A global concern
Cheap drugs destined for Canada fuel resistance in India: experts
Pharmaceutical waste and substandard sanitation are breeding antimicrobial immunity, say experts, who contend the West’s support of cheaply produced drugs makes it complicit.
Canadian Press reporters travelled to South Africa and India to investigate the growing epidemic of drug resistance, which experts describe as the single greatest threat to human health on the planet. This is the fourth story of a six-part series exploring how the unfettered use of antibiotics pushes humanity closer to a post-antibiotic era in which common infections may be impossible to treat. The R. James Travers Foreign Corresponding Fellowship helped fund the project.
Piakka Appalaraju steadily rows a small circular boat he uses to fish twice a week on the placid blue-green waters of Gandigudem Lake and remembers the moment last October when his livelihood suddenly evaporated.
Hundreds of thousands of fish began to wash ashore, their translucent white bodies floating to the top of an inky-black liquid. He and 50 other locals had paid for the fishing rights to the lake. Women stood weeping by the shore that day.
“It was a disaster scene. People collapsed after seeing the fish,” he says, speaking through a Telugu translator. “They were wordless. They were not in any position to express their grief. One after another, they came to the lake and they saw how the fish died.”
Indian media reported that wastewater from nearby pharmaceutical companies leaked into the lake during heavy rains and the state pollution control board ordered the companies to compensate the fishermen. The board did not respond to requests for comment from The Canadian Press.
But Appalaraju maintains the money wasn’t enough to cover his losses.
For the villagers who live around Hyderabad, the incident was another example of how the city’s booming drug-manufacturing industry damages their lands, waters and food sources — although companies deny causing any harm and say they voluntarily agreed to compensate villagers.
Hyderabad, the self-proclaimed “bulk drug capital of India,” churns out a steady stream of generic drugs, including antimicrobials, for global consumption. Dozens of facilities hold licences to export to Canada.
The worldwide overuse of antimicrobials in humans and animals is accelerating dangerous drug resistance, killing an estimated 1.5 million people a year and pushing medical care closer to a post-antibiotic era in which common diseases are no longer curable.
But resistance also appears to be growing in the environment. Some researchers say rivers, lakes and groundwater in Hyderabad contain elevated levels of antibiotics and drug-resistant superbugs.
Pharmaceutical waste and substandard sanitation are breeding antimicrobial immunity, say experts, who contend the West’s support of cheaply produced drugs makes it complicit.
Waste treatment
About a kilometre from Gandigudem Lake, a dusty red tanker truck painted with the words “Ind. Effluent Water” and “PETL” sucks up a murky brown fluid from an open well.
Scores of drug-manufacturing facilities operate in the area, known as the Kazipally pharmaceutical cluster, and many send their wastewater to the PETL, or Patancheru Enviro Tech Ltd., treatment plant.
One of the first studies on antimicrobial waste in the region in 2007 tested the treated wastewater from PETL. At the time, the plant released treated water into a stream that connects to three major rivers in Hyderabad, according to the report by Joakim
Larsson, an environmental pharmacologist at Sweden’s University of Gothenburg.
Larsson found the highest levels of pharmaceuticals ever reported in any effluent, or liquid waste.
The findings piqued his interest. Many previous studies on antimicrobial waste in the environment focused on humans excreting or improperly disposing drugs. But Larsson’s report suggested production facilities were releasing substantial amounts of medicines as well.
He has since published dozens of reports on the issue, including a 2014 study that found a Hyderabad lake teeming with antibiotics that contained 7,000 times more resistance genes than a Swedish lake.
The following year, he found the bacteria in the Hyderabad lake contained plasmids, which allow the microbes to transfer their resistance to one another.
Larsson expected to find resistant bacteria in any river or lake in India that receives sewage, but was shocked to discover the presence of antibiotics at much higher levels than humans would excrete.
When bacteria meet antibiotics, they learn to resist the drugs, he says, adding his greatest concern is that pollution is spawning new superbugs.
“That is sort of an irreversible event,” he says. “That thing can happen one time on our planet, and then we have opened Pandora’s box and we can’t turn back the clock again.”
Defending the Musi River PETL no longer dumps treated water into the stream. Now, an 18-kilometre pipeline carries the fluid to the Amberpet sewage plant, where it is again treated
before being discharged into the Musi River, a major waterway that flows through the centre of Hyderabad.
Some companies that operate here and are licensed to export to Canada say they do not send any wastewater to PETL because their factories have systems that result in zero liquid discharge.
Locals who live along the Musi River say the pipeline simply shifted the pollution.
