Cutting emissions by drug industry is crucial to reducing NHS’s carbon footprint

BMJ 2012; 345 doi: (Published 03 December 2012) Cite this as: BMJ 2012;345:e8243
  1. Nigel Hawkes
  1. 1London

Two thirds of the total greenhouse gas emissions accounted for by the NHS in England come from sources not directly controlled by the NHS: drugs, medical devices, business services, and manufactured products have a far larger “carbon footprint” than do hospitals, ambulances, or catering. Drugs alone account for more than 20% of total emissions and devices another 8%.

The figures make it clear that the drug and medical device industry is important if the NHS as a whole is to reduce its impact on the environment. New guidelines (, just published by Environmental Resources Management, a leading consultancy in international sustainability, provide a systematic way of working out the greenhouse gas emissions for drugs and medical products, as a conference held at St Thomas’ Hospital on 30 November heard.1

Charles Allison, a partner at the consultancy, explained that the guidelines aimed to ensure that companies that supply the NHS had a consistent way to measure their carbon footprint. “They spell out what is included and excluded from the calculations, what data is needed, the data quality, and how to report the results,” he said. “They will be used by producers to discover where their emissions originate, how they can be reduced, and how changing the design of products can reduce their impact.”

The guidelines have been produced under the auspices of the NHS Sustainable Development Unit by a steering group that includes many of the major drug companies. Allison said that companies could tell trusts how environmentally sensitive their products were, to “raise awareness,” but were not supposed to use the data to support claims that one product was better than another. “We’re not at that stage yet,” he said.

Peter Dunn, lead on global green chemistry at Pfizer, gave an example of how the guidelines were used to work out the carbon footprint of pregabalin (marketed as Lyrica), a treatment for neuropathic pain that clocked up sales of $3.7bn (£2.3bn; €2.8bn) in 2011. The calculation began with crude oil, the source of the chemicals used to manufacture the drug, and ended at the factory gate.

“Twenty different compounds are used to make Lyrica,” Dunn explained. “We compared three different processes and found that one of them reduced the carbon footprint from 1000 kg of carbon dioxide per kg of active substance to 150 kg. Over the lifetime of the product that would be equivalent to taking half a million US cars off the road for a year.”

He said that 90% of the drug’s carbon footprint was in chemistry, formulation, and packaging, with only 1% in distribution. “We’re looking at a fourth manufacturing process now to reduce that 90% share still further,” he said.

Erol Odabasi of Johnson & Johnson said that his company wanted its products to be more environmentally sustainable. He asked, “But how do you know? You have to have a methodology.” For medical devices, for example, that methodology involved comparing single use devices, which have higher transport costs, against multiple use devices, which require energy intensive sterilisation. The unexpected result of the analysis was that single use devices could have a lower footprint than multiple use ones.

In the foreword to the new guidance, Neil McKay, chief executive of NHS Midlands and the lead chief executive for sustainable development for the NHS in England, wrote that the guidance is a globally relevant, living document that is freely available and continually revised and updated. He said, “It is international in its scope, encourages transparent and accurate reporting, and helps to create a common language and methodology that will form the basis for further development.”


Cite this as: BMJ 2012;345:e8243