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Anti-Microbial Resistance: A Systemic Problem with Systemic Solutions

Following up on the last blog post about the OHSA event on Anti-Microbial Resistance, I would like to spend some words discussing how AMR is a systemic problem that requires systemic solutions using the Sustainable Development Goals as reference points. 

At first sight, AMR might look as a problem affecting only SDG3 – Health: doctors use antibiotics to cure infections, after some exposure, bacteria become “super-bacteria” resistant to antibiotics, doctors struggle to cure infections. While it is true that hospitals are large contributors to the development of AMR, if there were less infections, there would be less need for antibiotics. Good hygiene is the main defense against infections and it depends on access to clean water and availability of proper sewage, goals of SDG6. Moreover, individual behavior plays a significant role as well (i.e. demanding antibiotics every time we feel sick no matter the issue) and therefore SDG 12 – Responsible Consumption comes into play as well 

For these reasons, widespread reduction in antibiotics use might seem a good solution. However, this might exacerbate inequalities both across countries (while some countries overuse antibiotics others have barely any available) and within countries (for example, different socio-economic situations could prevent people from being able to spend a week in bed waiting for the illness to pass naturally) affecting SDG10 – Inequalities. Moreover, longer recovery periods, especially for kids and elders, would increase the burden on the primary caretakers, often female relatives, affecting SDG5 – Gender Equality. 

If limiting the use of anti-biotics is neither easy nor fair, another solution could be the invention of better antibiotics and treatments procedures. This is the realm of SDG9 – Industry, Innovation, and Infrastructure. However, innovation requires energy that needs to be clean (or we would solve one problem while worsening another) and affordable as described in SDG7. Affordability leads us back to SDG10: poorer countries lacking access to reliable and affordable energy would not be able to adopt these innovations increasing the lag among countries and preventing the solution of the problem (the pandemic demonstrated that bugs can easily fly across the world nowadays). 

Since limiting the use of antibiotics in human healthcare seems particularly difficult, we could aim to reduce their use in veterinary settings. On the plus side, reducing the use of antibiotics both in livestock and fish farms would help not only reduce AMR in human and farm animals but also spillovers in the wildlife that could affect biodiversity and sustainability both on land (SDG15) and below water (SDG14). On the downside, animals are the main source of proteins for many people in the world: reducing the use of antibiotics in veterinary settings, unfortunately, could lead to severe shortages in food and income, negatively impacting SDG1 – No Poverty and SDG2 – No Hunger.  

While all of this could be discouraging, it is important to remember how systemic problems require systemic solutions and that the right intervention, no matter the size, if targeted to the right node of the system will propagate through the system gaining power and width generating positive effects much larger than expected. This is a good reason to start from our daily actions, we cannot know for sure how large their impact will be! 

I invite all of you to be mindful when dealing with antibiotics. For example, do not demand antibiotics if your doctor does not prescribe them, complete the cycle if your doctor prescribes them, dispose of antibiotics properly (not in the toilet!) if you have extra or they expired, and wash your hands often to reduce the risk of infection and therefore of antibiotics. At this link (https://apps.who.int/world-antibiotic-awareness-week/activities/en/experience?s=1) you can find a very good educational tool developed by the WHO, OIE, and FAO to learn more about the proper use of antibiotics.  

By Dr. Luca Mantegazza, Research Program Coordinator

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