Protecting our Environment to Resist Antimicrobial Resistance

Antimicrobial Resistance (AMR) poses a threat to humanity equal to that of climate change. Both are global challenges. Both affect the sustainability agenda. Both are accelerated by human activity. Both operate across our planetary boundaries.

So why aren’t we arming ourselves with one of the most effective weapons at our disposal in dealing with it?

LIDC Interdisciplinary Research Fellow, Lorna Benton, explains how the environment itself is one of our most effective weapons in the battle AMR – but only if we use it wisely.

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In 2014, the UK government ordered a review into AMR which concluded that without intervention, AMR could lead to 10 million deaths per year by 2050. Recently, the Lancet published the first comprehensive assessment of the global burden of deaths associated with bacterial AMR, estimated at 4.95 million deaths in 2019. In 2020, targets to reduce AMR in the 2030 Sustainable Development Goals were added under SDG3 “Good Health and Well-being.” AMR was formally acknowledged as a development issue in the 2021 United Nations Sustainable Development Cooperation Framework which recommended opportunities for environmental policy co-benefits be explored as part of revisions of National Action Plans to address AMR. It is now widely recognised that AMR impedes progress to sustainable agriculture and agri-food systems (SDG 2). Environmental contamination of soil, groundwater and river ecosystems can occur when waste and wastewater are incorrectly managed or treated (SDGs 6 and 12), affecting the livelihoods and health of the most vulnerable who are more likely to live in or near contaminated environments.

Global governance: Leadership across Human, Animal and Ecosystem Health Systems

The COVID19 pandemic has driven home the importance of an inter-connected, multi-sectoral One Health framework. Earlier this year, the United Nations Environment Programme joined the FAO, OiE and the WHO in an AMR partnership (commonly known as the Quadripartite) to formalise recognition of governmental, societal and private sector stakeholders in the environmental sector.

The environment is a critical pathway for AMR pollution and transmission

Two of the leading sources of antimicrobial pollution are agricultural run-off from livestock and sewage. 75-90% of antibiotics are excreted from animals un-metabolized and enter sewage systems and water sources. Compounding this issue, poor regulation of chemical pollutants, ensures the presence and transmission of antibiotics and antimicrobial resistance genes through the wider environment.

Wastewater treatment plants (WWTPs) are reservoirs for antimicrobial pollution, due to a particularly harmful combination of un-metabolized antibiotics, various bacteria, mobile genetic elements and other metal compounds. WWTPs are often not designed such that pharmaceutical compounds and antibiotic resistance genes are effectively removed.

A global river study published this year detected antibiotics in 65% of sampled sites and found that a quarter of sites exceeded ‘safe’ levels of antibiotic pollution; most notably when situated close to WWTPs, waste or sewage dumps. In farming, river water may often be used for irrigation, whilst biosolids from WWTP processing are sometimes used as fertiliser, risking further contamination of soil and plant-based foods.

And so, the cycle continues.

What is being done to reduce AMR in our waterways?

Evidence shows that some of the most effective ways to remove antimicrobial pollution in WWTPs involve either biological methods (Biological Aerated Filter, Anaerobic Digestion & Biological Activated Carbon Filter) or membrane technology (Nanofiltration & Reverse Osmosis). However, low-cost and sustainable options are needed if we are to tackle this problem at scale.

There is innovation in this area too. Here at LIDC collaborate with partners at City University London, University of Nairobi, York University and Vetworks Eastern Africa to develop and test the efficacy of water filters made from banana rachis – as pictured, courtesy of White Rhino Film – along the Nairobi river basin.

Other nature-based solutions such as constructed wetlands can remove antibiotics from the aquatic environment. Microalgae have also been used in the removal of veterinary antibiotics from swine wastewater, thus preventing downstream river contamination. In the future, according to JPIAMR, there may be technological innovation in areas such as nano-active or antimicrobial materials, phage therapy, innovative cleaning strategies for hospitals, farms and environmental reservoirs and strategies to block gene transfer.

But we must be realistic. Even where technological solutions exist, funding, regulation or political infrastructure may not create demand for its use. We know that we face an uphill battle, and that this battle must be fought on many fronts.

Behaviour change: now!

The most important thing we can do to reduce antimicrobial pollution is to prevent it from entering the environment in the first place. Antibiotics have become a feature of modern life. Around the world, millions – if not billions – of people have come to view antibiotics as a crucial part of modern health care. They now have to be disavowed of this notion, and the power of patients as consumers will need to be harnessed in order that they can exert pressure to remove antibiotics from the food system. Raising awareness of the One Health rationale for reduced antibiotic use in the food system is a vital part of this process. Interventions to prevent misuse and overconsumption of antibiotics will need to be sensitive to the cultural and livelihood challenges they engender, and we need to ensure effective, alternative solutions are readily available – and affordable. Here, we can use some of the lessons we have learned during the COVID19 pandemic:

WASH and prevention of infection is still key

The global AMR agenda felt the consequences of the Covid-19 pandemic, including a rise in the misuse and consumption of antibiotics in healthcare settings and global food chain shortages. One main benefit is that the importance of Water, Sanitation and Hygiene (WASH) has been re-iterated loud and clear; notably, the importance of hand washing has been clearly communicated to global citizens that wish to minimise their risk of infection.

Co-ordinated efforts can – and do – happen at a time of crisis

COVID-19 is a novel pandemic that rose immediately to the top of the political agenda of most countries. In comparison, AMR is considered the ‘silent pandemic’. While we learn to live with in a time of dual pandemics, LSHTM has compiled a list of resources for addressing AMR in a time of Covid-19 here.

Greater urgency from informed citizens

The pandemic has in many ways given us a greater appreciation for our natural environment.

In the UK, many people took up ocean and river dipping throughout the pandemic as a way of engaging with the natural environment and socialising outside. Leveraging this interest, Surfers Against Sewage launched an effective citizen science campaign to measure sewage pollution in swim spots across the UK, with results published in their Water Quality report. Societal pressure encouraged the UK government to introduce new legislation including the 2020 Sewage (Inland Waters) Act, amend the Environment Bill and launch a major sewage pollution investigation into the ‘chemical cocktail’ of sewage, agricultural run-off and other pollutants. It’s clear that a ‘whole society’ approach has significant potential to address the antimicrobial resistance challenge in a way that embraces environmental concerns. As things stand, it may just be our best hope.

And finally..!

Are you/your team working to minimise the burden of AMR in the environment? Are you keen to develop networks to promote social, technological or behavioural solution? We’d love to talk to you about possible partnerships, co please contact us: lorna.benton@lidc.ac.uk or admin@lidc.ac.uk

Photo Credits: Image of environmental sampling along the Nairobi River Basin used courtesy of Dr Nduhui Gitahi, University of Nairobi Dr Nduhui Gitahi, Uni of Nairobi.

Feature image courtesy of Arek Socha, Pixabay

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