Curtailing pollution created by pharmaceuticals, agricultural and healthcare sectors is essential to reduce the emergence, transmission, and spread of superbugs – strains of bacteria that have become resistant to every known antibiotic – and other instances of antimicrobial resistance, known as AMR.
- Up to 10 million deaths could occur annually by 2050 due to antimicrobial resistance (AMR), on par with the 2020 rate of global deaths from cancer
- Pollution in key sectors of the economy contributes to the development, transmission and spread AMR.
- AMR’s economic toll could result in a GDP drop of at least $3.4 trillion annually by 2030, pushing 24 million more people into extreme poverty.
The importance of controlling pollution in terms of health is the key message of a report released by the UN Environment Programme (UNEP) in February 2023, on the environmental dimensions of AMR, which already is taking a serious toll on the health of humans, animals, and plants, as well as the economy.
The report, Bracing for Superbugs: strengthening environmental action in the One Health response to antimicrobial resistance was launched at the Sixth Meeting of the Global Leaders Group on AMR, held in Barbados. It calls for a multisectoral One Health response. This is in line with the work of the Quadripartite Alliance, including UNEP, the Food and Agriculture Organization (FAO), the World Health Organization (WHO) and the World Organisation for Animal Health (WOAH).
Environmental challenges have direct impact on health and wealth
“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 Prime Minister Mia Mottley, Chair of the One Health Global Leaders Group on Antimicrobial Resistance.
“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.”
The development and spread of AMR mean that antimicrobials used to prevent and treat infections in humans, animals and plants might become ineffective, with modern medicine no longer able to treat even mild infections.
What are the long term implications for antimicrobial resistance?
Listed by the WHO among the top 10 global threats to health, it is estimated that in 2019, 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).
AMR is expected to cause 10 million additional direct deaths annually by 2050. This equals the number of deaths caused globally by cancer in 2020. The economic toll of AMR is expected to result in a GDP drop of at least $3.4 trillion annually by 2030, pushing 24 million more people into extreme poverty.
The triple planetary crisis entails higher temperatures and extreme weather patterns, land-use changes that alter its microbial diversity, as well as biological and chemical pollution. All these contribute to the development and spread of AMR.
“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,” said Inger Andersen, Executive Director of UNEP. “Cutting down pollution is a prerequisite for another century of progress towards zero hunger and good health.”
The report highlights a comprehensive set of measures to address both the decline of the environment and the rise of AMR, especially addressing key pollution sources from poor sanitation, sewage, community and municipal wastes. These measures, if successfully implemented, will not only address vital needs but also provide an opportunity for innovative solutions.
Measures to effectively address AMR
One of the most important first steps will be the creation of robust and coherent national level governance, planning, regulatory and legal frameworks, and the establishment of coordination and collaboration mechanisms .
While the management of water is known to be critical to development, there is a growing need to 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.
Another factor is the importance of increasing the integration of environmental considerations into AMR National Action Plans, and AMR into environmental-related plans such as national chemical pollution and waste management programmes, national biodiversity and climate change planning. One of the biggest challenges in addressing any environmental challenge is the lack of holistic approaches to the problems faced.
International standards must be established for what constitutes a good microbiological indicator of AMR from environmental samples, which can be used to guide risk reduction decisions and create effective incentives to follow such guidance. Unless there is a standardised response, it will be impossible to measure and assess progress.
One of the core requirements will be the importance of redirecting investments, to establish new and innovative financial incentives and schemes. This is part of the wider investment picture, where it must become a priority to shift investment away from damaging activities – in large part still encouraged by social and economic systems that fail to address the impact of externalities. The investment case must be made effectively in order to guarantee sustainable funding, including the allocation of sufficient domestic resources to tackling AMR.
And, as with all the major changes in controlling damaging operational impacts, there needs to be a focus on effective and robust environmental monitoring and surveillance. That also means further research prioritisation to provide more data and evidence and better target interventions. This too will need to be funded.
Prevention is better than cure
The research around today already warns of the potential impact of allowing AMR to get out of hand. Prevention is at the core of the action needed to halt the emergence of AMR and environment is a key part of the solution. Comprehensive and coordinated strengthening of environmental action in the One Health response to AMR will reduce the risk and burden of AMR on humans and nature, as well as help address the triple planetary crisis.