Biomedical research and climate: things are heating up!

The MultiHealth group is today addressing an original topic that deserves consideration: the carbon footprint currently left by biomedical research. Initial recommendations have been made to limit it, but global awareness is needed.

The concept of CSR (Corporate Social Responsibility) first appeared in 1953 in a book by American economist Howard Bowen. Today, the challenge of sustainable development applies to all businesses and has been reinforced by the PACTE law of 2019. It can be summarized as follows: having a positive impact on society and the environment while remaining economically viable.

Carbon footprint is the indicator chosen to measure our environmental impact. It refers to the amount of greenhouse gases emitted by the activities of a human being or a company, or during the production of a good or service. Carbon impact is generally expressed in "carbon dioxide equivalent" or CO2e. In France, for example, this impact was estimated in 2021 at an average of 8.9 t of CO2e per person.

The health impacts of climate change are relatively well known, including an increase in infectious and respiratory diseases. However, there is very little data on the impact of the health sector itself on climate change.

In France, the Shift Project(1) published a report in April 2023 entitled " Decarbonizing healthcare for sustainable treatment. " According to its analyses, greenhouse gas emissions produced by all healthcare stakeholders (hospitals, private practices, administration, and complementary health insurance providers, etc.) are estimated at around 49 million tons of CO2e, representing more than 8% of France's carbon footprint.

Carbon footprint: a topic rarely considered in biomedical research

In 2022, a review of the global literature identified only five "acceptable"(2) articles devoted to the carbon footprint of biomedical research since 2007. This is surprisingly few. Overall, these studies identified three major contributors to greenhouse gas emissions:

• coordination operations, study management: from 23% to 39% depending on the study;
• the manufacture and distribution of the products under study: from 14% to 48%;
• travel by people involved in the study: from 19% to 29%. Only one study looked specifically at the contribution of patient travel; it was estimated at 16%.

In 2023, a global survey (15 countries, 4 continents) was conducted among academic research institutions and governments involved in clinical research to assess the measures taken to reduce CO2e emissions(3). Half of the respondents stated that almost none of their research projects took carbon footprint reduction into account (50% did not respond because they were "unfamiliar" with the concept).

In addition, 60% of respondents said that greenhouse gas emissions were not assessed by institutional review boards, ethics committees, or regulatory authorities (40% did not know).

In summary, neither sponsors nor regulatory authorities seem to have truly integrated carbon footprint assessment into the design or conduct of trials. However, more than 450,000 clinical studies are currently listed on the ClinicalTrials.gov website, demonstrating that the widespread adoption of more environmentally friendly practices could have a significant impact on global warming.

For responsible clinical research

Beyond the traditional measures implemented to reduce everyone's energy consumption, specific considerations have been given to biomedical research. In the United Kingdom, the National Institute for Health and Care Research has issued the first recommendations for reducing the carbon footprint of clinical studies(4). Developed by clinicians, these guidelines focus on the methodological and practical aspects that impact the footprint. Hofman et al. have also proposed a checklist for reducing the carbon footprint of clinical studies(3).

A summary of the recommendations, enriched with feedback, is presented in the box (see previous page). Overall, the recommendations are mainly aimed at reducing greenhouse gas emissions from activities related to study management (optimization of time and data management) and travel.

In conclusion, clinical research is lagging behind in terms of its contribution to sustainable development. A joint cross-disciplinary effort must be made quickly to limit greenhouse gas emissions. Reducing CO2e emissions is not only about preserving nature; limiting global warming also has health implications.

1 Think tank committed to climate change mitigation
2 Billiones R. Carbon footprint of clinical trials – Medical Writing, 2022 Vol 31 (1)
3 Hoffmann J-M, et al. BMJ Glob Health 2023;8:e012754. doi:10.1136/bmjgh-2023-012754
4 https://www.nihr.ac.uk/documents/nihr-carbon-reduction-guidelines/21685