Antimicrobial drugs, such as antibiotics, have saved the lives of millions of people around the world. However, the very drugs that have contributed so much to human health and prosperity are at risk of becoming a global public health threat due to burgeoning antimicrobial resistance.
Antimicrobial resistance occurs when, over time, bacteria, viruses, fungi and parasites adapt and become resistant to the drugs that are used to combat them. As a result, antibiotics and other antimicrobial medicines become ineffective, and infections become increasingly difficult - if not impossible to treat.
Even more alarming is the rapid spread of multi- and pan-resistant bacteria, or superbugs, which cause infections that are not treatable with currently available antimicrobial medicines. At the same time that antimicrobial resistance is spreading, the development of new and innovative antimicrobials has not kept up.
“Antimicrobial resistance has no boundaries. It can happen to anyone, anywhere,” said Aitziber Echeverria, Programme Management Officer with the United Nations Environment Programme (UNEP).
Silent killer
According to a systematic analysis published this year, in 2019 alone, 1.3 million deaths were estimated to be directly attributable to antimicrobial resistance, the majority in sub-Saharan Africa and Asia.
The overuse and misuse of antimicrobials in humans and livestock is the primary cause of antimicrobial resistance. Human exposure to antimicrobial resistance can occur through regular consumption of food contaminated by antimicrobial resistance microorganisms.
Chemical and biological pollution from intensive crop production, poor sanitation and inadequate sewage systems, pharmaceutical manufacturing, and hospitals is another significant source of antimicrobial resistance.
The climate crisis is also exacerbating antimicrobial resistance. Extreme events, such as floods and rising temperatures, help proliferate microbes in the environment, whilst biodiversity loss diminishes the richness of plant species that might one day give us the next great medicine.
Drug resistance in mycobacterium tuberculosis, malaria parasites, viruses, and HIV are all becoming a reality that could increase human suffering. Research shows that they could also deal a huge blow to the world economy due to productivity losses, increased healthcare costs and a rise in poverty since antimicrobial resistance disproportionately impacts low- and middle-income countries.
According to the World Bank, by the year 2050, the global Gross Domestic Product could decline up to four per cent, and the livestock sector - a major source of economic activity - could shrink up to 11 per cent, pushing 28 million people into extreme poverty globally. Ninety-three per cent of this could occur in developing countries if current antimicrobial resistance levels remain unchecked.
Despite the threat of antimicrobial resistance to human health and the global economy, it is often overlooked. This is one of the reasons why UNEP is working with the Food and Agriculture Organization of the UN (FAO), the World Health Organization (WHO) and the World Organization for Animal Health (WOAH) on the groundbreaking Quadripartite Collaboration for One Health, which aims to balance and optimize the health of people, animals, ecosystems and the wider environment.
World Anti-Microbial Resistance Awareness Week from 18 to 24 November is designed to raise awareness of these challenges.
One planet
“When you think about antimicrobial resistance, you have to think about all the complex interconnections between the environment, plants, animals and humans,” said Echeverria.
For Echeverria, the fact that antimicrobial resistance is so multifaceted and the environmental dimensions of it so complex makes finding solutions a challenging task. However, this interconnectedness can also be a huge benefit. “We all share one planet. By taking care, preventing, and appropriately managing one area, we can see the benefits in another one,” she said.
Antimicrobial resistance cannot be addressed separately from the triple planetary crisis of climate change, nature and biodiversity loss, and pollution and waste, all of which are driven by unsustainable consumption and production patterns.
The One Health approach addresses the connections between various sectors, human, animal, plant health, food production and the environment. For example, reducing unsustainable production, especially in livestock and agriculture, will help reduce deforestation and biodiversity loss, thus limiting the impact of climate change. Similarly, cutting down on environmental pollution will reduce the spread of antimicrobials.
The environment is the intersection where the main drivers of antimicrobial resistance meet. Experts say tackling it requires a concerted One Health response at global, regional and country levels. Country implementation is notably at the heart of a successful response to antimicrobial resistance, as it is in countries that the work of addressing the many challenges of antimicrobial resistance ultimately takes place.
This is why UNEP is also working with specific countries to tackle antimicrobial resistance. In India, for example, UNEP and the WHO are supporting the government in the preparation of the new National Action Plan on antimicrobial resistance by developing a state-of-the-art report on antimicrobial resistance and the environment and awareness-raising materials.
In 2021, UNEP became a co-signatory of the Antimicrobial Resistance Multi-Partner Trust Fund. The trust fund catalyzes action to support the implementation of antimicrobial resistance national action plans, including the strengthening of the environmental dimensions.
The next generation
Much like the climate crisis, the people who will be most impacted by antimicrobial resistance are young people who will have the most to lose if current antimicrobials cease to work.
For Hera Ali, an antimicrobials pharmacist in the United Kingdom, awareness and education are key. Ali is working on getting more young people, especially those in the healthcare field, to become antimicrobial stewards and take part in education campaigns, especially in disenfranchised communities, to help them understand the correct use and disposal of antimicrobials.
“So many people do not even know what antimicrobial resistance is and the damage caused by misusing antimicrobials, especially antibiotics,” she said.
About AMR Week
World Antimicrobial Awareness Week is a global campaign that is celebrated annually to improve awareness and understanding of AMR and encourage best practices among the public, One Health stakeholders and policymakers, who all play a critical role in reducing the further emergence and spread of AMR. The global theme for the 4th World AMR Week is “Preventing antimicrobial resistance together” - keeping with the objective of addressing AMR in a coordinated, multi-stakeholder, multidisciplinary and inclusive manner.
