson
Published in 5th International Symposium on the Environmental Dimension of Antibiotic Resistance, 9–14 June 2019, Hong Kong
Publication year 2019
Published at Department of Philosophy, Linguistics and Theory of Science
Centre for antibiotic resistance research, CARe
Institute of Biomedicine, Department of Infectious Medicine
Language en
Keywords antibiotic resistance, antimicrobial resistance, drug resistance, health policy, environmental policy, pharmaceutical policy, pollution, pharmaceuticals
Subject categories Technology and social change, Environmental medicine, Public Health, Global Health, Social Medicine and Epidemiology, Health Care Service and Management, Health Policy and Services and Health Economy, Medical Ethics, Practical philosophy


Question Emissions of high concentrations of antibiotics from manufacturing sites select for resistant bacteria and may contribute to the emergence of new forms of resistance in pathogens. Many scientists, industry, policy makers and other stakeholders recognize such pollution as an unnecessary and unacceptable risk to global public health. An attempt to assess and reduce such discharges, however, quickly meets with complex realities that need to be understood to identify effective ways to move forward. This paper charts relevant key actor-types, their stakes and interests, incentives that can motivate them to act to improve the situation, as well as counterincentives that may undermine such motivation. Method The actor types and their respective interests have been identified using research literature, publicly available documents, websites, and the knowledge of the authors. Result Thirty-three different types of actor-types were identified, representing e.g. commercial actors, public agencies, states and international institutions. These are in complex ways connected by differing and partly similar interests that sometimes may conflict, sometimes pull in the same direction. Some actor types can act to create incentives and counterincentives for others in this area. Conclusions The analysis demonstrates and clarifies the challenges in addressing industrial emissions of antibiotics, notably the complexity of the relations between different types of actors, their international dependency and the need for transparency. The analysis however also suggest possible ways of initiating incentive-chains to eventually improve the prospects of motivating industry to reduce emissions. High resource consumer states, especially in multinational cooperation, hold a key position to initiate such chains.

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