Advancing ecopharmacovigilance in South Africa: a call to action for pharmaceutical stakeholders

Abstract

Ecopharmacovigilance (EPV) represents an essential evolution of pharmacovigilance (PV), expanding the monitoring of pharmaceutical safety to environmental contexts. As pharmaceuticals enter ecosystems through anthropogenic activity, they persist as active pharmaco-environmental compounds (APECs), posing significant ecological and public health risks. Their contribution to the development and spread of antimicrobial resistance (AMR) is a growing global health threat. This article explores the connection between EPV and AMR, using the One Health approach to frame the interdependence of human, animal, and environmental health. It examines how insights derived from expanded monitoring of the pharmaceutical lifecycle can enhance strategies to mitigate contamination risks effectively. Healthcare facilities, community practices, and agriculture are key sources of antimicrobial waste. As antimicrobial waste continues to persist in wastewater, soil, and aquatic ecosystems, it exerts selective pressure on microbial populations, accelerating the spread of resistance traits through horizontal gene transfer. This environmental dimension of AMR reinforces the need for stewardship models that integrate healthcare policy, environmental science, and regulatory interventions. Pharmacists link antimicrobial stewardship (AMS) with EPV by guiding responsible medicine use and disposal. Integrating EPV into national and global AMR strategies is essential for reducing pharmaceutical pollution, strengthening environmental surveillance, and fostering more sustainable healthcare systems.