{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T12:12:29Z","timestamp":1788437549111,"version":"build-2803163510"},"reference-count":41,"publisher":"American Chemical Society (ACS)","issue":"34","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-045"}],"funder":[{"DOI":"10.13039\/501100001717","name":"Universiteit Leiden","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/501100001717","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Understanding differences in drug-specific carbon footprints across countries is increasingly important as healthcare sustainability and product-level reporting gain prominence in regulatory initiatives, such as digital product passports, yet such estimates remain largely unavailable due to sparse drug-level data. Here, we develop a hybrid life cycle assessment framework that enables quantification of drug-specific carbon footprints across regions under real-world data constraints. It combines drug-level life cycle inventory with international consumption and trade statistics and embeds a structured uncertainty assessment to evaluate key data gaps and modeling choices through robustness tests. We demonstrate its application using narrower-spectrum penicillin. We estimate that its global consumption in 2019 was associated with about 90 kt CO2e. Although modest in magnitude, the footprint\u2019s geographic distribution differs markedly from that of aggregated pharmaceuticals, showing that sector-level accounting can mask substantial cross-country heterogeneity. Across alternative assumptions, global totals vary by less than 30%, and country rankings remain largely stable, indicating that the observed patterns reflect structural differences in consumption and sourcing rather than artifacts of specific modeling choices. This framework offers a transparent pathway for drug-level carbon accounting under data scarcity and identifies data and methodological priorities to support future reporting, procurement, and decarbonization efforts in the pharmaceutical sector.<\/jats:p>","DOI":"10.1021\/acs.est.6c00661","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T17:01:28Z","timestamp":1787245288000},"page":"24007-24019","source":"Crossref","is-referenced-by-count":0,"title":["A\nHybrid LCA Framework for Drug-Level Carbon Footprint\nAssessment under Data Constraints: Application to Narrower-Spectrum\nPenicillin"],"prefix":"10.1021","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2545-5164","authenticated-orcid":true,"given":"Rosalie H.","family":"Hagenaars","sequence":"first","affiliation":[{"name":"Leiden University , , P.O. Box 9518, ,","place":["Leiden, The Netherlands, 2300 RA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjan","family":"de Koning","sequence":"additional","affiliation":[{"name":"Leiden University , , P.O. Box 9518, ,","place":["Leiden, The Netherlands, 2300 RA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0724-5962","authenticated-orcid":true,"given":"Reinout","family":"Heijungs","sequence":"additional","affiliation":[{"name":"Leiden University , , P.O. Box 9518, ,","place":["Leiden, The Netherlands, 2300 RA"]},{"name":"Vrije Universiteit , , De Boelelaan 1105 , ,","place":["Amsterdam, The Netherlands, 1081 HV"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnold","family":"Tukker","sequence":"additional","affiliation":[{"name":"Leiden University , , P.O. Box 9518, ,","place":["Leiden, The Netherlands, 2300 RA"]},{"name":"The Netherlands Organization for Applied Scientific Research TNO , ,","place":["Den Haag, The Netherlands, 2595 DA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7786-3179","authenticated-orcid":true,"given":"Ranran","family":"Wang","sequence":"additional","affiliation":[{"name":"Leiden University , , P.O. Box 9518, ,","place":["Leiden, The Netherlands, 2300 RA"]},{"name":"Nanjing University , , ,","place":["Nanjing, China, 210023"]},{"name":"Nanjing University Suzhou Campus , , ,","place":["Suzhou, China, 215163"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"316","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"issue":"3","key":"2026090307135852500_cit1","doi-asserted-by":"publisher","first-page":"e196","DOI":"10.1016\/S2542-5196(25)00028-2","article-title":"The Greenhouse\nGas Emissions of Pharmaceutical Consumption and Production: An Input\u2013Output\nAnalysis over Time and across Global Supply Chains","volume":"9","author":"Hagenaars","year":"2025","journal-title":"Lancet Planet. Health"},{"key":"2026090307135852500_cit2","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.jclepro.2018.11.204","article-title":"Carbon Footprint of\nthe Global Pharmaceutical Industry\nand Relative Impact of Its Major Players","volume":"214","author":"Belkhir","year":"2019","journal-title":"J.