The 28th session of the Conference of Parties (COP28) starts on 30th November 2023 and will continue to December 12th.

COP is the biggest multilateral forum on climate change, with decision-making powers and representatives from all member nations.

This years COP has particular significance as it will review the first global stocktake of progress toward the Paris Climate Change Agreement goals, and determine the responses. It is already obvious that progress has fallen short, we are not close to where we said we would be, or where we need to be.

At COP28 we must acknowledge, accept and learn from the failings, decide how we must change, and move forward. Fast.

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COP28 Health Day

COP28 is also significant as it the first time health has a dedicated focus. December 3rd is Health Day, and has been organised in collaboration with WHO, the Wellcome Trust, and many partners.

The main goal of Health Day is to raise awareness of the severe impacts of climate change on human health. It also aims to provide a platform to discuss the mitigation and adaptation solutions needed to ensure health and well-being.

These goals are equally daunting and doable. Daunting because there is so much that needs to be done, doable because there is so much that can be done.

Here, I have outlined five priority areas.

1. A global health adaptation fund

Health is often the last priority in climate adaptation efforts, receiving only 0.5% of adaptation financing. A dedicated fund for health adaptation could help close this gap and support countries and communities to build sustainable, resilient and equitable health systems. The health systems we will need to cope with the health impacts of climate change.

2. A global commitment to net zero health systems

The healthcare sector is responsible for a significant portion of greenhouse gas emissions. If the global healthcare sector was a country a 2019 study estimated it would be the fifth-largest greenhouse gas emitter in the world.

The Alliance for Transformative Action on Climate and Health includes 75 countries working towards building climate resilient and sustainable health systems. Many countries have started to set targets, but very few have made binding commitments with clear roadmaps to reach net zero. We need to increase health sector engagement, commitment, and action.

3. A coordinated global research program

Many aspects of human health are affected by climate change, but the evidence and data are still limited and fragmented. Federation of existing research and data would be invaluable, as would globally coordinated research programs to provide timely, reliable information on the health impacts of climate change. This is essential for the design of effective strategies and solutions.

4. A universal health coverage pledge

Universal health coverage is a key predictor of national adaptation capacity and vital for health equity. UHC should be the backbone of climate and health strategies. Alignment of climate-health interventions with the Sustainable Development Goal to achieve universal health coverage by 2030 would be a powerful statement, with potential to catalyse action towards both ambitions.

5. A health-in-all-policies approach

Health is not only a sector, it is a foundational, cross-cutting issue that affects and is affected by many other sectors, such as energy, transportation, agriculture, and industry. A health-in-all-policies approach means integrating health considerations into all policies and actions that have an impact on climate change and vice versa. This would help maximise the many health co-benefits of climate action and minimise the trade-offs and conflicts.

COP28 Health Day is an opportunity to put health at the centre of climate action and to mobilise the health community for climate action. If done right, it could be the start of a new era where health is a key driver and outcome of every COP and every climate discussion.

Let’s make it happen.

It’s Open Access Week, our annual opportunity to join together, raise awareness, and take action to drive equitable knowledge sharing, and the positive societal impacts open access to knowledge will deliver.

I've been an active and vocal advocate for open access to science, throughout my career. As a rare disease clinician, I witnessed firsthand the profound, often life-saving impact of access to global research on ultra-rare conditions. I fervently believe access should be universal, easy, and free for all readers.

There are challenges in providing universal access, notably, how the costs of delivering free-to-read content will be supported, and by whom. Many individuals and organisations are working tirelessly and creatively to address the challenges. Most are logistical issues that can be solved if we are committed to solving them. For priority areas we must solve them, urgently.

Providing universal access to medicines research is an urgent priority.

Universal access to medicines research

Medicines are a cornerstone of healthcare. In 2020, 4.5 trillion doses of medicines were dispensed at a cost of $1.4 trillion—approximately 16% of the global healthcare expenditure. Access to essential medicines is included in our right to health, enshrined in international law since 1946, and is a core target of the Sustainable Development Goals.

As well as increasing access to the medicines themselves, increasing and democratising access to medicines research is crucial. There is an urgent need to decrease medication errors, adverse effects, and non-adherence, and to increase knowledge on best practices, innovations, clinical-effectiveness, and cost-effectiveness. Universal, free availability of medicines research should be a priority objective of academia, pharmaceutical companies, and healthcare.

Current status of access

To investigate current accessibility to medicines research I used PubMed from the NIH National Library of Medicine, which is the go-to search tool for medical practitioners and researchers. PubMed gives the number of publications for a given search term, which you can filter to find those for which the ‘free full text’ is available.

