About ten million people could die annually by 2050 because of antimicrobial resistance (AMR), said a new report by the UN Environment Programme(UNEP), which highlighted the need to curtail pollution created by the pharmaceuticals, agricultural and healthcare sectors.
The study focuses on the environmental dimensions of AMR, which occurs when bacteria, viruses, fungi, and parasites change over time and no longer respond to medicines.
In the study, the UNEP calls for strengthening action to reduce the emergence, transmission and spread of “superbugs” – strains of bacteria that have become resistant to every known biotic – and other instances of AMR, which are already taking a serious toll on human, animal, and plant health.
AMR is among the top ten global threats to health, according to the World Health Organization (WHO). In 2019, drug-resistant infections led to an estimated 1.27 million deaths globally. Overall, nearly five million deaths were associated with bacterial AMR.
UNEP Executive Director Inger Andersenexplained that the triple planetary crisis – climate change, pollution and biodiversity loss – have contributed to this.
“Pollution of air, soil, and waterways undermines the human right to a clean and healthy environment. The same drivers that cause environment degradation are worsening the antimicrobial resistance problem. The impacts of anti-microbial resistance could destroy our health and food systems,” she warned.
Antimicrobials are an essential part of modern life. Yet, the more we use them inappropriately, the more the microbial world adapts. There is strong evidence that bacteria, parasites, viruses and fungi are becoming resistant to antimicrobials. Infections in humans, animals and plants are becoming difficult, sometimes impossible, to treat. Antimicrobial resistance (AMR) has therefore emerged as a principal public health problem, she said.
Though antimicrobials have been essential in reducing the burden of infectious disease in humans, animals and plants for decades, the study shows that their effectiveness was now in jeopardy because several antibiotic, antiviral, antiparasitic and antifungal treatments no longer work because of antimicrobial resistance or AMR.
AMR AND ENVIRONMENT
Global attention to AMR has mainly focused on human health and agriculture sectors, but there is growing evidence that the environment plays a key role in the development, transmission and spread of AMR. The environmental dimensions of AMR are complex and characterized by dynamic interactions, cyclic interrelationships, complexities and multiple causalities and dynamics in multi-dimensional media that impact global planetary health, the study mentioned.
In the study, the authors said that AMR can occur naturally or can be acquired. Increased use and misuse of antimicrobials and other microbial stressors, such as pollution, create favourable conditions for microorganisms to develop resistance both in humans and the environment from sources such as sewage, they said. Bacteria in water, soil and air for example can acquire resistance following contact with resistant microorganisms, they added.
The study shows that environmental dimensions of AMR include pollution from hospital and community wastewater, effluent from pharmaceutical production, run-off originating from plant and animal agriculture and other forms of waste and releases. These matrices may contain not only resistant microorganisms, but also antimicrobials, various pharmaceuticals, microplastics, metals and other chemicals, which all increase the risk of AMR in the environment. Polluted waterways, particularly those that have been polluted for some time, are likely to harbour microorganisms that increase AMR development and distribution in the environment. With increasing pollution and lack of management of sources of pollution, combined with AMR in clinical and hospital settings and agriculture, risks are increasing.
The UNEP in the study states that the key economic-sectors contributing to environmental dimensions of AMR are pharmaceutical and other chemical manufacturing and uses including a range of different chemicals, such as antibiotics, antivirals and fungicides as well as disinfectants; agriculture including animal production, aquaculture, food crops or those providing inputs such as feed, textiles, ornamental plants, biofuels and other agricultural commodities; healthcare delivery in hospitals, medical facilities, community healthcare facilities and in pharmacies where a broad range of chemicals and disinfectants may be used.
