A review article led by Dr. Ashish Sengar at the Indian Institute of Technology Delhi (IIT Delhi), published in Science of the Total Environment, sheds light on the alarming scale of pharmaceutical and personal care product (PPCP) contamination in Indian waters. The findings are stark: almost half of the compounds tested pose risks to either human health, aquatic life, or contribute to the rise of superbugs.
This revelation arrives at a moment when India, the world’s third-largest producer of pharmaceuticals, is grappling with soaring drug consumption, weak wastewater treatment, and rising antibiotic resistance. As the G20 debates global health preparedness and antimicrobial resistance, these findings could not be more urgent.
The invisible cocktail in our waters
Pharmaceuticals and personal care products have become pseudo-persistent contaminants, meaning they constantly enter the environment faster than they can degrade. Wastewater treatment plants are rarely equipped to remove them. As a result, rivers, lakes, and even groundwater carry residues of antibiotics, anti-inflammatory drugs, antidepressants, and sunscreens.
Sengar and his team reviewed 98 PPCPs detected across India, from treated wastewater to surface and groundwater. They calculated risk quotients (RQs) to measure potential harm. Nearly 47 per cent of the detected chemicals exceeded safe thresholds, signalling a real and present danger.
While the general public may assume that wastewater treatment plants act as filters, most Indian facilities are not designed to capture micro-pollutants. This allows high concentrations of active pharmaceutical ingredients to persist in rivers used for drinking water, bathing, and irrigation. For communities depending on these waters, exposure is unavoidable.
Superbugs lurking in rivers
One of the most alarming aspects of the study is the link between antibiotics in rivers and the risk for the selection of antimicrobial resistance (AMR). Antibiotics at even low concentrations can create selective pressure on bacteria, allowing resistant strains to survive and multiply. These resistant genes can then transfer to pathogens that infect humans.
The research found that 81 per cent of antibiotics detected in Indian surface waters pose a risk of AMR selection. Ciprofloxacin, a common antibiotic, was recorded at concentrations as high as 6,500 micrograms per litre in Hyderabad. This is the highest level ever reported in surface water globally. Such extreme pollution turns rivers into breeding grounds for resistance.
The World Health Organization has warned that AMR could cause 10 million deaths annually by 2050, with a cumulative economic loss of 100 trillion USD. India, often described as the “pharmacy of the world,” risks becoming the epicentre of a post-antibiotic era if drug waste continues to flow unchecked into its rivers.
Toxicity due to medicine
The health risks are not limited to resistance. Many pharmaceuticals exert direct toxic effects on humans and animals. The team assessed human health risks from drinking contaminated water, particularly focusing on vulnerable groups such as children.
Out of 49 pharmaceuticals detected in surface water, 11 exceeded thresholds of concern. Cetirizine, a common antihistamine used for allergies, showed an RQH (human risk quotient) of 1,185 for children aged 1–2 years. Antidepressants like citalopram and antifungals like fluconazole were also found at concentrations hundreds of times above safe limits. In some regions, long-term ingestion could result in chronic health issues that are only beginning to be understood.
Personal care products such as sunscreens, parabens, and triclosan did not show direct human health risks in this study. However, they still raised ecological concerns, particularly for aquatic life. Triclosan, for example, is known to disrupt endocrine systems in fish even at low concentrations.
Risk assessment of fish and algae
The ecological risk assessment was no less troubling. The researchers analysed impacts on three levels of aquatic life: fish, daphnia, and algae. About 28 per cent of detected PPCPs in surface waters inflicted high ecological risk.
Diclofenac, a common painkiller, has already been linked to the collapse of vulture populations in South Asia after exposure through livestock carcasses. In fish, it can damage kidneys and reproduction. Similarly, the presence of the antidiabetic drug metformin has been shown in other studies to feminise male fish. In the Indian context, such risks could devastate already stressed river ecosystems.
High levels of pharmaceuticals were concentrated in industrial regions. Hyderabad, home to one of the world’s largest clusters of pharmaceutical factories, was singled out as a hotspot where wastewater treatment plants fail to contain drug residues.
India’s pharmaceutical paradox
India’s pharmaceutical industry is worth 43 billion USD, ranking third globally by volume. It is both a lifeline and a liability. The country produces affordable medicines for much of the developing world, yet its own rivers and communities bear the brunt of unmanaged waste.
Over-the-counter drug sales and widespread self-medication add to the problem. With limited sanitation and patchy wastewater coverage, millions of Indians are exposed daily. The irony is stark: the same drugs that cure diseases in one part of the world are quietly creating new health crises in the country of origin.
This paradox raises difficult policy questions. Should stricter regulations be imposed on pharmaceutical hubs? How can wastewater treatment be upgraded to handle micro-pollutants? And how can India balance its role as a global medicine supplier with its environmental responsibilities?
A global problem with Indian lessons
While the study focuses on India, the issue is far from local. Pharmaceutical pollution is a global crisis. The United Nations Environment Programme has called pharmaceutical pollution a “planetary boundary threat,” and the G7 has discussed AMR as one of the top global health risks. In this context, India’s findings resonate far beyond its borders. As climate change alters rainfall patterns and increases water stress, the dilution capacity of rivers will shrink, potentially intensifying pollutant concentrations.
Technology and policy gaps
Technological solutions exist, but they are expensive. Advanced treatments like ozonation, activated carbon, and advanced oxidation processes can remove pharmaceutical residues. Yet few Indian plants employ these methods due to cost. Retrofitting existing infrastructure requires significant investment and political will.
Policy frameworks also lag. Current effluent standards rarely address pharmaceutical micro-pollutants. In Europe, regulators are beginning to set environmental quality standards for certain pharmaceuticals. India has yet to follow suit. Without enforceable guidelines, voluntary compliance is unlikely to be effective.
The study by Sengar underscores the need for screening and prioritisation. Not all PPCPs pose equal risks, but identifying the most harmful compounds can guide regulations. The authors stress the urgency of addressing pharmaceutical hubs, where drug residues were found at catastrophic levels.
What lies ahead
The study concludes with a sobering message: very high risk quotients (>1000) were recorded for certain pharmaceuticals, signifying severe potential for human health crises, aquatic toxicity, and AMR spread. Unless immediate action is taken, India could face a compounded challenge of polluted waters, collapsing ecosystems, and rising health care costs.
For policymakers, this is not just an environmental issue but a matter of national security and public health. For citizens, it raises uncomfortable questions about what is in their drinking water. For the global community, it highlights the interconnectedness of supply chains, environment, and health.
Should pharmaceutical pollution be treated with the same urgency as climate change and pandemics? And if so, who will take responsibility for cleaning up the invisible pharmacies flowing through our rivers?
Reference
Sengar, A., & Vijayanandan, A. (2022). Human health and ecological risk assessment of 98 pharmaceuticals and personal care products (PPCPs) detected in Indian surface and wastewaters. Science of the Total Environment, 807, 150677. https://doi.org/10.1016/j.scitotenv.2021.150677
