Dr Vanessa Cooper Fernanda Trevisan Maddie Stafford
Environmental sustainability in the pharmaceutical industry: how can behaviour science help?
The ongoing COVID-19 global pandemic has disrupted our economies, healthcare systems, and daily lives. Our priority as citizens, understandably, has been making the necessary adaptations to contain the spread of the virus. The priority for the pharmaceutical industry and scientists has been to develop vaccines and save lives.1 However, we must not allow the pandemic to delay us from acting towards sustainability. Failing to do so will lead to further industry challenges.
Sustainability has been described as meeting the needs of the present without compromising on the needs of the future.2 Environmental sustainability in the pharmaceutical industry is still to be achieved. In fact, the industry’s global carbon footprint (an indicator of environmental sustainability) is even higher than that of the automotive sector.3
Key challenges in the pharmaceutical industry
A key challenge in the pharmaceutical and healthcare sectors is how to best move towards a more sustainable industry whilst continuing to improve health and patient care.3 The need to increase sustainable practices within the pharmaceutical industry has been identified by policymakers, key opinion leaders and patients themselves.4 Priorities include:
- Reducing inequality in access to medicines and treatments both within and between countries4
- Addressing the industry’s contribution to water pollution (e.g., in water supplies, lakes and rivers) 4
- Reducing the amount of water used in the medicine supply chain4
- Increasing the use of sustainable materials in the packaging of pharmaceuticals4,5
- Reducing medicine wastage4
- Increasing recycling of packaging4,6
The role of behaviour science
Behaviour science has a pivotal role in the development of solutions for issues that involve the pharmaceutical industry, healthcare professionals and patients. Important examples of interventions would include reducing medicines wastage and increasing the recycling of packaging.
Reducing medicines wastage
Pharmaceutical waste was defined by the NHS as:
“Any substance or object the holder discards, intends to discard or is required to discard” is waste.7
According to the School of Pharmacy University of London, the estimated of pharmaceutical discards that goes to waste each year is £300 million.8
To reduce waste, interventions that draw on behaviour science can be helpful.9 For example, gaining a clear understanding of the needs, preferences and concerns of patients can help ensure that the prescription is appropriate. Providing support based on behaviour science can reduce medicine wastage due to failure to start, implement or complete a prescribed and dispensed medicine. It may also reduce the need for expensive and unnecessary changes to medicines for the same condition.10
Research conducted with patients across long-term conditions shows that patients’ beliefs about prescribed medicines influence both their decision to start treatment and ongoing adherence.11,12 Behaviour science can help researchers to identify the types of barriers influencing patients’ motivation, capability, and opportunity to adhere to specific medicines and develop appropriate support to address them. This support may be provided in person, for example by doctors, nurses, or pharmacists, over the telephone or via digital health tools.
Medicines wastage may also be reduced by consideration of the length of the prescription period in response to patients’ requirements, more effective use of medicine use reviews and improving support provided to isolated and frail patients living at home.10 Here too, behaviour science can help determine the type and content of adherence support required.
When medicines are not wanted, no longer needed or beyond their sell by date, most people throw them away or take them to a pharmacy. Unwanted medicines taken to a pharmacy are usually incinerated. Patients may be unaware of options for recycling of unwanted medicines, such as the one provided by Inter Care – Medical Aid for Africa. Inter Care is a charity which collects unused medicines from UK GP surgeries, checks their suitability, quality and expiry date, ensures that they are in their original, intact packaging and then dispatches them to medical centres in need of specific medicines in Africa.