\nClean. Prod."},{"key":"2026090307135852500_cit3","doi-asserted-by":"publisher","first-page":"129963","DOI":"10.1016\/j.jclepro.2021.129963","article-title":"Are Medicines\nMore Greenhouse Gas\nIntensive than Cars? Comment to Belkhir, L.. 2019: Carbon Footprint\nof the Global Pharmaceutical Industry and Relative Impact of Its Major\nPlayers","volume":"331","author":"Forin","year":"2022","journal-title":"J. Clean. Prod."},{"key":"2026090307135852500_cit4","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.jclepro.2019.03.092","article-title":"Analysis of Energy-Related\nCO 2 Emissions in China\u2019s Pharmaceutical\nIndustry and Its Driving Forces","volume":"223","author":"Gao","year":"2019","journal-title":"J. Clean. Prod."},{"issue":"12","key":"2026090307135852500_cit5","doi-asserted-by":"publisher","first-page":"e1000","DOI":"10.1016\/S2542-5196(22)00257-1","article-title":"HealthcareLCA: An Open\u202fAccess\nLiving Database of Health-Care Environmental Impact Assessments","volume":"6","author":"Drew","year":"2022","journal-title":"Lancet Planet. Health"},{"issue":"47","key":"2026090307135852500_cit6","doi-asserted-by":"publisher","first-page":"20363","DOI":"10.1021\/acssuschemeng.5c04708","article-title":"Closing Data\nGaps for LCA of Pharmaceutical\nProduction: Estimating Energy Usage by Upscaling Laboratory Data","volume":"13","author":"Ansar","year":"2025","journal-title":"ACS Sustain. Chem. Eng."},{"key":"2026090307135852500_cit7","doi-asserted-by":"publisher","first-page":"142550","DOI":"10.1016\/j.jclepro.2024.142550","article-title":"Application of Life\nCycle Assessment\nin the Pharmaceutical Industry: A Critical Review","volume":"459","author":"Chen","year":"2024","journal-title":"J. Clean. Prod."},{"issue":"7","key":"2026090307135852500_cit8","doi-asserted-by":"publisher","first-page":"6580","DOI":"10.1021\/acssuschemeng.8b05473","article-title":"Cradle-to-Gate Greenhouse Gas Emissions\nfor Twenty Anesthetic Active Pharmaceutical Ingredients Based on Process\nScale-Up and Process Design Calculations","volume":"7","author":"Parvatker","year":"2019","journal-title":"ACS\nSustain. Chem. Eng."},{"issue":"5","key":"2026090307135852500_cit9","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1111\/jiec.12655","article-title":"Truncation\nError\nEstimates in Process Life Cycle Assessment Using Input-Output Analysis","volume":"22","author":"Ward","year":"2018","journal-title":"J. Ind. Ecol."},{"issue":"4","key":"2026090307135852500_cit10","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1162\/10881980052541981","article-title":"Errors in\nConventional and Input-Output\u2500Based Life\u2500Cycle Inventories","volume":"4","author":"Lenzen","year":"2000","journal-title":"J. Ind. Ecol."},{"issue":"3","key":"2026090307135852500_cit11","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1007\/s10640-013-9649-8","article-title":"Specification and Aggregation Errors\nin Environmentally\nExtended Input\u2013Output Models","volume":"56","author":"Bouwmeester","year":"2013","journal-title":"Environ.\nResour. Econ."},{"issue":"4","key":"2026090307135852500_cit12","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1080\/09535314.2019.1609911","article-title":"Aggregating\nInput\u2013Output Systems with Minimum Error","volume":"31","author":"Lenzen","year":"2019","journal-title":"Econ. Syst. Res."},{"key":"2026090307135852500_cit13","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.ecolecon.2014.02.020","article-title":"Ecological\nFootprint of Nations: Comparison of Process Analysis, and Standard\nand Hybrid Multiregional Input\u2013Output Analysis","volume":"101","author":"Weinzettel","year":"2014","journal-title":"Ecol. Econ."},{"issue":"3","key":"2026090307135852500_cit14","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1016\/j.ecolecon.2005.05.011","article-title":"Physical and Monetary\nInput\u2013Output Analysis:\nWhat Makes the Difference?","volume":"57","author":"Weisz","year":"2006","journal-title":"Ecol. Econ."