Pharmaceutical Release into the Environment during Pandemics and Regional Epidemics

The Intergovernmental Panel on Climate Change states that population growth and climate change are likely to intensify the risk of future epidemics and pandemics. In light of these new societal pressures, there has been a significant push from both national and international organizations in the establishment of pharmaceutical preparedness plans. Epidemic and pandemic pharmaceutical usage differs from conventional usage in that upwards of 35% of the population will be infected and potentially treated with one or more pharmaceuticals. The 'bolus' of pharmaceuticals during a pandemic creates unprecedented and largely uncharacterised risks to the operation of sewage treatment plants, riverine aquatic systems and human health. Current regulations on pharmaceuticals are based on intended predicted use patterns under conventional conditions, rather than during a pandemic or epidemic. The distinction between conventional and large scale usage has not been of concern prior to the emergence of the current risk of pandemic influenza, for which large quantities of 'seasonal influenza' antivirals (i.e. Tamiflu) are being stockpiled. In the event of pandemic influenza, unprecedented quantities of a suite of pharmaceutical products are expected to be used to treat the infected and limit the spread of pandemic influenza among the uninfected. With each pharmaceutical comes a unique array of potential ecological targets, including humans. Moreover, the risks posed by a mixed waste stream can not be predicted by knowledge of the ecotoxicology of its constituent parts. Arguably the most critical service that could be disrupted by the influx of high concentrations of biologically-active chemicals is sewage treatment works (STW). Little is known regarding the effect of high concentrations of antibiotics on the operation and integrity of STW. Similarly, there is no peer-reviewed research on the effect of antivirals on STW or the environment. The current inability of the H5N1 virus to transmit from human-to-human, which is considered inevitabile by The Royal Society as well as most of the world experts, provides us with a valuable and possibly brief window of opportunity to assess the risks of our current pharmaceutical preparedness plan and adapt it accordingly. The proposed Initiative will provide a foundation of scientific understanding of the fate and effect of widespread pharmaceutical use during a pandemic and epidemic and a multi-disciplinary network of members capable of responding and adapting to not only an influenza pandemic, but the likely emergence of other epidemics and pandemics in our immediate future. During its first three years the PREPARE Initiative will: - develop and publish an on-line knowledge and networking tool to integrate existing information sources that help in the assessment of risks associated with pharmaceuticals in the environment under pandemic and epidemic conditions. This will provide a mechanism for those seeking such information to be rapidly guided to the best resource and help in interpretation of available knowledge. - run five knowledge gap identification workshops, for the discussion of key specialist topics in the assessment of pharmaceutical release into the environment under pandemic and epidemic conditions. - prepare articles for both peer-reviewed journals as well as the house publications of relevant professional organisations, describing the issue being addressed by the PREPARE Initiative, explaining the on-line resource and reporting on preliminary findings. A special journal issue will be initiated. - run a conference to report on outputs of the PREPARE Initiative during its first three years, to facilitate further knowledge transfer and gather consensus on the longer-term life of the initiative. - identify the lessons that can be learned on the use of scientific knowledge in policy making and regulation and publish a report on this.