Assessing sustainability in the pharmaceutical supply chain: A participatory multi-criteria approach in the Basque Country (Spain)

Abstract

The pharmaceutical industry faces urgent pressure to integrate sustainability into its complex supply chain, driven by environmental degradation, regulatory demands, and the need for operational resilience. Despite this, existing frameworks often fail to capture the systemic tradeoffs between economic efficiency, social equity, and environmental protection. This study assesses the sustainability of the pharmaceutical supply chain through a multi-criteria participatory approach in the Basque Country (Spain), using 30 indicators to analyze three key dimensions: economic, social, and environmental. The results reveal an asymmetric sustainability performance, reflected in a Global Pharmaceutical Sustainability Index (ISF) of 3.42 out of 5. The supply chain exhibits maturity in regulatory and ethical compliance, with high scores in environmental compliance (4.20) and ethics and compliance (4.18). However, it exhibits critical deficiencies in internal social well-being and economic value recovery, scoring lowest in employee satisfaction (2.73) and sustainable packaging (2.75). Furthermore, the economic dimension proved to be the weakest link (Economic ISF = 3.25), highlighting a structural struggle to transition toward circular models. The cognitive mapping methodology reveals that financial profitability (ROI) and environmental compliance act as the most strategic drivers for the transition toward a more sustainable supply chain. Finally, significant governance gaps and divergent stakeholder priorities were identified. This study provides a framework for improving the sustainability of the pharmaceutical supply chain and developing governance policies adapted to territorial characteristics.