Antimicrobial resistance: a global threat

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Third Global High-level Ministerial Conference on AMR - Muscat, Sultanate of Oman, 24-25 Nov 2022

AMR in the Environment: Perspectives from Latin America and the Caribbean - Online, 16 Nov 2022

2nd Annual Global Media Forum in lead up to WAAW 2022- Online, 16 Nov 2022

Political Leadership and Action on Antimicrobial Resistance: The Road to the 2024 UNGA High-level Meeting on AMR - New York, United States of America, 22 Sep 2022

Antimicrobial Resistance in the Environment Webinar Series - Online Webinar 4: Governance approaches for prevention and control of AMR in the environment - Upcoming Webinar 3: Technical solutions for prevention and control of AMR in the environment - 27 Oct 2022 Watch the recording of Webinar 3 in English, French and Spanish Webinar 2: Sources, drivers and impacts on AMR in the environment - 12 Sep 2022 Watch the recording of Webinar 2 in English, French and Spanish Webinar 1: Understanding the basics of environmental AMR for national action - 20 Jun 2022 Watch the recording of Webinar 1 in English, French and Spanish

The Summary for Policymakers - Environmental Dimensions of Antimicrobial Resistance (AMR) launched on the sidelines of UNEA 5.2.

The report calls to strengthen environmental action within the ‘One Health’ response to AMR, looks at the pollutants that exacerbate AMR in the environment, where they come from, and provides an overview of the environmental action required.

The environment is a key component to antimicrobial resistance and according to the World Health Organization, we may be entering a post-antibiotic era when treating previously simple bacterial infections will no longer be possible. Antimicrobial resistant infections may become the leading cause of death globally by 2050. Review on Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations. Review on Antimicrobial Resistance, London

Any substance of natural, semisynthetic or synthetic origin that kills or inhibits the growth of microorganisms, such as bacteria, viruses, protozoa and fungi.

Antimicrobial substances are used in the form of:

The inherited or acquired ability of microorganisms that allows them to resist the action of the antimicrobial agent; then, the microorganisms evolve and multiply in their presence. Sometimes, microorganisms develop resistance to more than one antimicrobial agent, and are referred to as “superbugs”.

Just as most antimicrobial agents are derived from the natural world, antimicrobial resistance can also occur naturally; bacteria and fungi are known to develop defence mechanisms to resist antimicrobial attack and survive, thus becoming antimicrobial resistant. However, human activity is playing a key role in accelerating this process and creating a global threat. Alarming rates of antimicrobial resistance have been identified and rates continue to increase all over the world.

The key reasons contributing to antimicrobial resistance include misuse and overuse of antibiotics in human health, food-animal production and agriculture, along with poor management of waste emanating from households, farms, factories and human and veterinary healthcare settings.

Pharmaceuticals, including antibiotics, and their metabolites can enter the environment through a variety of pathways, including manufacturing sites, untreated wastewater from households and hospitals, wastewater treatment plants, and municipal waste streams, animal husbandry, sewage sludge and aquafarming (Kümmerer 2009; Monteiro 2010; Lapworth et al. 2012; Rastogi et al. 2015; Haiß et al. 2016; Lübbert et al. 2017; Kümmerer et al. 2018; Kümmerer et al. 2019). GCO II p.311. Improved monitoring and surveillance systems to identify where antimicrobial resistance is found in the environment will inform policy solutions.

Antibiotics, antivirals, antiparasitic and antifungals agents are increasingly ineffective owing to resistance developed through their excessive or inappropriate use. This has serious consequences for human and animal health, and possibly for plant health, and negative impacts on food, the environment and the global economy. Worldwide, about 700,000 people die of resistant infections every year because available antimicrobial drugs have become less effective at killing resistant pathogens. The Independent O’Neill Review estimates this to rise to 10 million by 2050 – more deaths than cancer and diabetes today combined.

Tackling antimicrobial resistance is gaining momentum around the world as awareness to the problem increases. Antimicrobial resistance endangers achievement of the Sustainable Development Goals. Decision makers in politics, business, and civil society are increasingly aware of the scale of the problem the world faces and must combine efforts to urgently combat this threat.

Conscious that more needs to be done and more quickly to preserve health gains made in the last century and ensure a secure future, the Secretary-General of the United Nations convened in 2016 the Interagency Coordination Group (IACG) on Antimicrobial Resistance. The goal was to improve coordination between international organizations and to ensure effective global action against this complex threat. In 2019, the IACG concluded its mandate by submitting its report, ‘No Time to Wait’. The report highlights that, although evidence remains limited, concerns are growing about the impact of antimicrobial resistance on the environment and natural ecosystems.

