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 A short drive from the bustling tech hub of Hyderabad, Medak is the
heart of India's antibiotics manufacturing business: a district of
about 2.5 million that has become one of the world's largest
suppliers of cheap drugs to most markets, including the United
States.
But community activists, researchers and some drug company employees
say the presence of more than 300 drug firms, combined with lax
oversight and inadequate water treatment, has left lakes and rivers
laced with antibiotics, making this a giant Petri dish for
anti-microbial resistance.
"Resistant bacteria are breeding here and will affect the whole
world," said Kishan Rao, a doctor and activist who has been working
in Patancheru, a Medak industrial zone where many drug manufacturers
have bases, for more than two decades.
Drugmakers in Medak, including large Indian firms Dr Reddy's
Laboratories Ltd, Aurobindo Pharma Ltd and Hetero Drugs Ltd, and
U.S. giant Mylan Inc, say they comply with local environmental rules
and do not discharge effluent into waterways.
National and local government are divided on the scale of the
problem.
While the Central Pollution Control Board (PCB) in New Delhi
categorizes Medak's Patancheru area as "critically polluted", the
state PCB says its own monitoring shows the situation has improved.
The rise of drug-resistant "superbugs" is a growing threat to modern
medicine, with the emergence in the past year of infections
resistant to even last-resort antibiotics.
In the United States alone, antibiotic-resistant bacteria cause 2
million serious infections and 23,000 deaths annually, according to
health officials.
Thirteen leading drugmakers promised last week to clean up pollution
from factories making antibiotics as part of a drive to fight the
rise of drug-resistant superbugs, while United Nations member
countries pledged for the first time to take steps to tackle the
threat.
MAJOR EARNER
Patancheru is one of the main pharmaceutical manufacturing hubs in
Telangana state, where the sector accounts for around 30 percent of
GDP, according to commerce ministry data. Drug exports from state
capital Hyderabad are worth around $14 billion annually.
Local doctor Rao pointed to studies by scientists from Sweden's
University of Gothenburg that have found very high levels of
pharmaceutical pollution in and around Kazhipally lake, along with
the presence of antibiotic-resistant genes.
The scientists have been publishing research on pollution in the
area for nearly a decade. Their first study, in 2007, said
antibiotic concentrations in effluent from a treatment plant used by
drug factories were higher than would be expected in the blood of
patients undergoing a course of treatment. That effluent was
discharged into local lakes and rivers, they said.
"The polluted lakes harbored considerably higher proportions of
ciprofloxacin-resistant and sulfamethoxazole-resistant bacteria than
did other Indian and Swedish lakes included for comparison," said
their latest report, in 2015, referring to the generic names of two
widely used antibiotics.
Those findings are disputed by local government officials and
industry representatives.
The Hyderabad-based Bulk Drug Manufacturers Association of India (BDMAI)
said the state pollution control board had found no antibiotics in
its own study of water in Kazhipally lake. The state PCB did not
provide a copy of this report, despite several requests from
Reuters.
"I have not seen any credible report that says that the drugs are no
longer there," Joakim Larsson, a professor of environmental
pharmacology at the University of Gothenburg who led the first
Swedish study and took part in the others, told Reuters by email.
"There might very well have been improvements, but without data, I
do not know."
WATER TREATMENT
Local activists and researchers say the Common Effluent Treatment
Plant (CETP) built in Medak in the 1990s was ill-equipped to handle
large volumes of pharmaceutical waste.
After protests and court cases brought by local villagers a 20-km
(12-mile) pipeline was built to take effluent to another plant near
Hyderabad. But activists say that merely diverted the problem -
waste sent there, they say, mixes with domestic sewage before the
treated effluent is discharged into the Musi river.
A study published this year by researchers from the Indian Institute
of Technology, Hyderabad, found very high levels of broad-spectrum
antibiotics in the Musi, a tributary of the Krishna, one of India's
longest rivers.
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Local government officials responsible for the plants did not
respond to Reuters' requests for comment.
Nearly a dozen current and former officials from companies producing
medicines in Patancheru told Reuters that factory staff from various
firms often illegally dump untreated chemical effluent into
boreholes inside plants, or even directly into local water bodies at
night.
All the officials spoke on condition of anonymity and Reuters was
unable to independently verify those allegations.
Major manufacturers in the area, including Dr Reddy's and Mylan,
said they operated so-called zero liquid discharge (ZLD) technology
and processed waste onsite.
"Mylan is not dumping any effluent into the environment, borewells
or the CETP," said spokeswoman Nina Devlin.
Dr Reddy's said it recycled water onsite and complied with all
environmental regulations.
The same industry officials who spoke to Reuters said the pollution
control board rarely checked waste-treatment practices at factories,
adding that penalties for breaches were meager.
The Telangana state government did not respond to requests for
comment.
"We are aware some companies are releasing more than the allowed
effluent, but they are profit-making companies," said state PCB
spokesman N. Raveendher. "We do try and take action against the
offenders, but we cannot kill the industry also."
Many smaller companies also lacked the funds to install expensive
machinery for treating waste, he added.
COURT BATTLES
A series of local court cases have been filed stretching back two
decades, accusing drug companies of pollution and local authorities
of poor checks. In some cases, companies have been ordered to pay
annual compensation to villagers, but many are still grinding
through India's tortuous legal system.
Wahab Ahmed, 50, owns five acres of land near the shores of
Kazhipally lake, where he grew rice until a decade ago. He says the
worsening industrial pollution from several nearby pharmaceutical
factories left his land barren.
"We have protested, sued, and done all sorts of things over the
years ... that's how some of us are now getting around 1,700 rupees
(roughly $20) a year from the companies," he said.
"But what can you do with that small sum today?"
More than 200 companies were named as respondents in the case he was
referring to, filed by a non-profit organization on behalf of
villagers.
While pollution of farmland is a serious problem for villagers who
depend on it for their livelihood, the potential incubation of "superbugs"
in Medak's waterways has wider implications.
The issue is particularly worrisome in India, where many waterways
also contain harmful bacteria from human sewage. The more such
bacteria are exposed to antibiotics, the greater the chances they
will mutate and render such drugs ineffective against them.
The risk is that resistant bacteria would then infect people and be
spread by travel.
So far, most of the focus worldwide on antimicrobial resistance has
been on over-use of drugs in human medicine and farming.
"Pollution from antibiotic factories is a third big factor in
causing antimicrobial resistance," the chairman of one of the
world's largest drugmakers told Reuters. "But it is largely
overlooked."
(Additional reporting by Ben Hirschler in LONDON; Editing by Clara
Ferreira Marques and Alex Richardson)
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