By Smith Nwokocha

Antimicrobials have been essential in reducing the burden of infectious disease in humans, animals and plants for decades. However, their effectiveness is now in jeopardy because several antibiotic, antiviral, antiparasitic and antifungal treatments no longer work because of antimicrobial resistance or AMR.

The World Health Organization considers AMR in humans and animals to be one of the top ten threats to global health. Estimates suggest that by 2050 up to 10 million deaths could occur annually affecting economies and shifting more people into poverty. If not dealt with, AMR could also significantly affect agricultural production, again affecting economies and food security, and low-income and lower middle-income countries will bear most of the burden.

Global attention to AMR has mainly focused on human health and agriculture sectors, but there is growing evidence that the environment plays a key role in the development, transmission and spread of AMR. The environmental dimensions of AMR are complex and characterized by dynamic interactions, cyclic interrelationships, complexities,

and multiple casualties and dynamics in multi-dimensional media that impact global planetary health.

AMR can occur naturally or can be acquired. Increased use and misuse of antimicrobials and other microbial stressors, such as pollution, create favourable conditions for microorganisms to develop resistance both in humans and the environment from sources such as sewage. Bacteria in water, soil and air for example can acquire resistance following contact with resistant microorganisms.

The environmental dimensions of AMR include pollution from hospital and community wastewater, effluent from pharmaceutical production, run-off originating from plant and animal agriculture and other forms of waste and releases. These matrices

may contain not only resistant microorganisms, but also antimicrobials, various pharmaceuticals, microplastics, metals and other chemicals, which all increase the risk of AMR in the environment. Polluted waterways, particularly those that have been polluted for some time, are likely to harbour microorganisms that increase AMR development and distribution in the environment. With increasing pollution and lack of management of sources of pollution, combined with AMR in clinical and hospital settings and agriculture, risks are increasing.

The key economic-sectors contributing to the environmental dimensions of AMR can be broadly classified as: pharmaceutical and other chemical manufacturing and uses including a range of different chemicals, such as antibiotics, antivirals and fungicides as well as disinfectants; agriculture including animal production, aquaculture, food crops or those providing inputs such as feed, textiles, ornamental plants, biofuels and other agricultural commodities; healthcare delivery in hospitals, medical facilities, community healthcare facilities and in pharmacies where a broad range of chemicals and disinfectants may be used.

While the relationship between environmental pollution and AMR and the reservoir of resistance genes in the environment has been established, the significance and its contribution to AMR globally is still unclear. Even so, there is enough knowledge to implement measures to reduce the factors that influence AMR from an environmental perspective; this will also address the triple planetary crisis by addressing sources, sinks and waste.

Using the ‘One Health’ approach, which recognises that the health of people, animals, plants and the environment are closely linked and interdependent, can successfully address AMR. Some countries have already adopted this approach and have included environmental-related aspects into their National Action Plans on AMR. Agriculture, health and environmental agencies have in place many policy and regulatory frameworks and controls addressing some of the drivers and factors with an impact on environmental dimensions of AMR. Voluntary industry initiatives have established a common framework for managing discharge of antimicrobial compounds and apply it across manufacturing and supply chains among their members. International organizations and bodies are taking decisions and have initiatives such as the joint efforts of the Quadripartite Alliance (FAO, UNEP, WHO and WOAH) for strong and coordinated action.

Yet still more needs to be done.

This report calls for priority action to address key pollution sources from poor sanitation, sewage; community and municipal wastes; healthcare delivery; pharmaceutical manufacturing; intensive crop, and terrestrial and aquatic animal production sectors. There are many co-benefits of preventing and managing pollution in these sources to address biological wastes that contain resistant microorganisms that spread AMR, and chemical wastes that select for AMR. To prevent and reduce such pollutants it is crucial to:

 create robust and coherent national level governance, planning, regulatory and legal frameworks, as well as establish coordination and collaboration

mechanisms

 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

 increase integration of environmental considerations into National Action Plans on AMR, and AMR into environmental-related plans such as national chemical

pollution and waste management programmes, national biodiversity and

climate change planning

 establish international standards for what are good microbiological indicators of AMR from environmental samples, which can be used to guide risk reduction

decisions and create effective incentives to follow such guidance

 explore options to redirect investments, to establish new and innovative financial incentives and schemes, and to make the investment case to

guarantee sustainable funding, including the allocation of sufficient domestic resources for tackling AMR.

Prevention is at the core of the action and environment is a key part of the solution. Implementing comprehensive and coordinated strengthening of environmental action in the ‘One Health’ response to AMR will not only help reduce the risk and burden of AMR on societies but will also help address the triple planetary crisis.

