Emily
Editor, Senior Moderator
https://www.thelancet.com/journals/l...171-5/fulltext
Counting the carbon cost of heparin: an evolving tragedy of the commons
Published: June 07, 2022
DOI: https://doi.org/10.1016/S2352-3026(22)00171-5
Heparin, which is listed in WHO's Model List of Essential Medicines,[SUP]1[/SUP]
was discovered in 1916 and has been used as an anticoagulant since 1935, possessing potentiating effects on antithrombin. The global demand for heparin is rising, with the global heparin pharmaceutical market projected to grow from US$9·38 billion in 2021 to US$12·06 billion in 2028, and there is a possibility that demand might outstrip supply.[SUP]2[/SUP]
In addition to increased usage for treatment of rising cardiovascular disease and thrombosis cases in ageing populations, the demand for heparin has been exacerbated by its use during the COVID-19 pandemic for thromboprophylaxis and treatment of COVID-19-associated thromboembolic disease.
The only US Food and Drug Administration (FDA) approved source of heparin is currently porcine mucosa, given that usage of bovine heparin ceased in 1999 because of risks of possible contamination with the bovine spongiform encephalopathy agent derived from ruminant materials. To meet the rising global heparin demand, the offal of around 1100 million pigs is required annually.[SUP]3[/SUP]
There is a marked geographical concentration of pigs in east and southeast Asia, amounting to 95% of the pigs farmed worldwide, followed by Europe and the Americas. China alone is producing almost 50% of the global requirements of heparin, with 415·95 million pigs reported at end of March, 2021.[SUP]4[/SUP]
The shortage of upstream crude heparin has led to periodic supply shortages in the USA for certain heparin end products, with the African swine fever in China in 2019 resulting in the US House Committee on Energy and Commerce issuing a letter to the FDA warning of the outbreak's potential threat to the heparin supply to the USA.
Crude heparin is extracted from porcine intestinal mucosa by means of enzymatic digestion and filtration, followed by complexing with resins. It is estimated that 1 kg of intestinal mucosa will produce 160–260 mg of crude heparin, depending on the efficiency of extraction methods, which are closely guarded industrial secrets.[SUP]3[/SUP]
The carbon footprint of pork for every kg of pig carcass weight represents an emissions intensity of 6·1 kg of carbon dioxide (CO2) equivalent,[SUP]5 [/SUP]with annual CO2 emissions from the global porcine industry estimated at 668 million tons.[SUP]6[/SUP]
The carbon footprint generated from the porcine industry through procurement of fresh porcine intestines indirectly contributes to the net global CO2 emissions by the pharmaceutical industry, which was estimated as 52·0 megatonnes of CO2 emissions in 2015—a higher value than the estimated 46·2 megatonnes of CO2 emissions generated by the automotive industry.[SUP]7[/SUP]...
Counting the carbon cost of heparin: an evolving tragedy of the commons
Published: June 07, 2022
DOI: https://doi.org/10.1016/S2352-3026(22)00171-5
Heparin, which is listed in WHO's Model List of Essential Medicines,[SUP]1[/SUP]
was discovered in 1916 and has been used as an anticoagulant since 1935, possessing potentiating effects on antithrombin. The global demand for heparin is rising, with the global heparin pharmaceutical market projected to grow from US$9·38 billion in 2021 to US$12·06 billion in 2028, and there is a possibility that demand might outstrip supply.[SUP]2[/SUP]
In addition to increased usage for treatment of rising cardiovascular disease and thrombosis cases in ageing populations, the demand for heparin has been exacerbated by its use during the COVID-19 pandemic for thromboprophylaxis and treatment of COVID-19-associated thromboembolic disease.
The only US Food and Drug Administration (FDA) approved source of heparin is currently porcine mucosa, given that usage of bovine heparin ceased in 1999 because of risks of possible contamination with the bovine spongiform encephalopathy agent derived from ruminant materials. To meet the rising global heparin demand, the offal of around 1100 million pigs is required annually.[SUP]3[/SUP]
There is a marked geographical concentration of pigs in east and southeast Asia, amounting to 95% of the pigs farmed worldwide, followed by Europe and the Americas. China alone is producing almost 50% of the global requirements of heparin, with 415·95 million pigs reported at end of March, 2021.[SUP]4[/SUP]
The shortage of upstream crude heparin has led to periodic supply shortages in the USA for certain heparin end products, with the African swine fever in China in 2019 resulting in the US House Committee on Energy and Commerce issuing a letter to the FDA warning of the outbreak's potential threat to the heparin supply to the USA.
Crude heparin is extracted from porcine intestinal mucosa by means of enzymatic digestion and filtration, followed by complexing with resins. It is estimated that 1 kg of intestinal mucosa will produce 160–260 mg of crude heparin, depending on the efficiency of extraction methods, which are closely guarded industrial secrets.[SUP]3[/SUP]
The carbon footprint of pork for every kg of pig carcass weight represents an emissions intensity of 6·1 kg of carbon dioxide (CO2) equivalent,[SUP]5 [/SUP]with annual CO2 emissions from the global porcine industry estimated at 668 million tons.[SUP]6[/SUP]
The carbon footprint generated from the porcine industry through procurement of fresh porcine intestines indirectly contributes to the net global CO2 emissions by the pharmaceutical industry, which was estimated as 52·0 megatonnes of CO2 emissions in 2015—a higher value than the estimated 46·2 megatonnes of CO2 emissions generated by the automotive industry.[SUP]7[/SUP]...