The surprising environmental cost of rapid testing, mosquito nets, and other lifesaving health products

Many commonly suggested ways to address climate change present few ethical challenges: Cut fossil fuels. Eat less meat. Don’t buy fast fashion.

But what happens when products that contribute to climate change also save lives — millions of them? A new report, published on Tuesday by the global health initiative Unitaid, looks into this issue, quantifying the environmental impact of 10 essential public health items. 

Altogether, these products — including mosquito nets, rapid testing, pills, and injectables — contribute nearly 3.5 megatons of greenhouse gases (GHG) per year, more than the total emissions of the city of Geneva. Reducing their use isn’t an option. But the report points to strategies that could lead to 70% reduction in emissions by 2030, many of which could be implemented at no additional costs. 

Some of the items in the report can be relatively small in size — think tablets — but their production leads to high volumes of GHG emissions. When it comes to drugs, for instance, active pharmaceutical ingredients are very energy intensive to produce.

This is the case with HIV drug dolutegravir, a pill containing just milligrams of the active principle. Demand for the product is extremely high, with 30 million people expected to be in need of daily treatments by 2030. So every year, the pill contributes 2.7 megatons of GHG.

Other products cause high volumes of emissions because of the amount of materials — particularly plastic — they contain. That is the case with malaria nets and rapid PCR tests. 

According to the report, many emissions could be eliminated by increasing the use of renewable energy in production, more effective supply chain processes, and employing new materials.

A few of the interventions may be costly — recycled plastic for nets, for instance, comes at a premium. But the majority, sufficient to cut 40% of emissions by 2030, would require some upfront investment but lead to better financial returns. 

While the onus is on manufacturers to improve their practices, health agencies and other purchasers can support them, said Vincent Bretin, the director of results and climate at Unitaid. One way, he said, could be prioritizing manufacturers that meet certain criteria when awarding contracts. “This is the way that we give feedback for the investments that they made.”

Focusing on improving the environmental profile of public health products could also lead to more innovation in areas that are otherwise hardly at the center of research and development, said Bretin. “Constraints tend to generate ideas that use new solutions,” he said. An example already underway is the research into whether spatial repellents — small pieces of plastic that release chemical repellents into the air, protecting the whole home — could be as effective as nets, while using a much smaller amount of plastic. 

The report, said Bretin, is also a reminder of the value of pursuing effective solutions that have less of an environmental impact, even when they aren’t the most technologically advanced. Vaccines that require refrigeration to be transported, for instance, should not become the default option if there are equally effective solutions that can remain stable at higher temperatures.

Also noteworthy, according to the reports’ authors, is the uniquely vicious cycle by which the way health products are made can wind up reducing their effectiveness. For instance, waste from antibiotics contributes to antibacterial resistance, and emissions from various health products contribute to catastrophic climate events, which in turn bring on epidemics. 

“This report is a really interesting product. And I think it could lead to very different conversations for policymakers at lots of different levels,” said Cheryl Damberg, the director of the Center of Excellence on Health System Performance at the nonprofit policy think tank RAND, who was not involved in the report. “I think they have to think hard about how current policies need to be changed such that there are stronger market signals for producers to make these changes.”