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Urgent action needed to reduce the spread of superbugs

By Newcastle University
Close-up of superbugs through a microscope

To reverse the global spread of superbugs, the world must cut down environmental pollution and change how we behave, according to a new report by the UN. 

Curbing pollution of the environment with human, animal, pharmaceutical, agricultural and healthcare wastes is essential to reduce the emergence, transmission, and spread of superbugs.

The antimicrobial resistance problem

Antimicrobials – including antibiotics, antivirals, antifungals and antiparasitics – are medicines used to prevent and treat infections in humans, animals and plants.

Antimicrobial resistance (AMR) happens when disease-causing microbes, including bacterial and fungal pathogens, develop the ability to defend themselves against the drugs designed to kill them. This means the pathogens survive treatment and continue to grow. Resistant infections can be difficult, and sometimes impossible, to treat.

AMR occurs naturally over time, usually through genetic changes. Antimicrobial resistant microbes are found in people, animals, food, plants and the environment (in water, soil and air). They can spread from person to person, between people and animals, and to and from humans and animals and the environment. The main drivers of antimicrobial resistance include the misuse and overuse of antimicrobials; lack of access to clean water, sanitation and hygiene (WASH) for both humans and animals; inadequate infection and disease prevention and control in health-care facilities and farms; poor access to quality, affordable medicines, vaccines and diagnostics; lack of awareness and knowledge; and lack of enforcement of legislation.

A combination of AMR and the emergence of new superbugs is a growing global health crisis, potentially as significant to human survival as our changing climate.

The flagship report

Co-authored by Newcastle University’s Professor David W Graham, the flagship report Bracing for Superbugs: strengthening environmental action in the One Health response to antimicrobial resistance was launched at the Sixth Meeting of the Global Leaders Group on Antimicrobial Resistance AMR, held in Barbados on Feb 7 and 8.

“The new UN report on superbugs, antimicrobial resistance (AMR), and the environment is a game-changer because it provides strong evidence that our only way to prevent and reduce increasing AMR is through more holistic solutions, which cross all sectors.”

Professor David W Graham

The report shows that AMR, which can make non-resistant microbes into superbugs, is closely linked to the triple planetary crisis of climate change, biodiversity and nature loss, and pollution and waste. All of these issues are driven by human activity, unsustainable consumption and production patterns.

The report also states that we must change our behaviour and increase investment in cross-sectoral solutions in order to tackle the increasing AMR problem.

The impact of AMR

Listed by the WHO as among the top 10 global threats to health, it is estimated that 1.27 million additional deaths in 2019 were directly attributed to drug-resistant infections. Furthermore, 4.95 million total deaths worldwide were linked to the consequences of bacterial AMR (including those directly attributable to AMR).

The development and spread of AMR mean that antimicrobials used to prevent and treat infections in humans, animals and plants might turn ineffective, with modern medicine no longer able to treat even mild infections.

An earlier report found that:

  • Up to 10 million deaths could occur annually by 2050 due to AMR, on par with the 2020 rate of global deaths from cancer.
  • Pollution in key sectors of the economy contributes to the development, transmission and spread AMR.
  • AMR’s economic toll could result in a GDP drop of at least USD 3.4 trillion annually by 2030, pushing 24 million more people into extreme poverty.

Prof David Graham from Newcastle’s School of Engineering, who was recently appointed to the UN Quadripartite Technical Group On Antimicrobial Resistance and Use Integrated Surveillance (QTG-AIS), said: “The new UN report on superbugs, AMR, and the environment is a game-changer because it provides strong evidence that our only way to prevent and reduce increasing AMR is through more holistic solutions, which cross all sectors.

“The ethos is called One Health, which functionally states that human, animal and environmental health are intrinsically interlinked, and without reducing AMR in all sectors at once, AMR will continue to rise.

“The report’s importance is that it shows that environmental pathways are central to AMR transmission and spread, even to and from the human and animal health sectors. AMR prevention must include preventative action that crosses sectors, i.e., cross-sectoral integrated solutions, and increased global surveillance.”

Reducing the spread of superbugs

Increasing AMR and the spread of superbugs is a global health and development threat.

In addition to death and disability, prolonged illness results in longer hospital stays, the need for more expensive medicines and financial challenges for those impacted.

The report addresses these challenges with the following key recommendations:

  • create robust and coherent national level governance, planning, regulatory and legal frameworks, and 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
  • increase integration of environmental considerations into AMR National Action Plans, and AMR into environmental-related plans
  • establish international standards for what provide better microbiological and chemical indicators of AMR from environmental samples
  • explore options to redirect investments, to establish new and innovative financial incentives and schemes, and to make the investment case to guarantee the sustainable funding AMR prevention along value chains
  • environmental monitoring and surveillance and further research prioritization to provide more data and evidence and better target interventions, which is among the central mandates of QTG-AIS in which Graham is centrally involved.

UN Quadripartite is taking the lead

Since 1972, the United Nations Environment Programme (UNEP) has been the global authority that sets the environmental agenda, promotes the coherent implementation of the environmental dimension of sustainable development, and serves as an authoritative advocate for the global environment.

Surprising, until February 2022, UNEP was not formally involved in UN human, animal and agricultural health actions. However, based on evidence in the Bracing for Superbugs report, Tripartite, which previously only included the World Health Organisation, the Food and Agricultural Organisation, and the World Organisation for Animal, became Quadripartite by formally adding UNEP – a massive recognition of the importance of environment protection to global health.  

Regarding AMR and Quadripartite, the UNEP’s Executive Director Inger Andersen said: “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.”

Professor David W Graham

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Tags: Research, Research Excellence, Ageing and Health, Sustainable Development, Global