Emissions from pharmaceutical production and consumption have nearly doubled in the last 24 years, according to a new global analysis. The pharmaceutical industry has gotten more carbon-efficient, but these gains are swamped by an increase in prescriptions.
There’s growing awareness of the climate impact of the health care system, but many past studies of pharmaceutical-related emissions have been case studies of the footprint of individual drugs, not the whole industry.
Several national-level studies have flagged pharmaceuticals as a major contributor to the climate impact of health care overall, but most of these focused on high-income countries. Data haven’t been available to enable a global analysis – until now.
In the new study, researchers in the Netherlands leveraged a recently assembled Organization for Economic Cooperation and Development (OECD) database of emissions associated with production and consumption in different sectors of the economy. The OECD has recently expanded its coverage of Africa and Southeast Asia in particular.
The researchers analyzed OECD data from 76 countries (lumping the world’s remaining nations together in a 77th region), quantifying pharmaceutical greenhouse gas emissions over the last quarter-century.
Emissions related to pharmaceuticals increased by 77% between 1995 and 2019, the researchers report in The Lancet Planetary Health.
Pharmaceutical emissions have grown much faster than those of most other industries and faster than the global average of 49%.
The main reason for increased emissions is increased consumption of pharmaceuticals, especially in China. That country’s pharmaceutical emissions increased from the equivalent of 9.6 billion kilograms of carbon dioxide in 1995 to 71.2 billion kilograms in 2019, the largest absolute increase of any nation.
While China has the heftiest total pharmaceutical footprint, reflecting its large population, its per-capita footprint is less than half that of the United States. There, pharmaceuticals were responsible for a whopping 111 kilograms of carbon emissions per person in 2019.
On average, high-income countries had a per-capita footprint of 73 kilograms of carbon dioxide in 2019. That’s more than nine times higher than lower-middle-income countries at 8 kilograms.
Increased consumption of pharmaceuticals in middle-income countries can often be a positive indicator of greater health care access. But it’s not inevitable that emissions must increase to the same degree.
For example, some high-income countries have per-capita pharmaceutical footprints of just 20 or 30 kilograms of carbon dioxide – roughly one-fifth that of the United States. That’s all the more surprising because pharmaceutical manufacturing is so concentrated in just a few countries. More research is needed to understand what’s behind these variations, the researchers say.
Per-capita pharmaceutical footprints even decreased by at least 20% during the study period in 25 countries, most of them in Europe. In Europe overall, the pharmaceutical footprint decreased from 40.6 billion kilograms of carbon dioxide in 1995 to 33.0 billion tons in 2019.
Such decreases reflect improvements in the carbon efficiency of the pharmaceutical industry. Globally, such efficiency gains offset about half of emissions growth due to increased pharmaceutical consumption. But carbon-efficiency gains in the pharmaceutical industry slowed dramatically after 2008, the researchers found.
And pharmaceuticals are still substantially more carbon-intensive than health-care services, the analysis revealed, so holding pharmaceutical emissions down is key to keeping the overall carbon footprint of the health-care system in check.
Other studies have suggested that between three and 50% of medicines go to waste, due to expired stockpiles, unnecessary prescriptions, and large package sizes. Addressing these sources of waste, such as with programs to return or redistribute unused medications, could help reduce pharmaceutical emissions without compromising people’s access to needed drugs, the researchers argue.
Source: Hagenaars R.H. et al. “The greenhouse gas emissions of pharmaceutical consumption and production: an input-output analysis over time and across global supply chains.” Lancet Planetary Health 2025.
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