The Musi River near the village of Edulabad froths and bubbles with thick white foam. It smells of chemicals so strongly that the throat and eyes burn.
The village lost a court challenge to block the pipeline’s construction more than a decade ago.
Edulabad’s president Musi Shankar was bestowed with the nickname Musi in honour of his 30-year fight to protect the waterway from pollution. Stacks of photo albums, overflowing with pictures of his demonstrations and meetings with Indian politicians, fill his office. Despite his tireless efforts, he believes nothing has changed.
A government-built pipeline brings clean drinking water to the village. But polluted water feeds crops and livestock and people who work in fields suffer blisters and rashes, he says. Villagers who can afford to leave migrate in droves, he adds, while those too poor are stuck trying to eke out a meagre living on contaminated land.
“As there’s no alternative, they’re living here, even after knowing that it’s affecting their livelihoods, affecting their health, affecting their cattle,” he says through a translator.
On Peddaboina Raju’s rice paddy farm in Edulabad, the water from a bore well runs yellow-green.
His rice yield has dwindled and the husks are often empty. He cannot find a buyer for his barren land, but he cannot leave without the income from selling his property.
Raju wants government compensation to pay for his sons’ education.
“I have not received a single rupee from the government,” he says through a translator. “There is no support from outside.”
Multiple sources pollute the Musi River.
Hyderabad discharges about 600 million litres of untreated sewage into the river every day, according to a 2012 study by Pullaiah Cheepi, an economics professor at Hyderabad’s Osmania University. The waterway was also described as a “dumping ground” for slaughterhouses, hospitals and the textile, dye, and oil industries in a 2005 study partially funded by the Indian government.
Researchers have also found elevated levels of antibiotics in the river. A 2016 study by two civil engineers at the Indian Institute of Technology in Hyderabad found antibiotic concentrations were 1,000 times higher than those usually found in rivers in developed countries.
The same year, a German team led by infection specialist Dr. Christoph Lubbert at Leipzig University Hospital tested water samples from an irrigation channel at Edulabad and at two points along the Musi River, as well as from other locations in Hyderabad. They found all 28 sites contained antimicrobials. A sample from the Musi River had the largest number of antimicrobial agents along with many genes that drive resistance.
Lubbert’s team concluded that insufficient wastewater management by drug manufacturers led to “unprecedented” antibiotic contamination that is associated with the spread of resistant bacteria. In one spot, researchers found the highest concentration ever recorded of fluconazole, used to treat many fungal infections.
The level of fluconazole is so high that there’s no explanation for it other than pharmaceutical waste, says Lubbert.
“That single particular finding is very alarming.”
Industry disputes research The Telangana State Pollution Control Board is tasked with monitoring the pharmaceutical industry. It has, at times, taken action, as it reportedly did after the fish deaths in Gandigudem Lake. But locals and advocates say the board fails to act more broadly on
pharmaceutical waste.
The foam bubbling in the Musi River is the result of untreated domestic sewage, says board member secretary Sri P. Satyanarayana Reddy. The board, he adds, has never found any antibiotic residue or resistant bacteria in Hyderabad waters.
Reddy does not believe scientific studies that suggest the contrary. The mostly European scientists are biased, he says, adding he doesn’t know the methodology used. (All the studies that found resistance and are cited in this story were published in peerreviewed journals and described their methodology.)
Reddy urged The Canadian Press to email additional questions so he could forward them to the state government. More than a month after the first of several emails was sent, no one has replied.
Industry groups also believe the research is biased. Study teams interact with non-governmental organizations, locals, news reporters and institutes, but not the industry or statutory authorities, according to the Bulk Drug Manufacturers Association, which represents Indian pharmaceutical companies.
“The whole approach seems to be highly biased with an intention to blame the Indian pharma industry,” it says in a statement.
The Central Pollution Control Board has conducted a detailed inspection of PETL, the pipeline and treated effluents from the sewage treatment plant and found that “all parameters were well within the standards,” the pharma association says.
The industry group also disputes the allegation that fish in Gandigudem Lake died from industrial effluents. Instead, it maintains the incident occurred because there was heavy rainfall and the drains overflowed. Sometimes, it adds, fish die due to sudden changes in water quality and osmotic pressure.
The association describes the compensation paid to fishermen as “voluntary,” despite media reports that the board ordered the payment.
“As a goodwill and social responsibility, we had compensated for the loss irrespective of whether it is due to industry,” its statement reads. “Many times, it is the industry which is coming forward to help the surrounding communities as most of their livelihood is dependent on our activities, including local people having employment in our factories.”