World’s Leading HIV Drug Reduces Carbon Emissions By 26 Million Tons In Comparison To Predecessor – Health Policy Watch

The lifesaving HIV treatment dolutegravir (DTG), used by 24 million people in low-and middle-income countries (LMICs), has unexpectedly contributed to a significant reduction in carbon emissions when compared to the previous standard of care, efavirenz, according to the latest report by global health initiative Unitaid.

The report estimates that the transition to DTG will have prevented over 26 million tons of CO₂ from entering the atmosphere from 2017 to 2027. The emissions reduction is comparable to eliminating 10 years’ of carbon emissions from Geneva, Switzerland, according to the report released on Monday.

This is the first report to analyze the environmental impacts of a single widely used medicine compared to its alternative. It builds on Unitaid’s From milligrams to megatons report last year which analyzed the climate and nature assessment of 10 key public health products in its portfolio.

“One of the outcomes of this study of 10 products was that carbon emissions can be really significant and one product stood out as particularly important, it’s this one, dolutegravir,” Vincent Bretin, Director of Unitaid’s Results and Climate Team told Health Policy Watch.

“So, it’s [this report] really a deep dive on that comparison. And it’s showing that the previous generation of efavirenz was actually producing more emissions. So, all the steps required to manufacture it resulted in more carbon emissions worldwide compared to the current treatment,” he said.

Unitaid is hosted at the World Health Organization (WHO) and focuses mainly on supporting the treatment of tuberculosis, malaria, and HIV/AIDS along with its deadly co-infections in LMICs.

As global carbon emissions continue to rise and climate impacts worsen, different sectors are being called on to reduce their carbon footprint, while also meeting development agenda. It is in this context that Unitaid’s report provides a viable path forward for the reduction in the health sector’s carbon emissions.

Health sector’s carbon emissions

Health sector’s carbon emissions stand at roughly 5% of the global carbon emissions and is larger than the emissions of many big countries. While this has been discussed for a few years now, as Health Policy Watch has reported earlier, nothing concrete has been done to reduce these emissions.

Some 50-70% of the healthcare sector’s emissions comes from supply chains, according to various estimates, said Bretin. In the case of HIV treatment, 90% of the emissions come from the upstream part of the manufacturing process, he said.

DTG is the most effective and lowest-cost antiretroviral drug ever. It was rapidly scaled up across low- and middle-income countries starting in 2017, thanks to a concerted global effort by Unitaid, manufacturers, governments, global health organizations and affected communities. DTG is now the standard of care in over 110 low- and middle-income countries.

“This report demonstrates that we can achieve significant health improvements while also making strides in reducing carbon emissions. By adopting innovative practices and prioritizing sustainability, we can ensure that medicines like DTG are not only effective but also environmentally responsible,” Bretin said.

The reason for the reduction in emissions was found to be that DTG requires a smaller quantity of active pharmaceutical ingredients which naturally lowers emissions during the production process.

While DTG’s carbon footprint is significantly lower than its predecessor, it still remains very high, the report said, and there is a need for all stakeholders to work together to lower it further.

Need for innovation in the health sector

The sector will have to focus on technology upgrades and innovation to reduce carbon emissions of drugs and other pharmaceutical products.

The report outlines several measures that can be taken to reduce emissions from DTG even further, with the potential for application to other commonly used drugs.

Up to 40% of these emissions could be reduced through cost-saving measures such as process optimization to improve energy and material efficiency, and another 50% could be reduced by adopting green energy and materials, the report says.

Optimized supply chains, supported by coordinated efforts to improve distribution and production processes, will also be needed to further enhance environmental efficiency.

“While it (this report) demonstrates the potential for health interventions to contribute to our climate goals, it also highlights a missed opportunity: had climate considerations been mainstreamed into design of these efforts, its carbon footprint could have been reduced much further,” wrote Oyun Sanjaasuren, Director of External Affairs at the Green Climate Fund, the world’s largest climate fund, in the report’s foreword.

Unitaid hopes that the report encourages drug manufacturers, innovators, public health players and governments to look at the carbon emissions of the health sector.

“I think it’s the broader ecosystem that we need to look at that needs to shift from where we are right now to integrating climate considerations into our policies, ways of working approaches,” Bretin said.

No mechanism to prevent ‘greenwashing’

But promoting some products as greener than others opens the sector up to greenwashing – a form of marketing spin to persuade the public that the products are environmentally friendly.

End users have no way of knowing whether the drugs are green if more companies and entities use this claim while marketing their drugs.

“We don’t have yet the systems, the methods, the standards, as a global health community to do this in a standardized way, and to audit for instance, or to request information from manufacturers to ensure that what they do is really what they claim they’re doing,” Bretin acknowledged.

Unitaid’s report comes days before the International AIDS Society (IAS) Conference – the premier global event on HIV research and policy.

Image Credits: Unsplash, Unitaid report.