The healthcare business knows it has a climate-change problem.

The statistics are overwhelming — and alarming. Healthcare systems account for between 4% and 5% of global CO2 emissions, or roughly twice the total emissions of the aviation industry. In the U.S., the percentages are even more extreme: 7.6% of CO2 emissions, by the World Economic Forum’s conservative estimate. The true figure may be closer to 10%.

As repeatedly noted elsewhere, it’s hard to square these numbers with healthcare’s emphasis on, well, health. According to World Health Organization calculations, climate change is projected to result in an additional 250,000 deaths from malnutrition, malaria and heat stress every year between 2030 and 2050.

But if some critics believe that healthcare and pharma companies have moved too slowly to get their sustainability houses in order, people inside these organizations have a very different perspective. They claim that companies have pushed each other to adopt more stringent standards, despite the energy-intensive nature of manufacturing pharmaceuticals and the regulatory and safety concerns unique to the industry.

Cabinet Health supplies OTC medicines in reusable glass containers and refills in compostable packaging.

“We’ve been on the journey of environmental reduction for many years, but we just never called it what it was, which is reducing energy and water use,” says Claire Lund, VP of sustainability at GSK. “It’s been a more recent change in our consciousness that climate change and nature loss have a direct human health impact. That wider consciousness has really come to the fore in the last couple of years.”

Lund notes that the intensified focus isn’t a hard sell, internally or externally. “[The industry] has a proactive role to play in pushing forward an environmental agenda, because it has a direct impact on human health,” she adds.

Jim Greffet, head of ESG strategy at Eli Lilly, describes a similar evolution — namely, from a bottom-line-driven emphasis on efficiency to placing sustainability at the center of everything the company does.

“Prior to our current 2030 goals, Lilly had focused heavily on energy reduction and efficiency, but we had less focus on the transition to renewable energy sources,” he explains. “Our new goals include securing 100% of our purchased electricity from renewable sources.” Greffet points to a host of projects currently underway at Lilly, including “on-site solar and evaluating large-scale off-site renewable energy investments.”

If there’s true evidence of a sea change in industry attitudes toward environmental responsibility — and, again, plenty of skeptics remain — it may be reflected in the speed with which pharma companies have joined the Race to Zero, which is centered on a commitment to halve emissions by 2030. At the end of last year, 46% of the pharma and biotech sector (as measured by revenue) had adopted the pledge, up from 31% at the end of 2021.

Change is not limited to companies sitting on the Sustainable Markets Initiative Health Systems Task Force (see “A changing climate“). Pfizer, for example, has announced that, by 2040, it aims to decrease its greenhouse gas emissions by 95% and its supply-chain emissions by 90% from 2019 levels. That’s 10 years earlier than mandated by the Net-Zero Standard framework.

Hospitals and other healthcare systems have similarly set, and in some cases already met, their own climate-conscious goals. Anthem was the first U.S. health benefits company to join the global RE100 initiative, reaching a target of using renewable energy sources for 100% of its power needs four years ahead of schedule.

The challenges facing pharma are varied, but the one that tends to attract the bulk of attention — unfairly, to hear some tell it — concerns its packaging. That might be why companies are so eager to discuss the steps they’re taking to reduce waste.

GSK has pledged to eliminate single-use plastics by 2030 while carving out an exception for “plastics which are critical to product discovery and development, health and safety, and meeting regulatory obligations.”

Johnson & Johnson has committed to 100% recyclable, reusable or compostable plastic packaging by 2025. GSK has pledged to eliminate single-use plastics by 2030 while carving out an exception for “plastics which are critical to product discovery and development, health and safety, and meeting regulatory obligations.” Lilly’s efforts include a take-back pilot in Germany in which the company has partnered with hospitals and physicians’ offices to collect injection devices from diabetes products.

Smaller companies are also emerging in response to consumer interest in reducing plastic consumption. Take, for example, Cabinet Health, which supplies OTC medicines in reusable and compostable containers.

Cofounder Russell Gong notes that the healthcare industry produces more than 1.94 billion single-use plastic medicine bottles every year. “The vast majority of those are not recycled and end up in oceans, landfills and, eventually, our communities,” he says. “That disproportionately impacts communities of color and countries in the global south: 95% of all plastic bottles created end up back into the environment.”

Cabinet Health’s containers are colorful yet understated, and Gong views their combination of design and functionality as essential to getting consumers to embrace them (customers order starter glass containers and refills are sent in pouches of wood cellulose that is 100% compostable). The company claims that each new Cabinet customer results in the production of one less pound of plastic each year.

