A holistic framework for integrated sustainability assessment of pharmaceuticals

Environmental pollution of pharmaceuticals arises during drug development, production, use and disposal and can damage ecosystems, increase antimicrobial resistance and generate substantial greenhouse gas emissions. As a result, environmental sustainability of pharmaceuticals is an expanding theme in today's society. Several sustainability assessment methods have been developed for pharmaceuticals, however, most assessments typically consider only parts of the pharmaceutical chain and focus on the burdens of resource use and emissions, defined as the 'footprint'. On the other hand, these assessments usually do not simultaneously consider the societal benefits of pharmaceuticals, called the 'handprint', in addition to the benefit/risk assessment for the patient. Existing sustainability assessments are often limited to traditional impact categories, neglecting other dimensions of sustainability. A comprehensive sustainability assessment should capture more than just the environmental dimension and could thus holistically capture the three pillars of sustainability, i.e., environment, social, and economic. Currently, holistic methods that cover all impacts over the entire life cycle of pharmaceuticals are lacking. The objective of this study is to conceptualise and propose a holistic framework for integrated sustainability assessment of pharmaceuticals, based on the three pillars of sustainability and taking into account both footprint and handprint outcomes. The framework was developed using both top-down (literature search) and bottom-up approaches (stakeholder involvement). Gaps, barriers and opportunities to achieve sustainability are identified. As a result, this holistic framework can be helpful in decision making.