Propelling change: can respiratory care cut its carbon footprint without compromising patients?

“The mission of healthcare is to improve people’s quality of life so, if a pharmaceutical company has products or practices that are leading to climate change, it’s absolutely contradictory,” argues Maria Paola Chiesi, chair of the board for global biopharmaceutical company, Chiesi. The climate crisis is also a health crisis, she says, pointing to research by the University of Michigan Medical School, which shows that pollution has consequences not just for lung health but also for cardiovascular and brain health. When it comes to healthcare, one of Chiesi’s most widely used products is pressurised metered-dose inhalers (pMDIs), which are effective at treating chronic lung diseases such as asthma and chronic obstructive pulmonary disease (COPD). However, a propellant (a pressurised liquefied gas) in the inhaler is used to push out a dose of the medicine in a mist spray so it can reach the patient’s lungs and until the 1990s, that propellant contained chlorofluorocarbons (CFCs), a group of ozone-depleting greenhouse gases. When CFCs were phased out to protect the ozone layer, they were replaced with an alternative propellant, known as HFA (hydrofluoroalkane), which eliminated the risk to the ozone layer. Years later, standard HFA propellants were also identified to contribute to global warming. Chiesi had a choice to make. Switch propellant – or supply only dry powder inhalers that do not contain any propellants. The latter would have been cheaper, simpler and quicker. But Maria Paola explains why Chiesi chose the more challenging option. “Dry powder inhalers don’t suit all patients. Using a device that is not correct for them can destabilise the patient’s health condition and create a different problem,” says Maria Paola, whose team has worked closely with doctors for many years to find a better solution. In 2018 Chiesi began developing its Carbon Minimal Inhaler programme – a scientific, clinical and industrial initiative to reduce the carbon footprint of its inhalers that would support continuity of care for patients and healthcare professionals. “We don’t want patients to have to choose between their health and the safeguarding of the planet,” she says. To help patients remain on the right device for them, while reducing environmental impact, the company embarked on a “long, risky and expensive journey to re-engineer our inhalers to replace the propellant”. Her strategy was to make the transition seamless for patients and healthcare systems. The work led to the introduction of carbon minimal inhalers, which lower emissions without compromising clinical choice, treatment continuity or patient outcomes. They are made using a low global warming potential propellant (HFA 152a) and classified by the OECD (Organisation for Economic Co-operation and Development) as non-Pfas – sometimes referred to as “forever chemicals”. These inhalers reduce the product’s carbon footprint by up to 90% (compared with current Chiesi pMDis) down to a similar level as its dry powder inhalers. Yet to the doctors and patients, there’s no change in function. Maria Paola explains that she takes a holistic approach to product development. Sustainability is as much about the social and ethical aspects as it is about the environment, efficiency and business resilience, she argues. “We have worked hard to embed sustainability and this shared value principle in every aspect of the company.” Maria Paola has worked for Chiesi – founded by her grandfather Giacomo Chiesi in 1935 and adopting the legal form of Benefit Corporation in 2018 – for 30 years. In 2015, she created its sustainability department based on the concept of shared value creation: business success and societal progress are advanced together. She firmly believes that sustainability has to make good business sense: “We invest a lot in our people, including patients, suppliers and employees,” she says. “The switches we have made with inhalers are having a positive ripple effect. Both environmental and social sustainability are good investments that definitely pay off in the mid to long term. Ultimately, it’s all worthwhile.” But decarbonising healthcare requires long-term investment, scientific innovation and collaboration between industry, policymakers and healthcare providers. It’s a vast and complex challenge. “We need more alignment between the pharmaceutical companies, healthcare systems, patients, doctors and caregivers – otherwise everyone goes their own way and actions are less effective,” she says. “Some goals are slipping back to 2040 or 2045, and plans need to be totally transparent. Everyone involved needs the same level of urgency – but I don’t see that. There isn’t one player that is directing the entire sector. The European Federation of Pharmaceutical Industries and Associations (EFPIA) could orchestrate that, for example.” With headquarters in Parma, Italy, Chiesi exports to more than 100 countries and has 31 affiliates worldwide. Maria Paola believes that if front-running pharmaceutical companies unite, they could better coordinate the supply chain. “There are now some consortiums growing with pharmaceutical businesses and suppliers. It has been a slow process, but it could work,” she says. “Policymakers could also have a strong influence in assigning company objectives. We need a common language and agreement to tackle this problem” One glimmer of hope for the private sector is the Sustainable Markets Initiative launched by King Charles in 2020. About 10 of the biggest European pharmaceutical companies, including Chiesi, have joined with one specific goal. “The approach is very pragmatic,” she says: “what can we do together to decarbonise healthcare systems?” In the case of the carbon minimal inhalers, Maria Paola and her team are piloting take-back schemes for the collection of inhalers once patients have finished using them. “Exhausted inhalers still contain some propellant inside, so it is very important that they are collected and treated in an appropriate way without releasing anything into the environment. We realised that this is a challenge no single company can address alone. Therefore, we see partnerships as the most effective way forward.” This shift gives Maria Paola hope for the future: “Joining forces means that we can solve these problems together.” Find out more about Chiesi’s focus on sustainable respiratory care and the carbon minimal inhaler programme