The United Nations Environment Programme (UNEP) released a report in February 2023 that addresses the role of the environment in the development and distribution of the problem of AMR. The report advocates for a One Health approach to tackling this challenge, while encouraging greater emphasis on the environmental role in health threats.
The introduction by Inger Anderson of the UNEP identifies antimicrobials as “an essential part of modern life”. However, Anderson suggests that inappropriate use encourages the microbial world to adapt. AMR, she states, has become a “principal health problem”, resulting in around 5 million deaths in 2019, with up to 10 million each year predicted by 2050.
AMR is a “global” concern, but one that disproportionately affects LMICs through its links to “poverty, lack of sanitation, poor hygiene, and pollution”. A One Health approach, therefore, that demands an “all hands-on deck” response, will be crucial for future efforts to curb the AMR problem. Although Anderson recognises that “more research and development are pivotal” to the fight, we have “sufficient information” to act as an “issue of environmental, health, and economic concern”.
“We must do more.”
Anderson calls for “high-level political engagement, financial resources, and technical expertise, with a focus on country-level needs and demands”. As part of the Quadripartite Alliance, UNEP aims to promote environmental action in the response to AMR.
The problem of AMR
Although antimicrobials are “essential” in alleviating the burden of infectious diseases in humans, animals, and plants, their effectiveness is “now in jeopardy” due to AMR. AMR is considered one of the top ten global health threats by WHO, with significant consequences for human and animal health, the global economy, and human livelihoods predicted for the future.
“The environmental dimensions of AMR are complex and characterised by dynamic interactions, cyclic interrelationships, complexities and multiple causalities and dynamics in multi-dimensional media that impact global planetary health.”
However, “increased use and misuse of antimicrobials” are not solely to blame. Other “microbial stressors”, like pollution, create “favourable conditions for microorganisms to develop resistance” in humans and the environment. The environmental aspects of AMR include “pollution from hospital and community wastewater”, “effluent from pharmaceutical production”, and other forms of waste and releases.
“With increasing pollution and lack of management of sources of pollution, combined with AMR in clinical and hospital settings and agriculture, risks are increasing.”
A One Health approach “recognises that the health of people, animals, plants, and the environment are closely linked and interdependent”. The report states that this attitude can “successfully” be applied to AMR. Some countries are already using this approach, with environmental-related elements in their National Action Plans on AMR.
“Yet still more needs to be done.”
The report calls for priority action to “address key pollution sources”. The following suggestions are made in the report:
- 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 microbial 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.”
How do you think the ideas raised in the report can be implemented on a national and international scale? What challenges might we face, and how can the vaccine community contribute to these efforts?