In order to treat current bacterial infections worldwide a large quantity of pharmaceutically active ingredients (APIs) are manufactured globally each day. This process started in the UK in the 1940s and 50s following the invention of chemical purification of penicillin during World War II. Clearly a great deal of development, innovation and improved efficacy in the range of APIs has occurred since then. One of the major issues has been the time it takes to develop a new drug, the cost of all the tests needed for testing the efficacy and toxicity of any new drug against existing compounds. If this is too long and expensive no new drugs will get developed as patent life time is limited to around 20 years. Much of this time is taken up with clinical trials so once a drug is off-patent it is worth less and must be produced where employment and other costs are low. This provides a dilemma for those in need of antimicrobial agents as much of the production has moved to lower and middle income countries where costs are lower but this comes as the expense of reduced care about waste management to cut production costs. This now has been the trend during the last twenty-five years with small and medium sized pharmaceutical plants being built in Central America (principally Puerto Rico), Eastern Europe (Croatia), India and China. Out of all these India has emerged as the fastest growing, most successful pharmaceutical producer in the world. Unhappily the cost has been environmental pollution arising from small scale manufacturing developing in industrialised areas already badly polluted. However, there is a recent trend for major pharmaceutical hubs to maximise efficiency and establish suitable, local supplies of resources. Such hubs are newly emerging and there is still time to monitor their impact and most importantly regulate their activities to stop waste antibiotics entering both aquatic and terrestrial habitats and spreading resistant bacteria and damaging human health.

We have assembled scientists in India and the UK to work on this globally important issue and study one such pharmaceutical hub and test in real time how pollution impacts both the human community and the resistant status of bacteria around them. In the long term we all have the same goal: to produce drugs efficiently, cleanly and with responsibility for the careful disposal of APIs without pollution.

The academic teams will work together to develop chemical, microbial and public health technologies to produce a framework to evaluate impact. In turn these methods and approaches, when supported by appropriately analysed data and models, will establish in theory the best way to mitigate environmental impacts without making production economically non-viable. Antibiotic production is a vitally important industry and deserves to be served by state-of-the-art science to help solve the modern-day global needs of medicine with the market demand for cheap drugs. This dilemma can be addressed by medical anthropology combined with analytical technology and this is precisely what we will do in our team of experts doing battle with the problems of “cheap drugs for bad bugs”. We could equally quote “cheap drugs for bad health” as it is the local communities and workforce who are most exposed to enable consumers globally to benefit. This means that we must produce coherent evidence that current practices are impacting human and environmental health and this is not a trivial task but is well served by establishing multidisciplinary teams of international academic experts. Our aims are clear and this is our focus for our India-UK ResPharm team to resolve the dilemmas discussed in producing cheap antimicrobials.