I searched for papers on medicines included in PubMed over the last 10 years1 and used the full free text filter to see which were openly accessible.

Only 55% of papers had the full free text available and this has been stable over the last 10 years - very disappointing.

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Lessons from Covid-19

The accepted importance of providing immediate, free access to research publications was underscored in the pandemic when more than 50 publishers made over 350,000 coronavirus-related articles publicly available in PubMed and other repositories. This was prompted by a call from scientists ‘to ensure that research findings and data relevant to this outbreak are shared rapidly and openly to inform the public health response and help save lives’ and was aligned with prior statements on data sharing in public health emergencies.

To evaluate the impact of the response, I restricted my PubMed search to Covid-19 papers2, and found that 85% were available to download, in full, at no cost.

There is a way, if we have the will

The pandemic response shows it is possible to quickly and dramatically increase accessibility of research publications. When it is considered important enough.

The Sustainable Medicines Partnership believe all medicines research should be considered important enough. We are working together to design practical solutions that will drive and deliver action.

We will share more on this in 2024.

In the meantime please checkout the excellent content on Open Access medicines research from our friends and collaborators at Oxford Pharmagenesis and Open Pharma.

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In my twenties, my cause was mapping the uncharted territories of the human genome. It was a scientific pursuit. I didn’t think I was needed to turn the avalanche of new knowledge into better healthcare. I thought that would somehow just happen, because it would make such a difference to so many people.

The naivety of youth!

I came to realise translating knowledge into action, no matter how valuable that action could be, is hard work. Formidably hard. It needs commitment, energy, resilience, ingenuity, resources and resourcefulness. And none of these are enough without good timing.

To drive transformational change, the timing must be impeccable.

It took another two decades for me to realise we are not at the mercy of time. We can start the clock, if we can find a compelling cause. A cause that feels urgent, worthy, important, and overlooked.

Wasted medicines is such a cause.

Wasted medicines - hidden in plain sight

Over the past few years I have talked to hundreds of people about the vast quantities of medicines being wasted. Not a single person has challenged me on it. Not a single person has asked me for evidence that it occurs. Because everyone in the medicine supply chain knows it to be true.

And yet it is rarely spoken of, and there is little research or action to address wasted medicines. Perhaps because it feels intractable. Perhaps because it is a systemic failure for which no one feels accountable.

Whatever the reasons for the silence, it presents an opportunity to do something new, to cast light and energy on a pervasive problem that damages people, planet, and business.

A shared concern - everyone hates waste

Tackling complex, endemic problems is difficult, but it can be easier to build support, because such problems rarely polarise opinions. Reducing waste is particularly non-controversial; an antipathy of waste is a universal human trait. Nobody champions wasting precious resources!

Wasted medicines are not due to a single bad actor, or a single part of the supply chain. Everyone could do better, but no one is to blame, and the root causes are often unintended consequences of reasonable policies, as we describe in the Sustainable Medicines eBook.

Although this brings its own set of challenges, it fosters and stimulates cooperation, as we have found with the Sustainable Medicines Partnership.

And if everyone gets behind a simple, compelling vision, magic can happen. Solutions can be found and implemented.

Riding the zeitgeist - the wave of sustainability

Sustainability is no longer a niche concern. Societies are realising we cannot keep consuming and discarding without consequences. And people want and expect healthcare to do it’s part, as we showed in last week’s post.

The zeitgeist is shifting towards responsible consumption and waste reduction. Companies and organisations are under pressure from stakeholders and citizens to do better. Much better.

This provides opportunities to incentivise action. Addressing wasted medicines is not just about being responsible; it’s a strategic decision that can align values and value.

Wasted medicines - a gateway to systemic transformation

Wasted medicines are more than a problem to be solved; they’re a gateway to a more sustainable, resilient, equitable pharmaceutical industry. Focussing on wasted medicines will reveal challenges and opportunities at every stage of the pharmaceutical supply chain from development to disposal.

Over the coming weeks I will delve into these, and if you can’t wait, they are outlined in the Sustainable Medicines eBook.

The most important thing about timing….

Many external factors and forces will affect the success of mission-driven causes, and paying attention to them is important.

But one timing is more important than everything else.

Starting.

Not starting is the commonest reason for causes not getting anywhere.

The start doesn’t have to be big, or grand, or loud, or expensive. But it has to be something. Something more than a daydream or a dinner table gripe.