Gong acknowledges that Cabinet’s limited size puts a ceiling on its potential impact. That said, he hopes the company’s efforts will serve as an inspiration for others.

“With pharmaceutical companies, it’s like moving an elephant,” he says. “It’s hard to make them pivot — but once they move, they bring a ton of weight. Right now we’re the small player saying, ‘Hey, move the elephant this way.’”

While they go out of their way not to minimize concerns about plastic waste, pharma leaders believe that it is important to place the issue in its proper context.

“We’re looking at our own plastic use and what is relevant for us,” Greffet says. “But as a society, there are others that are certainly bigger contributors to this issue than pharma.”

Lund agrees, noting that “what is seen gets attention, and nobody sees the [more environmentally friendly] propellant in an inhaler.” She’s not wrong: One image of a turtle swimming in a sea of plastic tends to drive the conversation in a very different direction.

“The total volume of packaging used in the pharma sector is tiny,” Lund continues. “Coca-Cola’s total plastic waste is over three million metric tons a year; we are well under 1% of that. Even if we eradicated all plastic, it doesn’t actually make a significant dent on the total plastic packaging footprint that’s produced.”

Perhaps that’s why pharma seems more focused on its water and energy usage. Greffet notes that water “is essential to our operations and the facilities where we discover and manufacture our medicines, especially in parenteral manufacturing [used for non-orally administered medicines].” Without a robust water supply, he says, “We would not be able to produce our medicines at the quality standards that are necessary for our industry.”

He’s quick to share details about Lilly’s water management programs, noting that recycled or reused water makes up over 98% of the company’s water usage. He adds that Lilly has “mature systems” in place to mitigate risks of harmful discharges of pharmaceuticals in wastewater.

Sustainability projects underway at Eli Lilly’s corporate headquarters include on-site solar energy and evaluating large-scale off-site renewable energy investments.

GSK is similarly focused on water management. “For water pollution from active pharmaceuticals or antimicrobials, we have hard targets and have actually delivered most of our 2025 and some of our 2030 targets already,” Lund reports. “We’re making sure that not only our own sites are in compliance, but that suppliers of antibiotics and active pharmaceutical ingredients broadly are as well. We went fast and delivered.”

While abundant clean water is needed for pharma’s manufacturing processes, Lund takes pains to paint responsible water stewardship as central to GSK’s overall focus.

“Water is critical to human health,” she says, noting that GSK and Bayer are members of the Water Resilience Coalition, alongside many non-pharma companies and NGOs. “The basic and the best prevention for many diseases is washing your hands. To do that, you need access to clean water.”

If there’s a unique, industry-specific brake on the greening of pharma, it is, of course, the regulators. While nobody disputes the importance of safety and stability procedures, the industry has long bemoaned the immeasurable damage that can take place if a new propellant or other environmentally friendly tweak spends a decade making its way through the approval process.

“The interesting thing from a regulatory standpoint is that the pharmaceutical industry has to juggle the push to reduce landfill waste with the regulatory side of their operations, where the FDA and others impose huge requirements on packaging and protecting consumers and having to transport medicines under certain conditions,” explains Bob Martineau, a senior partner at Finn Partners who worked in the Office of the General Counsel at the EPA earlier in his career. “They’re almost contradictory pressures and companies have to navigate through them. You have pages and pages of paper in the packaging.”

The distance between the size of pharma’s carbon footprint today and the industry targets that loom in 2025 or 2030 can feel enormous. Still, Lund finds reasons for optimism on many fronts, including in areas that may not at first glance appear to be related to the environment.

“Telemedicine is a brilliant example, right?” she asks rhetorically. “If you could get patients to use telemedicine rather than go to doctors or to hospitals, then you reduce overall emissions across the board.” Lund also touts preventative measures, such as vaccines, as good for patients and the planet alike. Fewer hospital visits, after all, mean fewer emissions.

Finn Partners senior partner Bess Winston echoes Lund’s analogy, but in the realm of digitization. “It lightens the footprint in pharma and other industries that are label-heavy,” she says. “What we see is that little changes — lighter-weight materials, changes in fleets — all matter.”

Maybe it’s on the healthcare industry to do a better job telling its sustainability story. “Is that story being told, and is it being told effectively? It’s a challenge for pharma — but it’s a challenge for many industries.”