A call to action:

Limiting the emergence and spread of resistant pathogens is critical to preserving the world’s ability to treat diseases in humans, animals and plants, reduce food safety and security risks, protect the environment and maintain progress towards the SDGs (WHO

et al. 2021). The global response to AMR rests on collaboration between sectors that have traditionally fallen within separate policy spheres.  

The environment has received limited attention in tackling AMR, but evidence shows that the environment plays a key role in the development, transmission and spread of AMR. Now, while its

contribution and significance are determined, further and more coordinated action, with a focus on prevention, needs to be taken to limit the role of the environment in mediating, driving and causing AMR.

This report has shown that the environmental dimensions of AMR are multifaceted, requiring action at local, national, regional and global levels and with a broad array of stakeholders. Country implementation is particularly at the heart of a successful response to AMR, as it is in countries that the work of addressing the many challenges of AMR ultimately takes place. What is needed is a robust legal and regulatory framework that prevents the risk of AMR addressing the drivers and factors with an impact on environmental dimensions of AMR. This includes regulating the use of antimicrobials on farms, including aquaculture; limiting the discharge of effluent from pharmaceutical and other chemical industries,

and hospital waste; improving integrated water management; promoting water, sanitation and hygiene; and waste management.

While countries might have different processes for developing and managing an effective national governance mechanism for AMR, the need for a robust multisectoral coordination system has been highlighted across multiple fora as key for tackling AMR in a sustainable manner. Thus, countries need to integrate such 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.

Another priority area for urgent action remains to ensure continued political engagement and support in countries, including national budget allocations and scaling up technical capacity across all sectors to accelerate the implementation of the NAP on AMR. Countries need to explore innovative financial incentives and schemes, and to make the investment case to guarantee sustainable funding.

Environmental monitoring and surveillance and further research prioritization are also pivotal to provide more data and evidence and better

understand the complex dynamics of AMR. This will lead to improved science-policy interfaces to ensure informed decision-making and prioritise interventions.

Therefore, strengthening national, regional and global surveillance systems through improved data management, private sector engagement,

implementation of data-driven practices and reporting is critical.

Further engagement and commitment are needed from industry actors from the three economic sectors and their value chains that are key drivers of AMR development and spread in the environment

i.e. pharmaceuticals and other chemicals, agriculture and food, and healthcare. This commitment should include further steps to ensure more transparency and corporate responsibility regarding their contribution to the risk of AMR.

Globally, there is a need to establish international standards for what are good microbiological indicators of AMR from environmental samples, which can be used to guide risk reduction decisions and create effective incentives to follow such guidance.

National and global AMR-related planning and action, and the critical role and contribution of environmental authorities, experts and practitioners need to be strengthened. Strategies and plans need to utilise the ‘One Health’ approach while addressing financial/business, climate and cultural contexts.

Regulatory, economic and in some instances cultural barriers will need to be overcome. Gender equality and rights-based approaches need to be adopted

in order to make progress towards environmental sustainability. These issues need to be addressed and given prominence in deliberations on the topic.

The Quadripartite organizations need to continue leveraging their respective organizations’ resources and strengths to jointly support countries in scaling up national responses to AMR through a ‘One Health’ approach.

Solutions exist, and many of them have been captured in this report. They range from specific management actions to promoting sustainable production and consumption. A clear vision, ambitious targets and road maps supported by political prioritization of

a ‘One Health’ response to AMR and international enabling action are needed to leverage the momentum.

Summary

• The need for a robust multisectoral coordination system by all stakeholders, especially environment ministries and agencies, has been highlighted across multiple fora as key for tackling AMR in a sustainable manner.
• Strengthening national actions require boosting governance, planning and regulatory frameworks, through integrating AMR in national development planning and budgeting, and into environmental- related plans and processes. Likewise, incorporating environmental considerations

into NAPs on AMR and considering a systems approach for a possible national action framework.

• Priority actions required to improve reporting, surveillance and monitoring systems include developing and integrating environmental monitoring systems, strengthening systems for transparent and swift collection and reporting, monitoring and documenting releases of antimicrobials, resistant microorganisms and their genetic material to the environment, and strengthening surveillance for pandemic preparedness.
• Additional research and further work are needed such as clarifying the role of the environment as affected by human activity (e.g. pollution) on the evolution of AMR, understanding the relative importance of each pollution source, developing and enforcing standards to reduce antimicrobial discharges/emissions, and identifying cost-effective technological, social, economic and behavioural interventions.
• Prioritizing financing, including domestic resources, innovation and capacity development to support environmental action are crucial elements for strengthening the environmental action to tackle AMR.

Source/Full Report in the Link below: https://www.unep.org/resources/superbugs/environmental-action

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