Inger Andersen is Executive Director of the United Nations Environment Programme.
Antimicrobials save countless lives and protect vital economic sectors; they are basically a superweapon. Without them, modern medicine would struggle to treat even mild infections in humans, animals and plants.
However, a new report from the United Nations Environmental program shows that pollution of the environment affects the effectiveness of antibiotics, antivirals, antifungals and antiparasitics.
The result? An increase in crisis-level antimicrobial resistance super bugs and other insidious examples of antimicrobial resistance.
To limit the emergence and spread of antimicrobial resistance, we need to reduce environmental pollution at its source.
How big is the problem of antimicrobial resistance?
The World Health Organization lists antimicrobial resistance among the top ten threats global healthrightly so.
In 2019, an estimated 1.27 million deaths worldwide were directly attributed to drug-resistant infections. Nearly 4.95 million deaths worldwide have been associated with bacterial antimicrobial resistance.
Estimates suggest that up to ten million direct deaths per year could occur by 2050, equivalent to the number of global cancer deaths in 2020. Over the next decade, the effects of antimicrobial resistance will intensify healthcare systemsproductivity and agricultural output could lead to a gross domestic product deficit of at least $3.4 trillion a year and push an additional 24 million people into extreme poverty.
Antimicrobial resistance is also a matter of equity. It is closely linked to poverty, lack of sanitation and poor hygiene Global South hardest hit. Antimicrobials are commonly used in pesticides: in some countries, 85 percent of all pesticide applications on commercial farms and plantations are performed by women – often working during pregnancy or breastfeeding.
If we are serious about creating a fairer, safer world, tackling antimicrobial resistance should be near the top of the global agenda.
How do pollution and climate change contribute to antimicrobial resistance?
Three economic sectors have a profound impact on the development and spread of antimicrobial resistance: manufacturing of pharmaceuticals and other chemicals, agriculture and food, and healthcare. Municipal systems are also involved. Leakage of antimicrobials through these routes to the environment, e.g. via sewage, can cause bacteria, viruses, parasites or fungi become resistant to antimicrobial treatments to which they were previously susceptible.
The wider triple planetary crisis – from climate changeloss of nature and biodiversity, and pollution and waste – is also linked to the development and spread of antimicrobial resistance.
Higher temperatures and extreme weather may be associated with an increase in antibiotic-resistant infections. Municipal solid waste landfills are prone to interaction with wildlife and may contribute to the spread of antimicrobial resistance.
How can governments and industry beat antimicrobial resistance?
While the significance of the environment remains underexposed in AMR, the new report points to clear further steps that governments, industry and other key players can now take to stop the leakage of antimicrobials into the environment.
The pharmaceutical industry can strengthen inspection systems, change incentives and subsidies to upgrade the manufacturing process, and ensure adequate waste and wastewater containment and treatment.
The food and agriculture sector can limit the use of antimicrobials and reduce discharges to protect water sources of pollutants, resistant microorganisms and contamination with antimicrobial residues. This sector should also avoid antibiotics similar to those used as a last resort in human medicine.
The healthcare sector can increase access to high-qualityquality and sustainable water sources and sanitation, install hospital-specific wastewater treatment systems, and ensure safe and sustainable use and disposal of antimicrobial drugs.
Since about 56 percent of wastewater ends up in the environment with little or no treatment, and more than 600 million people have access to poor or basic services, it is also crucial to improve integrated water management and promote water purification and hygiene.
These actions, and more outlined in the report, must be supported at the highest level: with national action plans, international standards, reallocation of grants and investments, research and, above all, cooperation between sectors.
Adopting the ‘One Healthapproach – which recognizes that human, animal, plant and environmental health are interdependent – is particularly important to ensure everyone is on the same page.
Significant political momentum has been generated, including through the Global Leaders Group on Antimicrobial Resistance and the Quadripartite Alliance on One Health.
however, the threat grows. We now need more high-level political commitment, more finance, more technical expertise and, above all, more action.
Investment in new and affordable antimicrobials and other preventive measures should increase, but reducing pollution will be essential to ensure that this superweapon maintains its potency.