European Environment Initiative (EURENI)

Project background

Pharmaceutical residues from healthcare systems pose a serious but still underestimated risk to the environment. Hospitals frequently discharge high concentrations of active pharmaceutical ingredients, such as antibiotics, into municipal wastewater. Conventional treatment plants cannot completely remove these substances.  Only a few hospitals have their own purification systems. As a result, pharmaceutical residues enter rivers and lakes — where they can disrupt aquatic ecosystems. 

These residues do not only harm the ecosystem. They also contribute to the development and spread of antimicrobial resistance (AMR), which has become a growing public health threat. European experts warn that environmental pollution from antibiotics helps resistant bacteria to develop and multiply. While AMR is widely recognised as a serious challenge for human health, its environmental drivers remain largely overlooked. 

Many healthcare professionals are not fully aware of how pharmaceuticals affect the environment, or how hospital emissions contribute to AMR. Surveys across EU countries reveal clear knowledge gaps about the One Health approach. This integrated approach connects human, animal and environmental health as interdependent parts of a shared system.

At the policy level, awareness of pharmaceutical pollution in the environment is growing. However, concrete regulatory measures are still limited. The EU added pharmaceuticals to its Water Framework Directive Watch List in 2024. Yet binding quality standards are not expected before 2039, and possibly not before 2051. Most countries still monitor pharmaceutical residues in wastewater only on a voluntary basis.

These developments show the need for education and awareness efforts on the environmental dimension of AMR — especially for healthcare professionals and decision-makers in public health and environmental policy.

Project goals and measures

The project addresses the growing challenge of antimicrobial resistance by focusing on a largely overlooked source: pharmaceutical residues from healthcare settings, particularly hospitals. These residues damage aquatic ecosystems and can contribute to the spread of antibiotic-resistant bacteria.

To close knowledge and awareness gaps, the project develops a new online training module on pharmaceutical pollution in the environment. The module will be integrated into the existing AMR EDUCare e-learning platform and complements current modules. It targets hospital staff — especially those involved in prescribing and pharmaceutical waste. Participants learn how to reduce pharmaceutical emissions and become aware of One Health principles.

The project also runs awareness campaigns for medical, nursing and public health students. Campaign materials — including videos, posters and webinars — explain how pharmaceutical residues affect water ecosystems and public health, while also promoting responsible antibiotic use and disposal. In addition, these materials help healthcare professionals engage patients in conversations about proper medication disposal.

Beyond healthcare professionals, the project fosters dialogue among stakeholders and decision-makers. To strengthen knowledge exchange on the environmental aspects of antimicrobial resistance, it hosts stakeholder events during World Water Week in Brussels and Malta. These gatherings share insights from training activities and field observations, highlight key challenges, and showcase opportunities for action at the European level. The work aligns with EU water legislation, including the Water Framework Directive and the Urban Wastewater Treatment Directive.

By connecting education, communication and policy dialogue, the project supports practical solutions to reduce pharmaceutical pollution. It encourages hospitals and decision-makers to adopt environmentally responsible practices and to integrate water protection into the broader fight against antimicrobial resistance.