While the COVID-19 pandemic continues to wreak havoc on our daily lives, a silent pandemic has been brewing in the background for decades. Governments need to factor in new research and bring in businesses and consumers as active stakeholders before it is too late.
Antimicrobial resistance (AMR) is growing at an alarming rate. Globally, about 35% of common human infections have become resistant to available medicines. About 700,000 people die every year because available antimicrobial drugs — antibiotics, antivirals, antiparasitic and antifungals — have become less effective at combating pathogens. Resistance to second- and third-line antibiotics — the last lines of defence against some common diseases — are projected to almost double between 2005 and 2030. In India, the largest consumer of antibiotics in the world, this is a serious problem. According to a study published in The Lancet , an estimated 58,000 new-born children die annually from sepsis in India alone because antibiotics can no longer treat certain bacterial infections.
We have long known that microorganisms develop resistance to antimicrobial agents as a natural defence mechanism. We have also known for some time that human activity has significantly accelerated the process. The misuse and overuse of antimicrobials for humans, livestock and agriculture is probably the biggest reason for this, but other factors also contribute.
Research points to the role of environment and pollution in AMR. Once consumed, up to 80% of antibiotic drugs are excreted un-metabolised, along with resistant bacteria. Their release in effluents from households and health and pharmaceutical facilities, and agricultural run-off, is propagating resistant microorganisms. Wastewater treatment facilities are unable to remove all antibiotics and resistant bacteria.
In India, there is capacity to treat only about 37% of the sewage generated annually. The rest is discharged into natural water bodies without treatment. An analysis of single wastewater discharge from a treatment facility in India catering to drug manufacturers found concentrations of antibiotics high enough to treat over 40,000 people daily.
Water, then, may be a major mode for the spread of AMR, especially in places with inadequate water supply, sanitation and hygiene. Wildlife that comes into contact with discharge containing antimicrobials can also become colonised with drug-resistant organisms.
This issue has been on the radar of scientists for several years. The United Nations Environment Programme (UNEP) identified antimicrobial resistance as one of six emerging issues of environmental concern in its 2017 Frontiers Report. In that same year, the UN Environment Assembly pressed the need to further understand the role of environmental pollution in spreading AMR. UN agencies are working together to develop the One Health AMR Global Action Plan (GAP) that addresses the issue in human, animal, and plant health and food and environment sectors.
Comment | Weaker germs, stronger cures
The Centre and State governments in India can strengthen the environmental dimensions of their plans to tackle antimicrobial resistance. It is particularly important to promote measures that address known hotspots such as hospitals and manufacturing and waste treatment facilities.
This has started to an extent. Early in 2020, the Ministry of Environment, Forest and Climate Change (MoEF&CC) issued draft standards which set limits for residues of 121 antibiotics in treated effluents from drug production units. These standards await finalisation. And in July this year, the Ministry of Health and Family Welfare and MoEF&CC constituted the inter-ministerial Steering Committee on Environment and Health, with representation from WHO and UNEP.
We saw how quickly a pandemic can spread if we are not ready. This is an opportunity to get ahead of the next one.
Atul Bagai is Head, UN Environment Programme, Country Office, India