A lab worker tests for antimicrobial resistance. Photo: DFID/Flickr CC BY 2.0
Kochi: With a growing population, urbanisation and increasing demand for food and healthcare, the world can expect an increase in the use of antimicrobials and thus, an increase in antimicrobial resistance (AMR) in the environment, according to a report released by the United Nations Environment Programme on February 8. Climate change is making this worse, the report warned.
The report “Bracing for Superbugs: Strengthening environmental action in the One Health response to antimicrobial resistance”, launched at the Sixth Meeting of the Global Leaders Group on AMR held in Barbados, calls for immediate action to address sources of AMR pollution such as sewage, healthcare delivery, pharmaceutical manufacturing, intensive agriculture and animal production. It also calls for a One Health approach to tackle AMR – a multi-sectoral and disciplinary approach that recognises that the health of people, plants, animals and the environment are all linked.
AMR, a global health threat
Antimicrobials including antibiotics, antivirals and fungicides have helped treat numerous infectious diseases in people and animals and are also used to improve crop and animal production. However, their effectiveness is fast waning because microbes have developed resistance to them, and continue to do so. Antimicrobials are increasingly failing to cure infections. Such antimicrobial resistance or AMR in human and animal pathogens is among the top ten threats compromising global health, the WHO said in 2021.
As per some estimates, 1.27 million deaths were directly attributed to drug-resistant infections globally in 2019, the new UNEP report said. Others estimate that by 2050, AMR could cause up to 10 million additional deaths globally per year – that’s as many deaths caused by cancer in 2020, it noted.
AMR also has economic impacts. Studies show that though AMR is a global risk, Low Income Countries (India is one of them) and Lower-Middle Income Countries are disproportionately at risk.
“The environmental crisis of our time is also one of human rights and geopolitics – the antimicrobial resistance report published by UNEP today is yet another example of inequity, in that the AMR crisis is disproportionately affecting countries in the Global South countries,” said Mia Amor Mottley, Prime Minister of Barbados and Chair of the One Health Global Leaders Group on Antimicrobial Resistance, in a UNEP press release. “We must remain focused on turning the tide in this crisis by raising awareness and by placing this matter of global importance on the agenda of the world’s nations.”
“AMR is not just a health issue. AMR is not just an environment issue. AMR is an equity issue,” said Inger Andersen, executive director of UNEP. “One number makes that very clear. By 2030, AMR could cause a fall in GDP of USD 3.4 trillion per year. This could push an extra 24 million people into extreme poverty. If we are serious about increasing equity and saving lives, we must act now on AMR.”
The spread of AMR
AMR spread is not confined to point sources, the UNEP report highlighted. Transient and diffuse sources, which include water (rivers, lakes and sediments), overflows, agricultural runoff, soil, airborne transmission and wildlife migration (such as the movement of migratory birds) can also be important. Other critical factors are globalisation, climate change and the mobility of people and goods, and wildlife, it noted. “AMR challenges are closely linked to the triple planetary crisis of climate change, biodiversity loss and pollution and waste, all of which are driven by human activity, including unsustainable consumption and production patterns,” it said.
Andersen also added that the same drivers that cause environmental degradation are making the AMR issue worse.
“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. Cutting down pollution is a prerequisite for another century of progress towards zero hunger and good health.”
AMR is also likely to increase in future, the UNEP report warned.
“Fuelled by population growth, urbanization and growing demand for food and healthcare, we can expect an increase in the use of antimicrobials and in pollutant releases into the environment,” the report said.
A technical report prepared for the World Economic Forum in 2020 developed a water pollution risk score by taking into account available data on emissions from clinical use of antimicrobials, agricultural uses, as well as antimicrobial manufacturing. India falls in the category of nations with the highest pollution score (between 26 and 53, on a scale of 100 being the highest). “China and India have both high levels of discharge and low levels of treatment have the highest pollution risk,” the original report reads.
Tackling AMR can be a challenge, and will require a response based on a concerted-systems approach, such as ‘One Health’, at global, regional and country levels from all sectors, stakeholders and institutions, the UNEP report read. As per the WHO, a One Health approach is one in which programmes, policies, legislation and research are designed and implemented in such a way that multiple sectors communicate and work together to achieve better public health outcomes.
Effective wastewater and sludge treatment are critical to minimise AMR-relevant pollution because human waste is a leading source of antibiotic-resistant microbes, and municipal solid waste landfills and open dumps can often become hotspots in their transmission, per the report. Countries should also develop National Action Plans to tackle AMR, and incorporate AMR in climate change action and adaptation planning given the links between AMR and climate action, the UNEP report said.
The Union Ministry of Health and Family Welfare released India’s National Action Plan (NAP) for AMR in April 2017. However, “lack of sufficient finances remains a major challenge” in its implementation in the country, a 2019 study noted.
A national AMR surveillance network of state medical college labs (NARS-Net) has been established to generate quality data on AMR for priority bacterial pathogens of public health importance, the Union Minister of State for Health and Family Welfare, Bharati Pravin Pawar stated in a written reply in the Lok Sabha on February 3.
As of November 2022, only three states – Kerala, Madhya Pradesh and Delhi – had come up with their State Action Plans on AMR, reported Down to Earth.