The challenges of antimicrobial resistance development and spread must be urgently addressed using a coordinated multi-sectoral approach. The Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE) and the World Health Organization (WHO) joint efforts are a coordinated One Health approach and constitute the Tripartite Collaboration on AMR.

Owing to its significant linkages with the health of humans, animals and environment, antimicrobial resistance has been recognized as a One Health issue Global Action Plan on Antimicrobial Resistance. The Tripartite signed a Memorandum of Understanding on One Health and AMR in 2018.

The 'One Health' term  refers to the interconnectedness of human, animal, plant and environmental health. Addressing AMR therefore must take a multisectoral, multi-disciplinary approach and ensure communication, collaboration, and coordination among all relevant ministries, agencies, stakeholders, sectors, and disciplines, for optimal action.

Adopting a 'One Health' approach, which unites medical, veterinary and environmental expertise, helps governments, businesses and civil society achieve enduring health for people, animals and environments alike. Preventing the next pandemic – Zoonotic diseases and how to break the chain of transmission, UNEP, 2020

WHO in collaboration with FAO and OIE, developed a Global Action Plan (GAP) on AMR. The Member States of each of the three organizations agreed to implement the GAP, and Member States were invited to develop National Action Plans for AMR by 2017.

FAO, WHO and OIE have been supporting countries to develop and implement multi-sector 'One Health' National Action Plans, aligned with the objectives of the Global Action Plan, that address AMR in all relevant sectors in human, animal, and plant health, food and the environment.

AMR represents a major global threat across human, animal, plant, and environmental sectors. The environmental dimension of antimicrobial resistance has received comparatively less focus than AMR in human or animal health. However, the natural environment is an important reservoir of antimicrobial resistance. Drug-resistant microbes are in people, animals, food, and the environment (in water, soil and air). Water, and potentially soil, may be prime localities for AMR development and spread – especially in places with inadequate water supply, sanitation and hygiene Technical briefing, Tripartite, May 2020. “Superbugs” can spread between people and animals, including from food of animal origin, and from person to person.

Strong evidence indicates that release of antimicrobial compounds to the environment, combined with direct contact between natural bacterial communities and discharged resistant bacteria, are driving bacterial evolution and the emergence of more resistant strains.

The impacts to the environment from antimicrobial use are complex. Drinking and recreational water can contain both resistant organisms, as well as antimicrobial drug residues. Wildlife that come into contact with discharge from wastewater treatment plants, or livestock farms where antimicrobials are used, can also be colonized with drug resistant organisms, even without ever being given drug treatment.

The United Nations Environment Assembly (UNEA) also recognized that antimicrobial resistance is an increasing threat to global health, food security and sustainable development, and underlined the need to further understand the role of environmental pollution in the development of antimicrobial resistance (UNEP 2018).

UNEP, like other relevant stakeholders, is working to provide evidence that can inform national and global strategies on AMR. The environmental dimension of AMR was identified as an issue of emerging concern in a 2017 report by UNEP.

UNEA asked UNEP to present a report, developed in cooperation with relevant partners, on the environmental impacts of antimicrobial resistance and the causes for the development and spread of resistance in the environment, including the gaps in understanding of those impacts and causes.

In January 2021, the Food and Agriculture Organization of the United Nations (FAO), The South Centre and the United Nations Environment Programme (UNEP)organised the webinar "Advancing the One Health response to Antimicrobial Resistance (AMR)".

UNEP is increasing its coordinated activities with the Tripartite organizations in different areas promoting and strengthening the capacity of countries to implement the environmental dimensions of the 'One Health' approach (linking human, animal and ecosystem health), and enhancing and broadening the multi-stakeholder involvement in AMR collective work. This essential partnering also fulfils an important request from UNEA. This last year the United Nations Environment Programme was pleased to join the other Tripartite groups during the World Antimicrobial Awareness Week 2021 and 2020.

Closely linked to it, UNEP is carrying out activities on environmentally persistent pharmaceutical pollutants, considered an emerging policy issue in the Strategic Approach to International Chemicals Management (SAICM) context. In addition, UNEP in cooperation with other relevant partners is also developing a report on pesticides and fertilisers to be presented at UNEA-5. This report addresses the environmental and health impacts of pesticides and fertilizers and ways of minimizing them, a section dedicated to AMR is included.

Besides the Tripartite organisations and UNEP, other stakeholders - governments, academic institutions, civil society organizations, private sector and intergovernmental organizations - are actively working on antimicrobial resistance and environment issues such as Wellcome Trust, AMR Industry Alliance and many others.