},{"key":"2026090307135852500_cit15","doi-asserted-by":"crossref","DOI":"10.1016\/j.rser.2025.115443","article-title":"Hybrid LCA for Sustainable\nTransitions: Principles, Applications, and Prospects","volume-title":"Renewable and Sustainable Energy Reviews","author":"Hagenaars","year":"2025"},{"key":"2026090307135852500_cit16","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1016\/j.jclepro.2017.10.176","article-title":"Hybrid Life\nCycle Inventory Methods \u2013 A Review","volume":"172","author":"Crawford","year":"2018","journal-title":"J.\nClean. Prod."},{"issue":"2\u20133","key":"2026090307135852500_cit17","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1162\/108819899569449","article-title":"Product Environmental\nLife-Cycle Assessment Using Input-Output Techniques","volume":"3","author":"Joshi","year":"1999","journal-title":"J. Ind. Ecol."},{"key":"2026090307135852500_cit18","unstructured":"Organisation for Economic Co-operation and Development.\n          . Inter-Country\nInput-Output Tables, 2023 Edition. https:\/\/www.oecd.org\/en\/data\/datasets\/inter-country-input-output-tables.html (accessed Sept 13, 2024)."},{"key":"2026090307135852500_cit19","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.spc.2018.05.004","article-title":"Generic Flowsheeting Approach to\nGenerating First Estimate Material and Energy Balance Data for Life\nCycle Assessment (LCA) of Penicillin V Production","volume":"15","author":"Harding","year":"2018","journal-title":"Sustain. Prod. Consum."},{"issue":"49","key":"2026090307135852500_cit24","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.2411919121","article-title":"Global Trends\nin Antibiotic Consumption during 2016\u20132023 and Future Projections\nthrough 2030","volume":"121","author":"Klein","year":"2024","journal-title":"Proc. Natl. Acad. Sci. U. S. A."},{"key":"2026090307135852500_cit21","unstructured":"The European Parliament & The Council of the European Union.\n          . Regulation (EU) 2024\/1781 of 13 June 2024 Establishing a Framework\nfor the Setting of Ecodesign Requirements for Sustainable Products,\nAmending Directive (EU) 2020\/1828 and Regulation (EU) 2023\/1542 and\nRepealing Directive 2009\/125\/EC (Text with EEA Relevance), 2024. http:\/\/data.europa.eu\/eli\/reg\/2024\/1781\/oj (accessed Oct 02, 2025)."},{"key":"2026090307135852500_cit22","unstructured":"The European Parliament & The Council of the European Union.\n          . Directive (EU) 2022\/2464 of the European Parliament and of the Council\nof 14 December 2022 Amending Regulation (EU) No 537\/2014, Directive\n2004\/109\/EC, Directive 2006\/43\/EC and Directive 2013\/34\/EU, as Regards\nCorporate Sustainability Reporting, 2022. http:\/\/data.europa.eu\/eli\/dir\/2022\/2464\/oj (accessed Dec 23, 2025)."},{"issue":"1","key":"2026090307135852500_cit23","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1021\/acs.est.9b05245","article-title":"Enabling Full\nSupply Chain Corporate\nResponsibility: Scope 3 Emissions Targets for Ambitious Climate Change\nMitigation","volume":"54","author":"Li","year":"2020","journal-title":"Environ. Sci. Technol."},{"key":"2026090307135852500_cit25","doi-asserted-by":"crossref","unstructured":"Gaulier, G.; Zignago, S. B. A. C. I.: International\nTrade Database at the Product-Level. the 1994\u20132007 Version;\n2010\u201323, 2010. https:\/\/www.cepii.fr\/CEPII\/fr\/publications\/wp\/BibTeX.asp?abstract=true&NoDoc=2726 (accessed July 15, 2025).","DOI":"10.2139\/ssrn.1994500"},{"issue":"9","key":"2026090307135852500_cit26","doi-asserted-by":"publisher","first-page":"1218","DOI":"10.1007\/s11367-016-1087-8","article-title":"The Ecoinvent Database\nVersion 3 (Part I): Overview\nand Methodology","volume":"21","author":"Wernet","year":"2016","journal-title":"Int. J. Life Cycle Assess."},{"key":"2026090307135852500_cit29","unstructured":"Eurostat.\n          . Electricity prices for non-household\nconsumers -\nbi-annual data (from 2007 onwardshttps:\/\/ec.europa.eu\/eurostat\/databrowser\/view\/nrg_pc_205__custom_16951666\/default\/table?lang=en (accessed Aug 15, 2025)."},{"issue":"4","key":"2026090307135852500_cit100","doi-asserted-by":"publisher","first-page":"489","DOI":"10.3390\/resources2040489","article-title":"An Introduction to Environmentally-Extended\nInput-Output\nAnalysis","volume":"2","author":"Kitzes","year":"2013","journal-title":"Resources"},{"key":"2026090307135852500_cit20","unstructured":"WHO Collaboration Centre for Drug Statistics Methodology.\n          . ATC\/DDD Index, 2025. https:\/\/atcddd.fhi.no\/atc_ddd_index\/ (accessed July 14, 2025)."},{"key":"2026090307135852500_cit27","unstructured":"The World Bank.