28 May 2025

Amelie Vinzenz

In the last century, medical advancements and pharmaceutical breakthroughs have transformed healthcare, with antibiotics and vaccines playing pivotal roles in significantly extending life expectancy. However, the growing threat of antibiotic resistance is casting a shadow over these achievements. Once considered our most potent weapon against infectious diseases, antibiotics are becoming increasingly ineffective due to the rapid emergence and spread of antibiotic resistance. In addition to the risk posed by the massive use of antibiotics in human and veterinary medicine, contaminated production wastewater is a major reason for the development of antibiotic resistance. Recognising the gravity of this issue, the AOK, under the leadership of AOK Baden-Württemberg, has initiated and carried out a pilot study on environmental sustainability in antibiotic supply together with the Institute for Water Research (IWW) and the German Environment Agency (UBA). The aim of the pilot study is to create incentives for the environmentally friendly production of antibiotics through a voluntary bonus criterion as part of the awarding of discount contracts for pharmaceutical companies. The companies agree to comply with an effect-based maximum concentration (PNEC) in the production wastewater and surface runoff of the active substance production site and allow an on-site inspection by the IWW. Between September 2021 and November 2023, 21 inspections were conducted across ten production sites located in India and Europe. In addition, water samples from the nearby environment affected by the production facilities were analysed for antibiotics. The findings were alarming. At three production sites and at a water body near a fourth site, threshold values for five of the contracted antibiotics were significantly exceeded. The highest exceedance was found for ciprofloxacin. Here, the auditors were able to detect a wastewater concentration of >10µg/l, which exceeds the contractually agreed threshold value by an astonishing 11,000 per cent. Alarmingly high concentrations of antibiotics were also detected in the surrounding environment in the waters affected by production sites. In several instances, these contaminated waters flowed through heavily populated areas and agricultural land. The environmental sample with the highest exceedance of a threshold value was taken from a body of water that originates from the rainwater overflow of an Indian production facility. The water concentration of azithromycin measured here exceeded the ecotoxicologically relevant threshold value by at least 1,600,000 per cent. Despite these concerning findings, our study also revealed some positive outcomes. For instance, one of the Indian facilities took immediate action to upgrade its wastewater treatment, resulting in a significant reduction of a previously identified exceedance of the contracted antibiotic. Another facility improved its storage and recycling practices after an IWW inspection. As a result of the study, a more conscious and therefore more sustainable approach to antibiotics was established at this production facility. The results of the pilot study highlight an urgent need for action, not just at the national level but across Europe. This is even more important because our investigation has likely only scratched the surface of the environmental impact of antibiotic production. To effectively address this issue and safeguard both the environment and public health, we need a coordinated European approach that can bring the full weight of the European market to bear. The time to act is now, before the consequences of inaction become even more dire.

Before joining the team of Mr Wienands in March 2024, Amelie studied clothing technology and worked in the fashion industry for several years. She then changed career direction and decided to take a more meaningful path. Switching to AOK Baden-Württemberg was a significant step for Amelie; she isnow involved in an industry that puts people's well-being at the centre. In her current position, she focuses on the sustainable design of tenders, among other things. Working in the field of pharmaceutical supply gives Amelie the opportunity to actively contribute to shaping a better future and promoting sustainability in the healthcare sector.