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Superbugs, disease-causing microbes that have mutated to become resistant to antibiotics, are a threat to the lives of hundreds of thousands of people today and many millions tomorrow. These organisms turn curable illnesses such as tuberculosis, gonorrhea, and pneumococcal pneumonia into deadly ones.

This looming public health disaster has many causes. Overuse of antibiotics by humans and the routine use of antibiotics to help farm animals grow faster are key causes in the United States. One worrisome cause that has received virtually no attention until now is wastewater from drug manufacturing facilities in India and China, where a large portion of the world’s antibiotic supply is produced.

The US Food and Drug Administration guarantees the safety of all prescription drugs sold in our country no matter where they are made, so we can take antibiotics with confidence. However, the FDA has no jurisdiction over drug manufacturing pollution in foreign countries.


Recent reports indicate that Indian and Chinese drug makers routinely release untreated waste fluid containing active ingredients into surrounding soil and waterways. One study published in the Journal of Hazardous Materials showed antibiotic concentrations downstream of drug manufacturing plants in these countries that exceed those expected in someone being treated for infection. Researchers from Rice, Nankai, and Tianjin universities concluded that for every bacterium that entered a waste treatment plant in northern China, four or five antibiotic-resistant bacteria were released into the water system.

Pharmaceutical pollution of any type can be deadly, threatening habitats and poisoning drinking water. But antibiotic pollution doubles down on the dangers. The release of antibiotics into soil, streams, rivers and lakes creates a perfect storm for antimicrobial resistance to develop and spread.


This isn’t just a local disaster, because superbugs have no respect for national borders. Microbes travel freely through air and water. Bacteria are carried in livestock and agricultural products, which move across countries and continents as part of the global food system. And the ubiquity of international aviation means that antibiotic-resistant bacteria in people can travel thousands of miles in a matter of hours.

No physical barrier can be erected to prevent the spread of superbugs. Instead, they must be stopped at their source. Four vital steps can help reduce, if not eliminate, antibiotic pollution due to drug manufacturing.

First, US drug makers should require their suppliers to stop polluting. Last month, 13 pharmaceutical companies pledged to “review our own manufacturing and supply chains to assess good practice in controlling releases of antibiotics in to the environment” and to “reduce [the] environmental impact of manufacturing discharges, by 2020.” This is a positive step. But the timetable must be accelerated — we can’t afford three more years of rampant antibiotic pollution. And all other pharmaceutical companies must join in. The good news is that compared to other sources of antimicrobial resistance, addressing pollution is relatively easy and affordable because it involves a limited number of factories and fairly simple technical fixes that are already widely deployed by responsible manufacturers.

The superbugs are growing in number and strength. Hyacinth Empinado/STAT

Second, the FDA and other relevant US agencies should pressure their counterparts in India and China to toughen their regulations regarding pharmaceutical plant pollution and crack down on violators.

Third, major pharmaceutical retailers, such as CVS, Walgreens, and Walmart, should use their buying power to pressure US manufacturers to clean up their foreign supply chains. Retailers should demand that all the antibiotics they sell are produced through safe, non-polluting manufacturing processes.

Finally, we can all raise our voices to demand action by the businesses from which we buy our prescription drugs and the officials we elect to serve our interests.

This is all-hands-on-deck time. In the US, the Centers for Disease Control and Prevention estimate that more than 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 die as a result of those infections. Globally, superbugs are estimated to cause 700,000 deaths annually, a number that could top 10 million by 2050 if we don’t take effective action.

Reducing antibiotic-laden pollution from pharmaceutical manufacturing plants is a relatively easy, affordable part of the solution.

Henry A. Waxman spent 40 years serving in the House of Representatives, where he served as chairman and ranking member of the Energy and Commerce Committee and was a lead author of the landmark Clean Air Act Amendments of 1990. He is currently chairman of Waxman Strategies. Bill Corr served as deputy secretary of Health and Human Services from 2009 to 2015. He is currently a senior advisor at Waxman Strategies. (The company is working with the campaign organization Changing Markets to shed light on the issue of antibiotics in pharmaceutical waste.)