The carbon cost of clicking for health

They are as easy to hold as a felt marker and small enough for teenagers to tuck into their jeans. Some are even shaped like a cell phone, with an automated voice to deliver instructions on how to use them.

But all these portable devices have one thing in common: They come spring-loaded with a single dose of life-saving drugs that people – even those terrified of needles – can easily administer to themselves. Every year, more than 100 million autoinjectors are primed, pressed against flesh and clicked to inject drugs through an invisible needle, allowing people to manage diseases from anaphylaxis to arthritis, multiple sclerosis and diabetes.

They also come with a cost to the environment. The same ease-of-use that has made autoinjectors a multi-billion-dollar global industry has increased the carbon dioxide footprint that comes with making them by the tens of millions. Amid the clarion call for companies to join the global push towards net zero carbon emissions, a handful of med-tech companies are now starting to focus on the need to curb the greenhouse gases released when making autoinjectors in the first place.

Reducing the negative side-effects of his company’s products is a crusade for Sebastian Gerner, Innovation and Business Development Manager at Ypsomed, a Swiss-based, global manufacturer of auto-injection systems. The company’s analysis on the life cycle impact of existing autoinjectors found that each device has a carbon footprint of eight grams of carbon dioxide (CO2), with 70 per cent of emissions coming from plastic materials, 20 per cent from packaging and 10 per cent from production-related issues.

‘That’s a lot of plastic for a single shot’

“That’s a lot of plastic for a single shot,” says Gerner, who is also the president of Alliance to Zero, a still-small not-for-profit organization founded in 2021 to promote net zero emissions goals for supply chain companies in the pharmaceutical and biotech sectors.

Having pledged to be fully carbon neutral by 2030, Ypsomed has developed the YpsoMate Zero, which it claims to be the first C02-neutral autoinjector. The injector substitutes bio-methanol – a more biodegradable plastic – for methanol. And, working with multinational pharmaceutical companies that distribute the product, Ypsomed is exploring better ways to recycle injectors and the packaging as well as looking to overcome the biohazard obstacles that come with reusing injectors.

So far, Ypsomed’s device is well-short of being fully carbon neutral.

“We think we can reduce C02 emissions by 30 per cent with the different packaging and the different plastic material,” says Gerner. Yet that leaves 70 per cent of emissions untouched. Gerner says the gap will be addressed by buying carbon offset certificates, which he pledges will come by spending on projects such as reforestation that remove carbon dioxide from the atmosphere.

The industry was already under pressure to deal with the number of single-use plastic devices that wind up in landfills, and the challenge of balancing optimal patient care with environmental sustainability “is a really thorny problem,” says Fiona Miller, Professor of Health Policy, Chair in Health Management Strategies and Director of the Centre for Sustainable Health at the Institute of Health Policy, Management and Evaluation at the University of Toronto.

“We like to talk about high quality and low-carbon care and there are clearly instances where those two are well aligned,” Miller says. “But there are lots of examples that we haven’t drilled into that are not going to line up so nicely.”

Driven by demographics, the market for autoinjectors is expected to grow rapidly

The attention being paid to produce carbon-neutral products underscores the urgent need – and the potentially lucrative market – for the pharmaceutical industry to act on its decarbonization challenge. Estimates of the current market size for autoinjectors vary wildly: Various industry analysts put it anywhere from $2.4 billion to $45 billion globally.

What most analysts agree on, however, is that the market for autoinjectors will grow rapidly this decade, driven by the demographics of aging populations and the accompanying increases in chronic diseases.

That growing demand increases the pressure on the entire supply chain to come to grips with its greenhouse gas emissions challenge. In February, the World Health Organization warned again of the need to control rising amounts of medical waste that has been exacerbated by the COVID pandemic. The agency said its analysis of its growing waste challenge “comes at a time when the health sector is under increasing pressure to reduce its carbon footprint and minimize the amount of waste being sent to landfill – in part because of the great concern about the proliferation of plastic waste and its impacts on water, food systems and human and ecosystem health.” 

“We see companies starting new projects, who take this seriously and say they want the lowest footprint on the market,” Gerner says, adding that “depending on how far the pharmaceutical company is on their journey, they are willing to pay for it.”

Novo Nordisk, the Danish pharma giant that says it has produced more than 600 million insulin pens to date, is aiming for no CO2 emissions from operations and transport by 2030[SK1]  and “net zero emissions across (its) entire value chain by 2045 at the latest.” The company is tackling the complexities of recycling insulin pens by piloting a “take-back” program and has designed a sorting machine to separate plastics from other components so the plastic can be repurposed.

But the industry is clearly still in the early stages of resolving its emissions challenges.

“The medical device industry and pharmaceutical industry are very slow moving and heavily regulated industries,” says Gerner. “And smaller things take longer to change.”

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Stephanie Keeling


Stephanie Keeling is a rheumatologist and Professor of Medicine at the University of Alberta. She is currently a participant in the Certificate in Health Impact program at the Dalla Lana School of Public Health, University of Toronto

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