In this study, CARe researchers reveal the origin of active ingredients in medicines sold in Sweden. Branded, often more expensive products were more likely to contain active substances produced in countries with, in general, good environmental performance. Less expensive, generic copies were more likely to originate from countries with poorer environmental performance. It is acknowledged that the levels of pollution are likely to vary between factories within countries. The authors therefore conclude that emissions from manufacturing need to be measured, allowing for control and follow-up on industry commitments towards sustainable manufacturing of pharmaceuticals. Furthermore, in order for consumers, hospitals and pharmacies to be able to influence the environmental impact pharmaceutical manufacture have, initiatives to increase transparency in the production chain, improved procurement criteria, voluntary commitments from the industry and changes in the generic substitution systems will all be parts of the solution. The need for such initiatives are of particular importance for antibiotics, given the escalating health crisis caused by antibiotic resistance.