Antimicrobial resistance (AMR) is a complex and global issue, affecting all regions of the world. If current trends continue, it’s believed by 2050 antibiotic resistance will cause more deaths per year than cancer, becoming the world’s biggest killer.
As such, AMR is currently high on the political agenda of nation’s around the world as a sustainable solution is sought to reduce the rate at which antimicrobial pathogens are developing immunity to modern medicine.
However, the role of pharma packaging innovation is rarely discussed. While packaging alone does not hold the answer, it has an important part to play in making sure the healthcare system is part of the solution and not the problem.
Understanding the problem
To have a meaningful debate on the AMR crisis, it’s firstly important to understand the key factors currently contributing to its development.
The following contributors are widely cited as accelerating the rate at which bacteria is becoming immune and the emergence of more resistant strains: pharmaceutical waste; the over-prescribing and lack of access to antibiotic drugs; falsification of medicines; poor hygiene practices and the increase in global trade and travel.
The consequences of AMR are far-reaching, reducing our ability to treat common infectious diseases resulting in prolonged illness, more complications and higher fatality rates; the accelerated spread of infections due to ineffective treatments; compromising advances in medicines because of the risk of infection; and placing increasing financial pressure on global health care systems.
Since the historic United Nations Declaration on AMR was agreed in 2016, efforts have intensified across scientific, political and economic spheres to tackle it. However, evidence suggests while positive steps have been taken to slow the pace of AMR, there’s still a long way to go.
The World Health Organization (WHO) released a progress report in the summer which summarised: “progress with developing and implementing plans is greater in high-income than low-income countries but all countries have scope for improvement. No country is reporting established sustained capacity at scale in all domains”.
If this was a school report it would be “showing promise but must do better”.
Strengthening the frontline
Overuse and incorrect use of antibiotics is a major driver of resistance. A recent UK study estimated a fifth of prescriptions are inappropriately prescribed by GPs for illnesses such as a sore throat, cough, sinusitis and ear infections.
There’s a growing body of evidence suggesting the mismatch between dose amounts and course-length mandated by drug manufacturers and prescribers is leading to a considerable quantity of wasted and redundant antibiotics.
For example, a study published in the Australian and New Zealand Journal of Public Health found out of 32 of the most common antibiotic-prescribing scenarios, 10 had surplus doses left over and 18 had a dosage shortfall, leaving only 4/32 scenarios when the packaging size matched exactly the recommended dosage guidelines.
This is certainly an area where pharma packaging can help by ensuring labelling information corresponds accurately to the latest guidelines. Labelling guidelines also must keep up with wider health trends, such as the continued rise in child and adult obesity, which render recommended dosages outdated very quickly.
Developments in digital packaging technologies are also helping pharmacists and doctors on the frontline monitor usage data and get a clearer picture of compliance trends. “Smart” blister packs are becoming more advanced, utilising built-in microchips to capture use-related data and remind patients when the next dose is due. The data collected from these packs can then be accessed by health professionals to give a clear picture of a patient’s medicine-taking behaviour at home.
Over the next five years, the integration of more advanced digital features into the packaging and delivery systems of antibiotics will become the norm.
Tackling pharmaceutical wastage
According to the UN, the release of antibiotics into the environment is accelerating bacterial evolution and the emergence of more resistant strains.
While the aim of the pharmaceutical industry is to improve public health (while of course turning a profit), a failure to address the environmental impact of antibiotic pollution is undermining efforts. Only recently, The Bureau of Investigative Journalism reported none of the 18 big pharma companies polled would reveal how much antibiotic discharge is released from their factories.
As pharmaceutical waste includes degraded and contaminated products, pharma packaging can play an important role.
In the pharma industry, innovation has always been synonymous with new drug discovery and approval. However, while there’s no arguing about the importance of new antibiotic development in the fight against AMR, the next generation of packaging and delivery systems deserve the same attention.
With AMR placing increasingly complex demands on the supply chain, packaging and delivery components must be precision engineered to ensure antibiotics are delivered and administered to patients as intended. This involves the mass adoption of Quality by Design (QbD).
The underlying principle of QbD is that quality is built into a product from the outset rather than tested during manufacture. Knowledge-based design has a key role to play in establishing “the rulebook” about how a multitude of factors impact safety, efficacy and patient experience.
The pharmaceutical waste includes expired products, dispensed drugs that are unwanted or discontinued, and contaminated medications
Poor quality medicine
A sufficient dose of the right antibiotic medicine early on in an infection will kill susceptible strains and help suppress newly-mutated pathogens from spreading. However, if the medicine being relied upon is poor quality or falsified, the whole treatment process is undermined.
Currently, the sale of counterfeit pharmaceuticals is the world’s largest fraud market, worth more than $200bn per year. However, digital packaging solutions are offering greater supply chain visibility and making falsification harder.
Digital mass serialisation is becoming a popular solution to combat counterfeiting. This involves the generation of a random, pseudo code in a sequential manner by a technology provider entered into their or their customers’ database for later verification. The authentication process matches the unique code on a product to those stored in the database. If the code is present, the product is deemed to be genuine.
Origin has developed Smart-i PharmiTrack technology for the control of physical products in the supply chain and can be applied to any size of batch or even to a single unit measure. This technology can identify the security status and location of your product remotely, at any time, making attempt to seize or introduce falsified medicines into the supply chain much more difficult.
AMR is a complicated and multi-dimensional issue, requiring the collaboration of national governments, NGOs, scientific experts and the general population to solve.
While pharma packaging cannot claim to offer the solution to the AMR crisis, at this point, every stakeholder in the healthcare supply chain has a responsibility to play their part.
What is a terrifying threat may also be an opportunity to drive “health for all” across the world, balancing the many economic, social and health inequalities which continue to exist today.