Antimicrobial resistance (AMR) has been classified as one of the phenomena that belongs to the current top threats to human health. AMR is the process where bacteria become resistant to the antimicrobial drug and renders the antibiotic ineffective. This phenomenon is increasing exponentially due to misuse and overuse of antibiotics and is responsible for 700,000 annual deaths globally. If the contributing factors to AMR remain persistent, the estimated amount of annual deaths will increase to the exorbitant figure of 10 million by 2050. The inappropriate waste discharge from antibiotic manufacturing plants is the third major cause contributing to AMR. For this reason, environmental sustainability within the pharmaceutical industry is tightly linked to human health, and therefore, the importance of environmental risk management becomes crucial. Pharmaceutical supply chains are extremely complex, fragmented, and rigid due to the highly regulated environment and global distribution of the chains. Constant availability is sometimes compromised, and this leads to national shortages of antibiotics, which increase AMR. Therefore, supply chain sustainability risks (SCSRs) need to be thoroughly assessed and managed. The thesis aims to identify the sustainability risks that threaten the constant supply of antibiotics and further provide a comprehensive and sufficient framework on how to assess and manage SCSRs within the pharmaceutical industry. This research is based on the review of existing literature, followed by an empirical study that included a case study of two specific antibiotics relevant to the Swedish market. The analysis of publicly available databases, together with the qualitative interviews, revealed that the most susceptible node of the supply chain resides in the primary manufacturing stage. The most relevant SCSRs have been identified, and an adapted framework is suggested. The role of regulatory agencies has been demonstrated to be fundamental to achieve change concerning environmental progress. Further research needs to be implemented for the validation of the suggested framework within a practical context.

The increased use of antibiotics is considered to be correlated to the increased resistance against antibiotics, hence responsible use is necessary for it to remain efficient and sustainable. To mitigate the resistance, a wide variety of antibiotics should be made available with different Active Pharmaceutical Ingredients (API), providing patients with more aimed cures rather than just few general antibiotics applied for several diseases. A wider range of products requires more effort in maintaining the availability and assuring that antibiotics are always available to be prescribed to patients to buy at their local pharmacies. Facilitating a general availability and minimizing shortages traces back to the procurement process in the supply chain and the relations between involved stakeholders. Pharmaceutical supply chains are highly regulated and monitored by governmental agencies. This thesis aims to explore the procurement process, specifically from the perspective of the pharmacies in Sweden and identify reasons that may cause availability issues and shortage of antibiotics. The research is based on literature review and empirical data collection through interviews with stakeholders in the supply chain. Through cause-and-effect analysis, the reasons behind shortages have been identified, and the pricing model Product of the Period, PoP, has theoretically shown to be the major contributor to the issues. Further research needs to be conducted with a quantitative approach to assess how big of an impact PoP has on the supply chain and antibiotics shortages. The proposed solution is that stakeholders in the supply chain have to start measuring the shortages, specifically for antibiotics.

Antimicrobial resistance (AMR) is the process where the bacteria develop resistance towards the treating effect of an antibiotic drug. AMR poses an alarming threat to human health causing around 700,000 deaths per year around the globe. If appropriate measures to combat the resistance are not taken, the number of deaths globally could increase to around 10 million by the year 2050. There are various factors driving the growth of AMR of which antibiotic shortages are common. A clear insight into the pharmaceutical supply chain is necessary to understand the reasons causing antibiotic unavailability. Ensuring access to medicines is one of the major objectives of pharmaceutical supply chains. Pharmaceutical firms compete in a volatile market to increase their profits. Antibiotics render slim profit margins to pharmaceutical firms; declining profits and increasing costs of production have led to firms outsourcing their operations to suppliers in different geographical locations. This in turn forms complex supply chain structures with various actors of a single drug chain being dispersed across the globe. The complexity in these supply chains lead to antibiotic supply interruptions. National drug shortages drive the risk of AMR, and these shortages are caused when pharmaceutical supply chains are weak or fragile. Therefore, the pharmaceutical supply chains need to be thoroughly analysed. This thesis aims to explore the different possible upstream supply chain structures that could exist in pharmaceutical supply chains. The study also highlights the factors that motivate the firms to choose different supply chain structures. This research is based on the existing literature on pharmaceutical supply chains. Qualitative semi-structured interviews, reports and existing research articles guided the authors in building a typology of upstream pharmaceutical supply chains based on: how different processes are handled by the MAH, the geographical location of operations in the chain, and the sourcing strategy of the Market Authorisation Holder (MAH) who owns the license for the drug. The findings of this study outline how a pharmaceutical firm could possibly structure the upstream supply chain based on its strategies. This study is limited to conceptualizing only the actors involved in the direct supply chain of the focal firm (MAH), further research including actors in the extended supply chain needs to be performed to get deeper insights into pharmaceutical supply chains.