Vulika Nangombe

In 2024, the WHO’s Division on Access to Medicines and Health Products issued a call to action for sustainability in the pharmaceutical sector. The initiative, ‘Greener Pharmaceuticals’ Regulatory Highway’, underscored the need to reduce the environmental footprint of medical products. It explicitly called on the regulatory community to adopt initiatives towards ‘innovative approaches in the manufacturing, distribution, and usage of medical products.’ 1 This timely initiative aligns with the growing recognition of interconnectedness between climate change, pollution—including ‘pharmaceutical pollution’—and public health. However, the need to decrease greenhouse gas emissions should not overshadow other relevant areas for action in the pharmaceutical sector. Here, we focus on the negative environmental impact of the inappropriate elimination of pharmaceutical waste generated at the last mile in healthcare.

Background: Drug-resistant tuberculosis (DR-TB) is a considerable barrier to ending TB globally by 2035. In most high TB-burden countries in the sub-Saharan region, drivers of DR-TB treatment success are unknown. Objectives: To determine predictors and patterns of treatment success rates (TSRs) in DR-TB in Namibia to inform strategies of national TB programmes. Methods: A nationwide retrospective observational cohort study of a 6 year DR-TB database, 2014–19, was carried out. Independent predictors of successful treatment outcome in DR-TB were determined by multivariate logistic regression. Results: Of the 1494 DR-TB patients included, 56.3% (n = 841) were male, the mean (±SD) age was 35.6 ± 14.2 years, and 8.3% had TB/HIV coinfection. The overall TSR was 66.5% (n = 994) and it increased marginally between implementation of the second and third medium-term plans for TB and leprosy (MTP-II and MTP-III). Being female was associated with lower odds of treatment success [adjusted OR (aOR) = 0.6; 95% CI: 0.34–0.89; P = 0.015), as was a young age (under 5 years) (aOR = 0.1; 95% CI: 0.0007–0.421; P = 0.005) and ages of 5–14 years (aOR = 0.0; 95% CI: 0.002–0.269; P = 0.002). Namibian nationality also showed a reduced likelihood of treatment success (aOR = 0.3; 95% CI: 0.089–0.961; P = 0.043). Among clinical predictors, bilateral pulmonary forms were inversely associated with treatment success (aOR = 0.2; 95% CI: 0.057–0.498; P = 0.001). Conversely, baseline monoresistance was linked to an increased likelihood of treatment success (aOR = 7.6; 95% CI: 1.427–40.631; P = 0.018). Conclusions: Whilst DR-TB TSRs improved, they are below the global target and vary by clinical and patient demographics. Targeted interventions for high-risk patients, including female patients, those aged under 15 years, locals and those with bilateral pulmonary disease using community-based approaches to boost adherence, alongside leveraging the skills of clinical pharmacists, should now be explored.