Generated Summary
The document is a report by the United Nations Environment Programme (UNEP) that examines the environmental dimensions of antimicrobial resistance (AMR) and proposes a ‘One Health’ response. It highlights the critical role of the environment in the development, transmission, and spread of AMR, emphasizing the need for action across multiple sectors. The report reviews available evidence, addresses the key economic sectors contributing to AMR, and outlines strategies for prevention and management. The methodology involved a consultative and extensive review process engaging over 50 experts and stakeholders globally, including the Quadripartite organizations (FAO, UNEP, WHO, and WOAH). The scope encompasses the complex interactions, cyclic interrelationships, and dynamics in multi-dimensional media impacting global planetary health.
Key Findings & Statistics
- In 2019, AMR was responsible for an estimated 1.27 million deaths directly attributed to drug-resistant infections globally and 4.95 million deaths associated with bacterial AMR (including those directly attributable to AMR).
- By 2050, up to 10 million deaths could occur annually—on par with the 2020 rate of cancer deaths.
- If unchecked, AMR could shave US$ 3.4 trillion off GDP annually.
- AMR could push 24 million more people into extreme poverty in the next decade.
- A recent World Economic Forum report (2021) points out that disease causes worktime and productivity losses, and it estimates that if current trends continue unchecked, AMR could increase animal mortality rates by one percent, an equivalent loss of US$13 billion in livestock value (US$3 billion of which is attributed to waterborne AMR) and US$3 billion in aquaculture value.
- By 2050, up to 10 million deaths could occur annually.
- In 2019, 1.27 million deaths were directly attributed to drug-resistant infections globally, and 4.95 million deaths were associated with bacterial AMR (including those directly attributable to AMR).
- The Global Action Plan (GAP) on AMR, adopted in 2015, includes the goal that by 2017 all World Health Assembly Member States would have a National Action Plan on AMR (NAP) aligned with the GAP objectives.
- Over 85 per cent of the world’s population live in countries which have developed, or are in the process of developing, a NAP.
- In 2020 the global use of fungicides and bactericides in agriculture were 605,986 tons.
- In Europe it is estimated to be 1.4 billion tons of manure produced per year.
- A technical report was prepared for the World Economic Forum (Vivid Economics 2020) assessing the costs and risks of water pollution globally.
- Wastewater releases can translate into carriage of AMR strains in exposed people (Leonard et al. 2018).
Other Important Findings
- The report recognizes that human activities create pollution that promotes the emergence of AMR in the environment. AMR can cause human, animal or plant diseases or soil biodiversity loss that can lead to further use of antimicrobials (a negative feedback from initial use) that only exacerbates AMR.
- The report reviews the available evidence on environmental dimensions of AMR and calls for urgent, comprehensive, and coordinated strengthening of environmental action in the ‘One Health’ response to AMR.
- AMR in the environment includes pollution from hospitals, community wastewater, pharmaceuticals production, agriculture run-off and other waste and releases. These matrices may contain not only resistant microorganisms, but also antimicrobials, pharmaceuticals, microplastics, metals, and other chemicals, which all increase the risk of AMR in the environment.
- The key economic sectors contributing to the environmental dimensions of AMR are: pharmaceutical manufacturing, agriculture, and healthcare delivery.
- The environmental dimensions of AMR are complex and characterized by dynamic interactions, cyclic interrelationships, complexities, and multiple causalities and dynamics in multi-dimensional media that impact global planetary health.
- AMR challenges cannot be understood or addressed separately from the triple planetary crisis of climate change, biodiversity loss, and pollution and waste because they are all driven by unsustainable consumption and production patterns.
- The transmission and spread of AMR are not confined to point-sources, with transient and diffuse sources also being important.
- The report underscores the need to address key pollution sources such as poor sanitation, sewage, municipal wastes, healthcare delivery, pharmaceutical manufacturing, intensive crop, and animal production sectors.
- The report highlights the importance of improving water, sanitation, and hygiene (WASH) to prevent AMR spread.
- The report calls for the establishment of international standards for good microbiological indicators of AMR from environmental samples.
- The document points out that the use of plastics in agriculture creates microplastic pollution of soils and is concerning because current uses are unsustainable.
- The report cites that mass gatherings of people include sporting events such as the FIFA World Cup.
Limitations Noted in the Document
- The document acknowledges that while the relationship between environmental pollution and AMR is established, the significance and contribution to AMR globally is still unclear.
- While more research and development are pivotal to fighting AMR, sufficient information is already available for stakeholders to act on AMR as an issue of environmental, health, and economic concern.
- The report notes that more research on the gender- and age-differentiated impacts and outcome of resistant infections is required to understand how to target policies and assist the most vulnerable populations.
- While causal pathways are still being established and researched to demonstrate how environmental factors contribute to resistance in human and animal pathogens, there is already sufficient knowledge to implement measures to reduce the factors that influence AMR from an environmental perspective.
- There is a need to better understand the processes in more complex environmental media and matrices.
- The significance of disinfectants and bacterial response governing this phenomenon requires further research.
Conclusion
The UNEP report offers a comprehensive overview of the environmental dimensions of AMR, emphasizing its complexities and the urgent need for a global response. The report underlines the importance of a ‘One Health’ approach, advocating for collaboration between the human, animal, plant, and environmental health sectors. It stresses that tackling AMR requires action across various sectors, including pharmaceutical production, agriculture, healthcare, and waste management. The report’s findings highlight that the environment acts as a critical reservoir and transmission pathway for AMR, influenced by factors like pollution, climate change, and human activities. The report advocates for strengthening national actions by integrating AMR into development planning, incorporating environmental considerations into National Action Plans, and recognizing the critical role of environmental authorities and regulators. The report’s analysis of the drivers of AMR emphasizes the need for a systems approach that considers the entire chemical lifecycle and promotes the implementation of the best available technologies. The document stresses the importance of surveillance and monitoring systems for AMR in wastewater, the use of antimicrobials, and the promotion of transparent data collection. These findings underscore the need for increased financial investment, innovation, and capacity development to support environmental action to tackle AMR. The report advocates for recognizing the interconnectedness of human, animal, plant, and environmental health and emphasizes the need for international collaboration and coordinated action, particularly in the context of achieving the Sustainable Development Goals (SDGs). In short, the report calls for immediate action to protect human, animal, and environmental health by reducing the sources, transmission, and impact of AMR. By acknowledging the interdependencies between human activities and the environment, the report lays out a clear vision and actionable steps for governments, industries, and communities to collaborate and safeguard the future against AMR. This requires a unified global effort, grounded in scientific evidence, that addresses the root causes of AMR and promotes the well-being of all living beings and the environment.