Antimicrobial Resistance: A Global Threat


Human Wrongs Watch

(UNEP)* — This year the United Nations Environment Programme is pleased to be joining the other Tripartite groups during the World Antimicrobial Awareness Week 2020

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The environment is key component to antimicrobial resistance and according to the World Health Organization, we may be entering a post-antibiotic era when simple and previously treatable, bacterial infections will no longer be possible.

What is an antimicrobial?

Any substance of natural, semisynthetic or synthetic origin that kills or inhibits the growth of microorganisms, such as bacteria, viruses, protozoa and fungi.

Antimicrobial substances are used in the form of:

What is antimicrobial resistance (AMR)?

The inherited or acquired ability of microorganisms that allows them to resist the action of the antimicrobial agent; then, the microorganisms evolve and multiply in their presence. Sometimes, microorganisms that develop resistance to more than one antimicrobial agent are referred to as “superbugs”.

Just as most antimicrobial agents are derived from the natural world, antimicrobial resistance can also occur naturally; bacteria and fungi are known to develop defence mechanisms to resist antimicrobial attack and survive, thus becoming antimicrobial resistant.

However, human activity is playing a key role in accelerating this process and creating a global threat. Alarming rates of antimicrobial resistance have been identified and rates continue to increase all over the world.

The key reasons contributing to AMR include misuse and overuse of antibiotics in human health, food-animal production and agriculture, along with poor management of waste emanating from households, farms, factories and human and veterinary healthcare settings.

Pharmaceuticals, including antibiotics, and their metabolites can enter the environment through a variety of pathways, including manufacturing sites, untreated wastewater from households and hospitals, wastewater treatment plants, and municipal waste streams, animal husbandry, sewage sludge and aquafarming (Kümmerer 2009; Monteiro 2010; Lapworth et al. 2012; Rastogi et al. 2015; Haiß et al. 2016; Lübbert et al. 2017; Kümmerer et al. 2018; Kümmerer et al. 2019). GCO II p.311

Pathways of antibiotics for human and veterinary use in the environment (adapted from Berkner, Konradi and Schonfeld 2014)

Antibiotics, antivirals, antiparasitic and antifungals agents are increasingly ineffective owing to resistance developed through their excessive or inappropriate use, with serious consequences for human and animal health, and possibly for plant health, and negative impacts on food, the environment and the global economy.

Worldwide, about 700,000 people die of resistant infections every year because available antimicrobial drugs have become less effective at killing resistant pathogens. The Independent O’Neill Review estimates this to rise to 10 million by 2050 – more deaths than cancer and diabetes today combined.

Tackling antimicrobial resistance is gaining momentum around the world as awareness to the problem increases. Antimicrobial resistance endangers achievement of the Sustainable Development Goals.

Decision makers in politics, business, and civil society are increasingly aware of the scale of the problem the world faces and must combine efforts to urgently combat this threat.

Joining forces – The Tripartite

Conscious that more needs to be done and more quickly to preserve health gains made in the last century and ensure a secure future, the Secretary-General of the United Nations convened in 2016 the Interagency Coordination Group (IACG) on Antimicrobial Resistance. The goal was to improve coordination between international organizations and to ensure effective global action against this complex threat.

The challenges of AMR development and spread must be urgently addressed using a coordinated multi-sectoral approach. The Food and Agriculture Organization (FAO), the World Organisation for Animal Health (OIE) and the World Health Organization (WHO) joint efforts are a coordinated One Health approach and constituted the Tripartite Collaboration on AMR.

Owing to its significant linkages with the health of humans, animals and environment, AMR has been recognized as a One Health issue Global Action Plan on Antimicrobial Resistance. The Tripartite signed a Memorandum of Understanding on One Health and AMR in 2018.

One Health Response to antimicrobial resistance

The ‘One Health’ term  refers to the interconnectedness of human, animal, plant and environmental health. Addressing AMR therefore must take a multisectoral, multi-disciplinary approach and ensure communication, collaboration, and coordination among all relevant ministries, agencies, stakeholders, sectors, and disciplines, for optimal action.

