Pharmaceutical Release into the Environment during Pandemics and Regional Epidemics

政府间气候变化专门委员会表示，人口增长和气候变化可能会加剧未来流行和大流行的风险。鉴于这些新的社会压力，国家和国际组织大力推动制定药物准备计划。流行病和大流行药物的使用与常规使用不同，35%以上的人口将受到感染，并可能使用一种或多种药物进行治疗。大流行期间大量的药物给污水处理厂的运行、河流水生系统和人类健康带来了前所未有的、在很大程度上不同寻常的风险。目前对药品的监管是基于常规条件下的预期使用模式，而不是在大流行或流行病期间。在出现目前的大流行性流感风险之前，常规使用和大规模使用之间的区别并不令人担忧，目前正在为这种风险储存大量的“季节性流感”抗病毒药物(即达菲)。一旦发生大流行性流感，预计将使用史无前例的数量的一套药物来治疗感染者，并限制大流行流感在未感染者中的传播。每种药物都有一系列独特的潜在生态目标，包括人类。此外，混合废物流带来的风险不能通过了解其组成部分的生态毒理学来预测。可以说，高浓度生物活性化学品的涌入可能扰乱的最关键的服务是污水处理厂(STW)。关于高浓度抗生素对STW的操作和完整性的影响，人们知之甚少。同样，没有关于抗病毒药物对STW或环境的影响的同行评议研究。H5N1病毒目前无法在人与人之间传播，皇家学会以及世界上大多数专家都认为这是不可避免的，这为我们提供了一个宝贵且可能短暂的机会之窗，以评估我们目前的药物准备计划的风险并相应地对其进行调整。拟议的倡议将为科学理解在大流行和流行病期间广泛使用药物的命运和影响奠定基础，并为能够应对和适应流感大流行以及在不久的将来可能出现的其他流行病和大流行的多学科成员网络奠定基础。在最初的三年中，准备倡议将：-开发和出版一个在线知识和联网工具，以整合现有的信息来源，帮助评估大流行和流行病条件下环境中与药物有关的风险。这将为那些寻求这类信息的人提供一种机制，使他们能够迅速找到最佳资源，并帮助解释现有的知识。-举办五次知识差距查明讲习班，讨论在大流行病和流行病条件下向环境释放药物的评估中的关键专家专题。-为同行评议的期刊以及相关专业组织的内部出版物编写文章，说明编写倡议正在处理的问题，解释在线资源，并报告初步调查结果。将推出一期特别期刊。-举办一次会议，报告编制倡议头三年的产出，以促进进一步的知识转让，并就倡议的较长期寿命达成共识。-确定在决策和监管中利用科学知识可以吸取的经验教训，并就此发表一份报告。

The Intergovernmental Panel on Climate Change states that population growth and climate change are likely to intensify the risk of future epidemics and pandemics. In light of these new societal pressures, there has been a significant push from both national and international organizations in the establishment of pharmaceutical preparedness plans. Epidemic and pandemic pharmaceutical usage differs from conventional usage in that upwards of 35% of the population will be infected and potentially treated with one or more pharmaceuticals. The 'bolus' of pharmaceuticals during a pandemic creates unprecedented and largely uncharacterised risks to the operation of sewage treatment plants, riverine aquatic systems and human health. Current regulations on pharmaceuticals are based on intended predicted use patterns under conventional conditions, rather than during a pandemic or epidemic. The distinction between conventional and large scale usage has not been of concern prior to the emergence of the current risk of pandemic influenza, for which large quantities of 'seasonal influenza' antivirals (i.e. Tamiflu) are being stockpiled. In the event of pandemic influenza, unprecedented quantities of a suite of pharmaceutical products are expected to be used to treat the infected and limit the spread of pandemic influenza among the uninfected. With each pharmaceutical comes a unique array of potential ecological targets, including humans. Moreover, the risks posed by a mixed waste stream can not be predicted by knowledge of the ecotoxicology of its constituent parts. Arguably the most critical service that could be disrupted by the influx of high concentrations of biologically-active chemicals is sewage treatment works (STW). Little is known regarding the effect of high concentrations of antibiotics on the operation and integrity of STW. Similarly, there is no peer-reviewed research on the effect of antivirals on STW or the environment. The current inability of the H5N1 virus to transmit from human-to-human, which is considered inevitabile by The Royal Society as well as most of the world experts, provides us with a valuable and possibly brief window of opportunity to assess the risks of our current pharmaceutical preparedness plan and adapt it accordingly. The proposed Initiative will provide a foundation of scientific understanding of the fate and effect of widespread pharmaceutical use during a pandemic and epidemic and a multi-disciplinary network of members capable of responding and adapting to not only an influenza pandemic, but the likely emergence of other epidemics and pandemics in our immediate future. During its first three years the PREPARE Initiative will: - develop and publish an on-line knowledge and networking tool to integrate existing information sources that help in the assessment of risks associated with pharmaceuticals in the environment under pandemic and epidemic conditions. This will provide a mechanism for those seeking such information to be rapidly guided to the best resource and help in interpretation of available knowledge. - run five knowledge gap identification workshops, for the discussion of key specialist topics in the assessment of pharmaceutical release into the environment under pandemic and epidemic conditions. - prepare articles for both peer-reviewed journals as well as the house publications of relevant professional organisations, describing the issue being addressed by the PREPARE Initiative, explaining the on-line resource and reporting on preliminary findings. A special journal issue will be initiated. - run a conference to report on outputs of the PREPARE Initiative during its first three years, to facilitate further knowledge transfer and gather consensus on the longer-term life of the initiative. - identify the lessons that can be learned on the use of scientific knowledge in policy making and regulation and publish a report on this.