‘One Health’ approach, which recognises that the health of people, animals, plants and the environment are closely linked and interdependent, can successfully address AMR. Some countries have already adopted this approach and have included environmental-related aspects into their National Action Plans on AMR. Agriculture, health and environmental agencies have in place many policy and regulatory frameworks and controls addressing some of the drivers and factors with an impact on environmental dimensions of AMR. Voluntary industry initiatives have established a common framework for managing discharge of antimicrobial compounds and apply it across manufacturing and supply chains among their members. International organizations and bodies are taking decisions and have initiatives such as the joint efforts of the Quadripartite Alliance (FAO, UNEP, WHO and WOAH) for strong and coordinated action.
The report calls to
- create robust and coherent national level governance, planning, regulatory and legal frameworks, as well as establish coordination and collaboration mechanisms
- increase global efforts to improve integrated water management and promote water, sanitation and hygiene to limit the development and spread of AMR in the environment as well as to reduce infections and need for antimicrobials
- increase integration of environmental considerations into National Action Plans on AMR, and AMR into environmental-related plans such as national chemical pollution and waste management programmes, national biodiversity and climate change planning
- establish international standards for what are good microbiological indicators of AMR from environmental samples, which can be used to guide risk reduction decisions and create effective incentives to follow such guidance
- Explore options to redirect investments, to establish new and innovative financial incentives and schemes, and to make the investment case to guarantee sustainable funding, including the allocation of sufficient domestic resources for tackling AMR.
WHAT ARE ANTIMICROBIALS?
Antimicrobials – antibiotics, antivirals, antifungals and antiparasitics – are medicines widely used to prevent and treat infections in humans, aquaculture, livestock, and crop production.
WHAT IS ANTIMICROBIAL RESISTANCE (AMR)?
AMR occurs when microorganisms such as bacteria, viruses, parasites or fungi become resistant to antimicrobial treatments to which they were previously susceptible. Increasing use and misuse of antimicrobials and other microbial stressors (e.g. the presence of heavy metals and other pollutants) creates favourable conditions for microorganisms to develop
IMPACT OF AMR
• The World Health Organization (WHO) lists AMR among top 10 threats for global health.
• Limiting the emergence and spread of AMR is critical to preserving the ability to treat diseases, reduce food safety and security risks, and protect the environment.
• Without effective antimicrobials, modern medicine would struggle to treat even mild infections among humans, animals, and plants.
• In 2019, it is estimated that 1.27 million deaths were directly attributed to drug-resistant infections globally, and 4.95 million deaths worldwide were associated with bacterial AMR (including those directly attributable to AMR). Estimates suggest that by 2050 up to 10 million additional direct deaths could occur annually. That is on par with the 2020 rate of global deaths from cancer.
• In the next decade, AMR could result in a GDP shortfall of at least USD 3.4 trillion annually and push 24 million more people into extreme poverty.
CLIMATE CHANGE AND AMR
• The climate crisis and AMR are two of the greatest and most complex threats the world currently faces. Both have been worsened by, and can be mitigated by, human action.
• Higher temperatures can be associated with increases in AMR infections, and extreme weather patterns can contribute to the emergence and spread of AMR.
• Antimicrobial impacts on microbial biodiversity may affect the cycles of carbon and methane, which are directly involved in regulating earth’s climate.
BIODIVERSITY LOSS AND AMR
• Land-use changes and climate change alter soils’ microbial diversity in recent decades, and microbes inhabiting natural environments are sources of pharmaceutical discovery.
• Municipal solid waste landfills and open dumps are prone to wildlife and feral animal interaction and can contribute to the spread of AMR.
• There is no evidence currently for the increase of AMR accelerating biodiversity loss. Pollution and AMR
• Biological and chemical pollution sources contribute to AMR development, transmission, and spread.
• Three economic sector value chains profoundly influence AMR’s development and spread:
o Pharmaceuticals and other chemicals manufacturing
o Agriculture and food including terrestrial animal production, aquaculture, food crops or those providing inputs such as feed, textiles, ornamental plants, biofuels, and other agricultural commodities.
o Healthcare delivery in hospitals, medical facilities, community healthcare facilities and in pharmacies where a range of chemicals and disinfectants are used.