Adopting a ‘One Health’ approach, which unites medical, veterinary and environmental expertise, helps governments, businesses and civil society achieve enduring health for people, animals and environments alike. Preventing the next pandemic – Zoonotic diseases and how to break the chain of transmission, UNEP, 2020

WHO in collaboration with FAO and OIE, developed a Global Action Plan (GAP) on AMR. The Member States of each of the three organizations agreed to implement the GAP, and Member States were invited to develop National Action Plans for AMR by 2017.

FAO, WHO and OIE have been supporting countries to develop and implement multi-sector ‘One Health’ National Action Plans, aligned with the objectives of the Global Action Plan, that address AMR in all relevant sectors in human, animal, and plant health, food and the environment.

AMR and the environment

AMR represents a major global threat across human, animal, plant, and environmental sectors. The environmental dimension of antimicrobial resistance has received comparatively less focus than AMR in human or animal health.

However, the natural environment is an important reservoir of AMR. Drug-resistant microbes are in people, animals, food, and the environment (in water, soil and air). Water, and potentially soil, may be major modes for AMR development and spread – especially in places with inadequate water supply, sanitation and hygiene Technical briefing, Tripartite, 2020. “Superbugs” can spread between people and animals, including from food of animal origin, and from person to person.

Strong evidence indicates that releases of antimicrobial compounds to the environment, combined with direct contact between natural bacterial communities and discharged resistant bacteria, are driving bacterial evolution and the emergence of more resistant strains.

The impacts to the environment from antimicrobial use are complex. Drinking and recreational water can contain both resistant organisms, as well as antimicrobial drug residues.

Wildlife that come into contact with discharge from wastewater treatment plants, or livestock farms where antimicrobials are use, can also be colonized with drug resistant organisms, even without ever being given drug treatment.

Resistant bacteria and antibiotic residue

UNEA

The United Nations Environment Assembly (UNEA) also recognized that antimicrobial resistance is an increasing threat to global health, food security and sustainable development, and underlined the need to further understand the role of environmental pollution in the development of antimicrobial resistance (UNEP 2018).

World Antimicrobial Awareness Week message from Inger Andersen:

Our current work

UNEP, like other relevant stakeholders, is working to provide evidence that can inform national and global strategies on AMR. The environmental dimension of AMR was identified as an issue of emerging concern in a 2017 report by UNEP.

UNEA asked UNEP to present a report, developed in cooperation with relevant partners, on the environmental impacts of antimicrobial resistance and the causes for the development and spread of resistance in the environment, including the gaps in understanding of those impacts and causes.

UNEP is increasing its coordinated activities with the Tripartite organizations in different areas promoting and strengthening the capacity of countries to implement the environmental dimensions of the ‘One Health’ approach (linking human, animal and ecosystem health), and enhancing and broadening the multi-stakeholder involvement in AMR collective work.

This essential partnering also fulfils an important request from UNEA. This year the United Nations Environment Programme is pleased to be joining the other Tripartite groups during the World Antimicrobial Awareness Week 2020.

Closely linked to it, UNEP is carrying out activities on environmentally persistent pharmaceutical pollutants, considered an emerging policy issue in the Strategic Approach to International Chemicals Management (SAICM) context.

In addition, UNEP in cooperation with other relevant partners is also developing a report on pesticides and fertilisers to be presented at UNEA-5. This report addresses the environmental and health impacts of pesticides and fertilizers and ways of minimizing them, a section dedicated to AMR is included.

Besides the Tripartite organisations and UNEP, other stakeholders – governments, civil society organizations, private sector and intergovernmental organizations – are actively working on AMR and environment issues such as Wellcome Trust, AMR Industry Alliance and many others.

*SOURCE: UNEP. Go to ORIGINAL.

Chemicals & Waste

2020 Human Wrongs Watch

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