Antimicrobial Resistance

In January 2021, an infant was admitted to a hospital in the American state of Kansas with tuberculosis.

Doctors would soon discover the strain of bacteria behind the infection was immune to four commonly used treatments, found a recent study.

Before long, a dozen other people had fallen ill with the disease, which affects the lungs and was once one of the world’s deadliest maladies.

AMR happens when microorganisms evolve and stop responding, or respond less, to treatment. This process is on the rise worldwide and was responsible for nearly 1.3 million deaths in 2019, making it a bigger killer than AIDS and malaria. And the situation is expected to get worse.

“AMR is truly a global crisis that requires urgent action,” said Jacqueline Álvarez, the Chief of the Chemicals and Health Branch at the United Nations Environment Programme (UNEP). “From healthcare workers, to veterinarians, to policy makers to the general public – we must all educate ourselves about the dangers of AMR and step up efforts to prevent it.”

World AMR Awareness Week will take place from 18 – 24 November. This year’s iteration will feature summits, panel discussions, press conferences, and a host of other events around the world. Ahead of that, here is everything you need to know about AMR, including its links to the environment, and what can be done to counter its spread.

What is AMR?

AMR occurs when microorganisms, such as bacteria, viruses, parasites, or fungi, become resistant to antimicrobial treatments to which they were previously susceptible. The more microbes are exposed to pharmaceuticals, such as antibiotics, the more likely they are to adapt to them.

What are some of the main drivers of AMR?

One of the primary drivers is the overuse and misuse of antibiotics in both human medicine and agriculture. In many cases, antibiotics are prescribed when they are not necessary or are not used correctly. This can lead to the survival and proliferation of resistant bacteria. The use and overuse of antimicrobials in agriculture, including to promote growth and prevent disease in livestock, is also a major contributor to the development and spread of AMR. Pollution from the pharmaceuticals, agriculture and healthcare sectors, and municipal waste, are also propelling AMR.

AMR weighs especially heavily on the developing world. Why is that?

This is true. Poverty, coupled with a lack of access to healthcare, can exacerbate the spread of AMR. As well, people in developing countries, especially those living in informal settlements, often do not receive proper diagnoses, leading to the over-prescription of antimicrobials. As well, a lack of access to clean water and sanitation makes them more vulnerable to infections.

How does the state of the environment affect the spread of AMR?

There is growing evidence that the environment plays a key role in the development, transmission and spread of AMR. Its proliferation is linked to the triple planetary crisis of climate change, nature and biodiversity loss, pollution and waste.

For example, higher temperatures, storms and floods can fuel the spread of bacterial, viral, parasitic, fungal and vector-borne diseases. Severe weather events can also cause wastewater and sewage to overwhelm treatment plants, allowing untreated sewage rich in antimicrobial-resistant microbes to contaminate surrounding communities.

As well, wastewater laced with medicines, including that from animal production facilities, hospitals and pharmaceutical companies, can feed drug resistance.

We cannot stop using antimicrobials. So, how can we fight AMR?

Antimicrobials have saved countless lives and are essential to modern medicine. But we need to use them more judiciously. Healthcare professionals should only prescribe antibiotics when necessary and in the right dosage and duration. The use and overuse of antibiotics in agriculture must also be limited. It is imperative that countries adopt the One Health approach, which recognizes that the health of people, animals, plants and the environment are interdependent.

The old saying, “An ounce of prevention is worth a pound of cure” applies to AMR. Preventative measures, such as improving water, sanitation and hygiene, as well as putting in place strong international and national regulatory frameworks to enforce controls on the sale and distribution of antibiotics, will go a long way in reducing AMR.

What responsibilities do governments have to counter AMR?

AMR is a global problem; therefore, international cooperation among nations is essential. Developing multi-stakeholder national action plans is key. Countries must also work together on strategies, information sharing and surveillance of antimicrobial use and resistance. However, fixing the AMR crisis is not just dependent on governments alone. Pharmaceutical companies, the chemical industry, regulators, municipal governments, human and animal healthcare professionals and students, scientists and the public all have a role to play.

“AMR exploits the critical links between humans, animals and the environment,” said UNEP’s Álvarez. “This is why finding solutions for AMR requires that all stakeholders—from world leaders and healthcare professionals to pharmaceutical and food industry officials—work together to prevent its development and spread.”

What is UNEP doing about AMR?

There is growing evidence that the environment plays a key role in the development, transmission and spread of AMR. UNEP, as the leading global environmental authority, is working to provide science-based evidence that can inform strategies on AMR and ensure that the environmental dimensions are adequately reflected in the One Health response to AMR.

In February 2023, UNEP launched the report Bracing for Superbugs, which offers an overview of the scientific findings on AMR and solutions to prevent its spread.

Moreover, UNEP has joined forces with the Food and Agriculture Organization of the United Nations (FAO), the World Health Organization (WHO) and the World Organization for Animal Health (WOAH) to form the Quadripartite Alliance. By emphasizing the One Health approach, it aims to optimize the health of people, animals, plants and the wider environment. The partnership coordinates a global, multisectoral AMR response, promotes strong governance and leadership and supports countries in developing and implementing national action plans on AMR.

Source: UNEP

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