published a report The United Nations said today that we are ignoring a major part of the superbug problem: the environment. It acts as a repository for bacterial genes that confer antimicrobial resistance, and it receives farm runoff and pharmaceutical wastewater, allowing new resistance to emerge.
“The drivers of environmental degradation are exacerbating the problem of antibiotic resistance,” Inger Anderson, executive director of the United Nations Environment Programme, said in a statement. “The impact of antimicrobial resistance has the potential to wreak havoc on our health and our food systems.”
The 120-page policy paper, “Preparing for superbugs,” recognizes that the environment is where antibiotic resistance emerges and flourishes, killing as many as 1.27 million people each year. Public health planners have recognized problems in hospitals and urgent care centers, as well as on farms that produce livestock, fish and crops. The report provides researchers with a framework for understanding pathogens that are not restricted to these economic sectors, such as drug-resistant bacteria emerging downstream of hospital wastewater treatment plants and agricultural fungicides that turn common nosocomial infections into incurable diseases. It said the government should develop regulations to curb antibiotic contamination, rely on food producers to reduce antibiotic use, improve sanitation systems to remove drug-resistant bacteria in sewage, and develop monitoring programs to verify that environmental protection is working.
In effect, it elevates UNEP’s leadership in the global fight to contain drug-resistant bacteria, placing it with other UN agencies – the World Health Organization, the OIE and the Food and Agriculture Organization – under the umbrella of One Health. Ways to link human, animal and environmental issues. This is important because countries are already developing plans to control antibiotic resistance through a United Nations process that began in 2016. Countries are now being urged to consider environmental protection when trying to reduce drug-resistant infections in humans.
It’s a long overdue move that redefines the superbug problem from one caused by misbehaving users to a shared responsibility for the endangered planetary microbiome.
“Environment is one thing that links different loci of selection for antimicrobial resistance in a meaningful way,” said Claas Kirchhelle, a historian of science and medicine and assistant professor at UCD. “In the long run, this should be the direction of antimicrobial stewardship, not just the next two to three years, but 20 to 30 years.”
Given that the earliest antibiotics were derived from the products of organisms found in nature, it seems remarkable that the role of the environment has been neglected until now. Yet two years ago, when Kirchhelle and researchers from six other countries reviewed 75 years of international antimicrobial resistance policy statements, they found that only two of the 248 countries had environments that warranted sustained attention. “It’s reasonable to think about it just from a human health perspective — after all, millions of people die from AMR,” he said, referring to antimicrobial resistance. “But for half a century, we’ve been talking about how to regulate AMR, and we’re still facing increasing antimicrobial use and rising antibiotic resistance. So it’s time to really think more broadly.”