Recycling of packaging
Pharmaceutical packaging involves blister, plastic bottles, closures, speciality bags and others. Several studies point to sustainable innovations in packaging to reduce pharma packaging waste and carbon footprint.5
Interventions targeting waste-related behaviours such as recycling are also a key part in achieving sustainability in the pharma industry. Often these interventions are designed without a systematic approach applying behaviour science theories.13 Behaviour change theory can be useful to identify the desired behaviour, understand factors that facilitate the behaviour and act as barriers and help guide the development of interventions.14
An analysis of recycling behaviour in a London University was carried out using the COM-B model (a simple framework which can be used to analyse facilitators and barriers to carrying out behaviour in terms of the individual’s capability, opportunity and motivation) and the Theoretical Domains Framework (TDF) (which synthesises the key components of behaviour change theories into 14 domains in order to aid the development of interventions).15 The findings, shown in Table 1, may be a useful starting point for pharmaceutical companies who wish to develop interventions to support final users to recycle medication packaging. They indicate that interventions should focus on
- Enhancing motivation to recycle for example by addressing doubts about the need to recycle medicines and the environmental impact of recycling (or not recycling), identifying and addressing concerns such as concerns about what happens to waste once it has been recycled, and increasing personal responsibility for recycling by addressing doubts that an individual’s behaviour can have an impact
- Increasing psychological capability by addressing knowledge gaps – for example by clearly indicating which materials can and cannot be recycled and providing clear instructions about how to recycle
- Making it easy for users to recycle by providing easily accessible recycling facilities
Table 1: Barriers and drivers of recycling behaviour15
|COM-B component||TDF domain||Example|
Environmental context and cues
Availability and accessibility of a recycling bin
Beliefs about the consequences of recycling
Doubts about whether materials placed in the bin are recycled and uncertainty about the environmental impact
Concerns about contamination deterred participants from putting non-recyclable materials in the recycling bin
|Social/professional role and identity||Some participants expressed a personal responsibility to recycle|
Most participants intended to recycle
Barriers to implementing intentions included laziness and lack of priority. Making it easy to carry out intentions (e.g. with clear instructions and accessible bins) was important
Participants had a good knowledge of which materials were recyclable but were less able to identify materials which could not be recycled.
A lack of informational cues such as signs indicating how to dispose of different materials
The idea that environmental and health issues are intertwined became clear during this pandemic. While the positive environmental impacts of our public health response has been seen during the pandemic, enhancing sustainable practice within the industry remains a priority. With the pharmaceutical industry in the media spotlight, another huge opportunity for environmental impact could be involving users and behaviour change experts in initiatives to increase sustainability.
- World experts and funders set priorities for COVID-19 research. 12 February 2020 https://www.who.int/news/item/12-02-2020-world-experts-and-funders-set-priorities-for-covid-19-research (Accessed 7th July 2021).
- Report of the World Commission on Environment and Development: Our Common Future (1987) https://digitallibrary.un.org/record/139811 (Accessed 28th July 2021).
- Belkhir, Lotfi, and Ahmed Elmeligi. “Carbon footprint of the global pharmaceutical industry and relative impact of its major players.” Journal of Cleaner Production214 (2019): 185-194.
- Milanesi, Matilde, Andrea Runfola, and Simone Guercini. “Pharmaceutical industry riding the wave of sustainability: Review and opportunities for future research.” Journal of Cleaner Production 261 (2020): 121204.
- Raju, Geo, et al. “Comparison of environmental sustainability of pharmaceutical packaging.” Perspectives in Science8 (2016): 683-685.
- Padhi, Sidhartha S., Rupesh K. Pati, and A. Rajeev. “Framework for selecting sustainable supply chain processes and industries using an integrated approach.” Journal of Cleaner Production184 (2018): 969-984.
- Trueman, P., et al. “Evaluation of the scale, causes and costs of waste medicines. Report of DH funded national project.” (2010).
- Hazell, Bertie, and R. Robson. “Pharmaceutical waste reduction in the NHS. 2015.” Report No.: Version 1 (2018).
- Gainforth, Heather L., et al. “Developing interventions to change recycling behaviors: A case study of applying behavioral science.” Applied Environmental Education & Communication 4 (2016): 325-339.
- Taylor, David. “Reducing medicines wastage through improving patient care.” (2011): 5-7.
- Horne, Rob, et al. “Understanding patients’ adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the Necessity-Concerns Framework.” PloS one12 (2013): e80633.
- Horne, Robert, et al. “Patients’ perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence: the utility of the necessity-concerns framework.” JAIDS Journal of Acquired Immune Deficiency Syndromes3 (2007): 334-341.
- Michie, Susan, Lou Atkins, and Robert West. “The behaviour change wheel.” A guide to designing interventions. 1st ed. Great Britain: Silverback Publishing(2014): 1003-1010.
- Michie, S., et al. “ABC of behaviour change theories. 2014.” Great Britain: Silverback Publishing(2014).
- Gainforth, Heather L., et al. “Developing interventions to change recycling behaviors: A case study of applying behavioral science.” Applied Environmental Education & Communication 15.4 (2016): 325-339.