Environment and Antimicrobial Resistance: Bracing for Superbugs

Environmental pollution can create favourable conditions for microorganisms to develop resistance. Only by using a “One Health” approach—which recognises that the health of people, animals, plants and the environment are closely linked and interdependent—will we be able to find solutions to the problem of antimicrobial resistance.

It has been estimated that, by 2050, more than 10 million people could die each year from infections caused by resistant microorganisms—fully 2 million more than those who die from cancer.

Antimicrobials are the key discovery that has decreased the rate of infection-related death in recent decades. However, misuse and abuse of antimicrobials have brought about a situation in which many antibiotic, antiviral and antiparasitic treatments are ineffective because the organisms they target—bacteria, viruses and parasites—have developed resistance mechanisms against them.

To date, efforts to curb antimicrobial resistance have been directed at human health, animal health and agriculture. However, a growing body of evidence suggests that the environment plays a very important role in the development, transmission and spread of antimicrobial resistance.

Environmental Pollution, a Source of Resistance

Environmental pollution can create favourable conditions for microorganisms to develop resistance. Pollution sources range from hospital wastewater and urban sewage to factory effluents, agricultural runoff and other forms of waste. All of these forms of discharge contain not only resistant microorganisms but also other substances—such as traces of antibiotics, microplastics, metals and other chemical substances—that increase the risk of generating and spreading resistance in the environment.

A "One Health" Approach

Only by using a “One Health” approach—which recognises that the health of people, animals, plants and the environment are closely linked and interdependent—will we be able to find solutions to the problem of antimicrobial resistance. Multiple disciplines—medical, veterinary, research professionals, etc.—need to collaborate locally, nationally and internationally to attain optimal health for people, animals and our environment.

United Nations Report on Superbugs and the Environment

In February 2023, the United Nations Environment Programme published a report entitled Bracing for Superbugs: Strengthening environmental action in the One Health response to antimicrobial resistance.

This report reviews the available evidence on the environmental aspects of antimicrobial resistance. It was prepared with the involvement of agencies such as the Food and Agriculture Organisation of the United Nations (FAO), the United Nations Environment Programme (UNEP), the World Health Organisation (WHO) and the World Organisation for Animal Health (WOAH).

In addition to providing an overview of the transmission and spread of antibiotic resistance via the environment (soil, air, water) to animals and humans and describing how other agents can facilitate the development of antimicrobial resistance, the report also establishes a relationship between antimicrobial resistance and the triple planetary crisis of:

1. Climate change.High temperatures and concentrations of oxygen and carbon dioxide in the environment can also influence the survival and proliferation of bacteria and the rate at which they acquire resistance.
2. Biodiversity loss. The use of antimicrobials can lead to the loss of biodiversity, which used to protect us from the spread of antimicrobial resistance.
3. Pollution and waste. The discharge of pollutants into the environment can contribute to the development and spread of antimicrobial resistance.

In addition to the aforementioned factors, globalisation, the growth of the population and of cities in particular, and global flows of people, animals and food are causing the spread of antimicrobial resistance to increase.

Bracing for Superbugs

Preventing the development and spread of resistance in the environment will have a major impact on our health. To do this, it is necessary to:

• Ensure robust multisectoral coordination on the part of all stakeholders, including ministries and environmental agencies.
• Strengthen national actions by integrating antimicrobial resistance into country-level development planning and budgets, as well as environmental issues.
• Prioritise actions to improve reporting, surveillance and monitoring systems, including systems for monitoring the release of antimicrobials, resistant microorganisms and their genetic material into the environment and strengthening surveillance for pandemic preparedness.
• Carry out further research and work to clarify the role of the environment as affected by human activity (e.g. pollution) on the evolution of antimicrobial resistance.
• Prioritise financial resources to support environmental action.

Therefore, ALL of us—governments, environmental agencies, researchers, funding agencies, industry representatives, producers, farmers, and citizens—are essential to this process.

"Bracing for Superbugs: Strengthening environmental action in the One Health response to antimicrobial resistance" UNEP report