\n          . World Development Indicators\u2500Population,\nTotalhttps:\/\/data.worldbank.org\/indicator\/SP.POP.TOTL (accessed Apr 26, 2024)."},{"key":"2026090307135852500_cit28","unstructured":"The World Bank.\n          . World Development indicators - GNI per capita, Atlas\nmethod (current US$)https:\/\/data.worldbank.org\/indicator\/NY.GNP.PCAP.CD (accessed Apr 26, 2024)."},{"issue":"3","key":"2026090307135852500_cit200","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1111\/jiec.12945","article-title":"Lifting the Veil on\nthe Correction of Double Counting\nIncidents in Hybrid Life Cycle Assessment","volume":"24","author":"Agez","year":"2020","journal-title":"J.\nInd. Ecol."},{"key":"2026090307135852500_cit30","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9780511626982","volume-title":"Input\u2013Output\nAnalysis","author":"Miller","year":"2009"},{"key":"2026090307135852500_elcit1936722816","unstructured":"World Bank Group.\n          . Doing Business\n- Electric Prices by Country. https:\/\/archive.doingbusiness.org\/en\/data\/exploretopics\/getting-electricity (accessed 2025-846 11-06)."},{"key":"2026090307135852500_cit31","unstructured":"Rickwood, S., Harry, L.\n          Antimicrobial Resistance: Understanding\nthe Threat and Shaping the Response\n          https:\/\/www.iqvia.com\/locations\/emea\/blogs\/2024\/10\/antimicrobial-resistance-understanding-the-threat-and-shaping-the-response (accessed Aug 20, 2025)."},{"key":"2026090307135852500_cit32","unstructured":"European Centre For Disease Prevention and Control.\n          \n          Antimicrobial\nConsumption in the EU\/EEA (ESAC-Net)\u2500Annual Epidemiological\nReport 2023, 2024."},{"key":"2026090307135852500_cit33","unstructured":"World Health Organization.\n          .  Global Antibiotic Resistance Surveillance\nReport 2025: WHO Global Antimicrobial Resistance and Use Surveillance\n(GLASS); Geneva, 2025."},{"key":"2026090307135852500_cit34","doi-asserted-by":"publisher","first-page":"101053","DOI":"10.1016\/j.onehlt.2025.101053","article-title":"A Review\nof Antimicrobial Resistance\nChallenges in Nigeria: The Need for a One Health Approach","volume":"20","author":"Alabi","year":"2025","journal-title":"One Health"},{"key":"2026090307135852500_cit35","unstructured":"World Health Organization.\n          . Antimicrobial\nresistance in Viet\nNam. https:\/\/www.who.int\/vietnam\/health-topics\/antimicrobial-resistance (accessed Oct 24, 2025)."},{"key":"2026090307135852500_cit39","unstructured":"Organisation for Economic Co-operation. Pharmaceutical Sales (HEALTH_PHMC\/DF_PHMC_SALES).\n          . OECD Health Statistics. https:\/\/data-explorer.oecd.org\/ (accessed Sept 11, 2025)."},{"key":"2026090307135852500_cit40","unstructured":"Organisation for Economic Co-operation and Development. Pharmaceutical consumption (HEALTH_PHMC\/DF_PHMC_CONSUM).\n          . OECD Health Statistics. https:\/\/data-explorer.oecd.org\/ (accessed Nov 06, 2024)."},{"key":"2026090307135852500_cit41","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1186\/s12961-025-01386-w","article-title":"The Role of Environmental\nImpact Assessments in Hospital Care: Healthcare Professionals\u2019\nViews on Research and Implementation Priorities","volume":"23","author":"Kouwenberg","year":"2025","journal-title":"Health Res. Policy Syst."}],"container-title":["Environmental Science &amp; Technology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/pubs.acs.org\/doi\/pdf\/10.1021\/acs.est.6c00661","content-type":"application\/pdf","content-version":"vor","intended-application":"unspecified"},{"URL":"https:\/\/pubs.acs.org\/esthag\/article-pdf\/60\/34\/24007\/66912661\/acs.est.6c00661.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/pubs.acs.org\/esthag\/article-pdf\/60\/34\/24007\/66912661\/acs.est.6c00661.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:14:06Z","timestamp":1788434046000},"score":1,"resource":{"primary":{"URL":"https:\/\/pubs.acs.org\/esthag\/article\/60\/34\/24007\/5278478\/A-Hybrid-LCA-Framework-for-Drug-Level-Carbon"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,20]]},"references-count":41,"journal-issue":{"issue":"34","published-online":{"date-parts":[[2026,8,20]]},"published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1021\/acs.est.6c00661","relation":{},"ISSN":["0013-936X","1520-5851"],"issn-type":[{"value":"0013-936X","type":"print"},{"value":"1520-5851","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,20]]}}}