Jacqueline Alvarez, Chief of the Chemicals and Health Branch at the UN Environment Programme (UNEP), explores the importance of holistic, One Health efforts to mitigate the growing threat of antimicrobial resistance
It’s been almost a century since the discovery of penicillin, which kickstarted the production of drugs that fundamentally changed the world. Millenia after our species learnt to defend itself against large predators, it successfully beat microscopic bacteria, too. This revolutionary discovery helped physicians save countless lives and made our modern food systems possible.
As this class of drugs has become more accessible, excessive use and misuse of antimicrobials, as well as other microbial stressors such as pollution, have created the conditions needed for microorganisms to develop resistance to antimicrobials, turning antimicrobial resistance (AMR) into one of the most pressing global health and development challenges of our time.
As the challenge of AMR grows, a ‘wait and see’ approach by governments might very well end up in a new era in which physicians are helpless before deadly superbugs, which keep growing no matter the drug prescribed. A recent study by the Global Research on Antimicrobial Resistance (GRAM) Project attributes at least one million deaths each year since 1990 to drug-resistant infections. It projects more than 39 million lives will be claimed between now and 2050.
Facing such a grim trajectory ahead, more and more countries are determined to break down the resistance to antimicrobials. Last year, the UN General Assembly held a High-Level Meeting on AMR. The ensuing Political Declaration, comprising 44 commitments, underscores the imperative for global action, combining sector-specific and multisectoral interventions.
While a dose of antibiotics is prescribed by a single physician, taking on widespread resistance to antimicrobials requires collaboration. A One Health approach has been developed to meet this challenge, linking the health of humans, domestic and wild animals, plants, and their wider environment to create a cohesive and sustainable response.
At the global level, this role is taken by the AMR Quadripartite partners: the Food and Agriculture Organization of the United Nations (FAO), the UN Environment Programme (UNEP), the World Health Organization (WHO), and the World Organisation for Animal Health (WOAH).
Though frequently overlooked, the environment plays a pivotal role in AMR. In 2023, UNEP released a report detailing the environmental aspects of AMR development, transmission and spread, offering a comprehensive overview of scientific findings on the subject.
Biological and chemical pollution sources contribute to AMR
The release of antimicrobials and antimicrobial-resistant microorganisms into the environment and other microbial stressors – such as pollution – allow microorganisms to develop resistance both in humans and the environment from different sources. A key concern is the waste and wastewater generated by economic sectors, including the pharmaceutical industry, healthcare facilities, and agriculture, as well as by municipalities and individual households. Tackling pollution is therefore essential to prevent and reduce the release of antimicrobials, resistance microorganisms and antimicrobial resistance genes from various sources.
At the global level, the environmental aspects of AMR include promoting healthcare waste management standards and ensuring universal access to safe water, sanitation, and hygiene in healthcare settings. It involves a broad range of actions: strengthening multi-sectoral engagement in AMR National Action Plans, preventing and reducing the release of antimicrobials and AMR pathogens across key sectors, enhancing surveillance systems, and promoting research and raising awareness.
At the national level, UNEP supports countries to strengthen environmental AMR interventions in their national action plans, improve monitoring systems, and develop and implement policies to prevent and reduce the discharge of antimicrobials and AMR pathogens from the economic sectors mentioned above.
Interventions to address the AMR challenge must prioritize low and middle-income countries, where its impact is felt disproportionately. This includes strengthening global and regional coordination for integrating environmental considerations into the One Health approach through enhanced governance structures and policy processes, supporting environmental AMR surveillance, and raising awareness about its environmental dimensions and best practices.
AMR poses a significant global challenge with far-reaching implications for public health, food security, economic stability, and sustainable development. It is part of the triple planetary crisis of climate change, nature and biodiversity loss, pollution and waste that no nation can take on single-handedly.
Addressing AMR through environmental action is urgent – that is clear. Integrated and holistic pathways to curb it and promote sustainable practices can safeguard public health and livestock productivity. Above all, this work can ensure that future generations continue to benefit from the revolutionary discovery of antimicrobials.
