Antimicrobial resistance (AMR) is one of the most urgent topics that needs to be addressed in the One Health field. At the end of anti-microbial awareness week 2022, I want to discuss how addressing this “wicked problem” requires a multi-pronged approach.
Antimicrobials, such as antibiotics, play a key role in improving the quality of life of billions of people around the world. From curing previously lethal infections such as typhoid fever, cholera, or tuberculosis, to opening the way for outstanding advancements in surgical procedures, for example, by significantly reducing the risk of infection in complex interventions, like hip replacements. However, their misuse and (especially) overuse are reducing their effectiveness by promoting the development of microbes immune, or resistant, to them.
In 2016, the so-called O’Neill report presented a roadmap on how to fight AMR. In the rest of this blog post, I will focus on the actions that each of us can take to contribute to this fight, especially regarding antibiotics. Linking this post to our series on Sustainable Development Goals and One Health, I will also be highlighting, throughout the text, the SDGs that are most relevant to this issue.
Learning about this problem and raising awareness about it is an important first step (SDG4 – Education). Most people use antibiotics at least once in their life and knowing how to properly use them (SDG12-Sustainable Consumption), and the causes and consequences of AMR is really important. This is even more important for all those people (SDG8 – Decent work) who are tasked daily with managing and prescribing antibiotics: doctors, nurses, pharmacists, veterinary doctors, researchers, managers (e.g., of antibiotics manufacturing plants, wastewater treatment plants, etc.), and farmers.
Farmers indeed! In wealthier countries, more antibiotics are used for livestock than for humans. While antibiotics can support the production of food (SDG2 – Zero hunger), many types of antibiotics are prescribed for both humans and animals. This, can further support the development of bacteria resistant to these antibiotics, potentially affecting human health in a negative way (SDG3-Good health).
Moreover, only a part of each dose of antimicrobials is absorbed by the animal, while the rest is released into the environment through the animal’s waste. This greatly increases the risk of developing superbugs among wildlife (SDG15-Life on land) which can affect the environmental balance by coming back to infect domestic animals and humans, thus reducing food production and affecting the livelihood of millions. While eating meat from animals raised with antibiotics is safe, promoting the purchase of meat from animals raised without or with little use of antibiotics will significantly support the AMR fight by encouraging producers to reduce their use inappropriately. Antibiotics are heavily used in fish farming as well, where they are often illegally dumped directly in the water, further boosting their distribution in the environment (SDG14-Life below water).
In this fight, reducing the consumption of antibiotics by humans is especially important as well. While nobody advocates for not treating sick people, there are two areas where we can do more and do better. On one hand, antibiotics should be used rigorously and exactly as prescribed (SDG12-Sustainable consumption). For example, patients should not demand their doctor to prescribe antibiotics when they have the flu or other viral infections. They also should be educated on fully completing the treatment and not stopping it as soon as they start to feel better, also, patients should dispose of expired medicines properly. On the other hand, if people get less sick, there will be less need for antibiotics. This is another reason why keeping vaccinations up to date is very important. While it is easier to accomplish in wealthier countries, in lower-income countries, significant help is needed to improve access to vaccines (SDG3-good health), clean drinking water, and proper sewage (SDG6-Clean water and sanitation) to reduce the spread of communicable diseases. Since bugs do not respect borders, this is something that concerns all of us, no matter where we live.
By: Dr. Luca Mantegazza | Research Program Coordinator