Antimicrobials are a superweapon, which protect human health and the health of the species upon which we depend. This widely used family of substances– antibiotics, antivirals, antifungals and antiparasitics – prevent and treat infections in humans, aquaculture, livestock and crops.
Antimicrobials have saved countless lives and protected vital economic sectors. They continue to do so. But their effectiveness is under threat. Scattergun and careless use of this superweapon is increasing the emergence of antimicrobial-resistant superbugs and increasing other instances of antimicrobial resistance, or AMR, at critical levels.
As this report tells us, a key pathway for AMR is through pollution of the environment by the pharmaceutical, agriculture and healthcare sectors, and municipal systems. This leakage increases the ability of organisms that can harm us to build up resistance to drugs. The wider triple planetary crisis of climate change, nature and biodiversity loss, and pollution and waste contributes further to the development and spread of AMR – through higher temperatures and extreme weather events, land-use changes, and biological and chemical pollution.
Millions of people already die each year from AMR worldwide. If we continue to pour antimicrobials into the environment – through runoff from farms, effluents from manufacturing pharmaceuticals, disposal of hospital waste and municipal wastewater – we can expect at least 10 million deaths each year by 2050. And, in a world profoundly skewed in favour of wealthy nations and communities, AMR will hit the most vulnerable the hardest.
Poverty, lack of sanitation and poor hygiene make AMR worse. Antimicrobial pesticides have a devastating impact on women because women farm the world.
In some countries 85 per cent of all pesticide applications on commercial farms and plantations are done by women – often working while pregnant or breastfeeding.
AMR is not just a health issue. AMR is not just an environment issue. AMR is an equity issue. 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 bottom line is that getting serious about AMR means preventing environmental pollution. Limiting the discharge of antimicrobial-laced waste to the environment is important for everyone – because every sector is guilty of adding to the AMR burden. I won’t get into every specific recommendation of the report, as there are many, but let’s cover a few.
The pharmaceutical sector must upgrade manufacturing processes, overseen by strong regulatory and inspection systems. The agriculture sector must look hard at pesticide use and avoid using antibiotics that correspond to those used as last resort in human medicine. In the healthcare sector, strong infection prevention control programmes to reduce antimicrobial use and wastewater treatment to prevent biological pollution can limit environmental contamination. Municipal systems must improve their treatment of wastewater, which is currently too often discharged directly into the environment. All of this will take resources, and this is why financing, is critical for the Global South.
Action in the sectors most responsible must be backed with national action plans. With international standards, realignment of subsidies and investments, and more research and surveillance. And all of this must be done through the ‘One Health’ approach – which recognizes that the health of people, animals, plants and the environment are interdependent. There is simply no way we can deal with AMR unless we take a joined-up approach to all aspects of the problem.
Significant momentum on AMR has developed, including through the Global Leaders Group and the Quadripartite Alliance. We must use this momentum to bring change. Investment in new and affordable antimicrobials and other preventative measures should grow, but we must stop the pollution at source to ensure this superweapon retains its power.