If you have read this far I’m guessing some of you have sustainable healthcare ideas you believe are worthy of attention (and intention). Why not start by sharing them in the comments. Or email me - I always love hearing from fellow cause junkies!

Just start!

More than 60 healthcare systems have committed to achieving net zero carbon emissions. Given the profound impact of the climate crisis on health and well-being, it's no surprise healthcare sectors are taking their environmental responsibilities seriously.

But this task is far from simple. Amid rising backlogs, increasing costs, and many varied pressures, it is essential to carefully consider the potential consequences of embracing this extra obligation.

To do this, we need to understand the choices and trade-offs. We need to search for solutions that can address emissions and alleviate other pressures. We need to ensure prioritising environmental issues doesn't inadvertently create or exacerbate other problems.

And, importantly, we must understand the concerns and expectations of the population.

How do people want healthcare to navigate this new responsibility?

Medicine emissions - a critical contribution

Reducing carbon emissions related to medicines must be prioritised in healthcare Net Zero strategies, because pharmaceuticals account for a large proportion of emissions: 25% in the NHS.

For a few medicines, such as anaesthetics and inhalers, there has been success in measuring, stratifying, designing, and implementing carbon reduction strategies.

However, these instances remain exceptions, primarily because so little information about medicine-related emissions is available.

Public sentiment on medicine carbon footprints

To gauge public sentiment on this topic, we conducted an online survey. We received responses from 1304 individuals from four countries, the UK (312 participants), U.S. (308), Australia (380), and France (304).

We asked them the following questions:

What did we learn?

People care about healthcare emissions

There was remarkable consistency across the four nations, particularly in relation to how they wanted health systems and medicine manufacturers to act.

• 84% of people felt it was important for medicine manufacturers to disclose the carbon footprint of their products.

• 84% of people felt it was important for health systems to try to reduce the carbon footprint of the medicines.

• 84% of people felt it was important for health systems to choose medicine suppliers with a lower carbon footprint, if the costs were the same. 

A smaller, but still sizeable percentage (73%) felt it was important for doctors to have access to carbon footprint information when deciding which medicines to prescribe.

Personal preferences vary

People had more diverse opinions when asked if they personally wanted information about the carbon footprint of the medicines they were taking.

• 52% did want the information.

• 13% did not want it.

• 27% didn’t mind.

• 8% didn’t know.

To explore this further we commissioned qualitative research with 1-to-1 interviews to delve deeper into the reasons behind people's choices. Please read the full report - it contains many observations that we have found interesting and useful.

Some key takeaways from the research:

Very few people had previously considered the environmental impact of medicines.

People were positive about including the carbon footprint rating on over-the-counter (OTC) medications as it enables more informed choice.

Clear and well-timed public communication will be key to addressing any concerns.

Solutions to drive change

At YewMaker, we have been developing MCF Classifier, a suite of data-driven solutions that provide standardised, user-friendly medicine carbon footprints that will enable carbon-informed medicines use, and prioritisation of carbon-reduction interventions. We will be sharing more on MCF Classifier later this year.

The substantial contribution of pharmaceutical emissions to the overall healthcare carbon footprint, combined with the lack of accessible data, has driven interest and support for our work.

It's encouraging to see that our commitment resonates with the views of patients and the public, who overwhelmingly support the health sector's commitment to reducing the carbon footprint of medicines.

This mission, and the mission of Net Zero healthcare, is not just a responsibility, it's a shared commitment. It's what healthcare owes to society, and it's what the public rightly expects from healthcare.

We believe healthcare can be sustainable. Good for us, good for our planet, and good for business.

Did you know that the carbon emissions of the healthcare sector are equivalent to the fifth largest country? Or that we throw away billions of safe, effective medicines every year?

Healthcare spend increases year on year, healthcare waste increases year on year, but 2 billion people do not have access to even basic healthcare.

YewMaker wants this to change

YewMaker builds science-based sustainable healthcare solutions and multi-stakeholder action collaboratives to deliver change.

We will all need to play a part - countries, corporations, communities, and citizens - to build the healthcare we deserve, without damaging our planet.

Here we will call out the problems, their impacts, and our urgent to deal with them. But it won’t be all doom! We will tell you about the projects the Sustainable Medicines Partnership are driving, and will share inspiring stories from our many collaborators.

We will all need to play a part - countries, corporations, communities, and citizens - to build the healthcare we deserve, without damaging our planet.

The good news is that we can all make a difference, and we can all start today.

Thank you for being on this journey with us.

Please share this blog with others who might want to come along.

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