What's the link? Food, human health, livestock, environment, and antimicrobial resistance

Shobha Shukla / Bobby Ramakant *

Medicines which aim to relieve pain and suffering, may cure us of diseases and avert untimely deaths, are at increasing risk of becoming ineffective against disease-causing microbes. Antimicrobial resistance occurs when microbes such as bacteria, viruses, fungi, and parasites no longer respond to medicines. This makes common infections harder to treat, more expensive to treat, more difficult to treat, and increases the risk of disease spread, severe illness and death.

Antimicrobial resistance emerges naturally, usually through genetic changes in microbes. However, the overuse and misuse of antimicrobials (antibiotic, antiviral, antifungal, and antiparasitic medications) have dangerously accelerated antimicrobial resistance.

Antimicrobial resistance is undermining a century of progress in medicine

Joseph Thomas who leads the World Health Organization (WHO)'s Antimicrobial Stewardship and Awareness, said "Antimicrobial resistance is undermining a century of progress in medicine, infections that were previously treatable and curable with our drugs are becoming (or at risk of becoming) incurable (as medicines are not working against infections). Even common infections are becoming risky and a problem. Surgeries are becoming risky. Cause of all this is found in the behaviour of human beings who are misusing or overusing antimicrobials. We must ensure that when we are sick we are only taking antimicrobials on medical advice and medical supervision."

When we use antimicrobials irresponsibly or inappropriately - for example, taking antibiotics for a viral infection like a cold, or taking antimicrobials without a diagnosis from a medical professional - fungi, bacteria, viruses and parasites have the opportunity to develop resistance to the medicines.

"Having good infection control is key to controlling antimicrobial resistance (AMR). So if infection control is good along with water, sanitation and hygiene - in clinical settings, veterinary settings and in food producing settings - it will help to stop the spread of infection and this in turn will reduce the use of antimicrobials to treat those infections. Use of poor quality drugs and/or unnecessary use of antimicrobials in humans, animals and in food production is also fuelling AMR" said Dr Haileysus Getahun, Director of the WHO Department of Global Coordination and Partnership on Antimicrobial Resistance (AMR). Dr Getahun is also the Director of Joint Tripartite Secretariat on AMR (comprising United Nations Food and Agriculture Organization - FAO, World Organization for Animal Health - OIE, and WHO) that coordinates the joint work of the organisations across the #OneHealth spectrum.

Covid-19 has brought antimicrobial resistance into spotlight. A systemic review found that while there were only 6.9% of 3338 covid-19 patients with bacterial infection, 72% of them had received antibiotics. The adverse impact of this irrational use of antibiotics in covid patients will manifest itself in future, warned Dr Getahun.

Agrees Dr Ishwar Gilada, Secretary General of OMAG (Organized Medicine Academic Guild) which brings several associations of medical experts on one forum in India: "The Covid-19 pandemic has provided another example of how irresponsibly and inappropriately antibiotics as well as antivirals were used. We need collective and urgent action to stop indiscriminate use of antimicrobials (be it antibiotics, antivirals or antifungals)."

Dr Getahun added: "Antimicrobial resistance is a complex problem that demands a comprehensive, multisectoral response. It is to be addressed through different mechanisms -including regulations and also by enhancing the robustness of the human and veterinary health systems to make sure that antimicrobials are prescribed based upon the needs and not due to oversight of the trained medical professionals. Antibiotics should not be sold over the counter."

Why we need food, veterinary, human health and environment sectors to join forces for combatting antimicrobial resistance?

"We need different sectors- food sector, veterinary sector, human health sector and environment sector- to work together and coordinate for the One Health approach. Humans are abusing antibiotics not only in the human health sector, but also in agriculture and livestock. The more we use antimicrobials in any sector, the greater are the chances that resistance will develop and the drugs will become ineffective.

In humans, antibiotics are often used as substitutes for decent infrastructure, decent hygiene measures and for proper diagnosis and treatment. Over 30% of health facilities do not have running water supply- so it is difficult to practice good hygiene in such environments. So antibiotics are used as a cheaper substitute.

There is widespread use of antibiotics for prevention of infection and in treating infections that will not respond to antibiotics- like flu, where antibiotics will not work (as it is a viral infection)" said Dr Elizabeth Tayler, Technical Lead for WHO in the Tripartite Joint Secretariat for AMR, supporting the collaboration between FAO, OIE, UNEP (UN Environment Programme) and WHO at global, regional and country levels. She has led the development of the Tripartite Strategy and the development of the AMR multi-partner Trust Fund.

In animals, there is a push to intensify livestock production, very often in unsanitary facilities with poor biosecurity. So antibiotics are used to prevent infections. Sub-therapeutic doses of antibiotics are used for growth promotion in livestock and also for blanket prevention in animal herds. In many countries more antibiotics are being fed to healthy animals than to sick humans and sick animals.

Dr Tayler underlined that antimicrobials are increasingly used in plant kingdom - 440,000 kg streptomycin and tetracycline sprayed on citrus tress (like orange trees) in California, drug resistant Aspergillus has been linked to use of the anti-fungal Azole (used to treat fungal infections in humans) in tulip industry. Anti-fungals are used in flower production that leads to resistance in humans.

Antimicrobials leak into the environment. Significant antibiotic residues have been found in effluents from intensive agriculture and from hospitals- all ending up in the river waters used by people to bathe and drink. In some cases levels of antimicrobials compounds in waters around medicine manufacturing sites have been found to be higher than therapeutic concentrations in the blood of patients taking those medicines.

WHO has declared antimicrobial resistance as one of the top 10 global health threats

This year during the World Antimicrobial Awareness Week (18-24 November), Go Blue campaign is the new initiative to raise awareness, stop resistance. By Going Blue, individuals, workplaces, landmarks, and communities will be helping spread awareness about antimicrobial resistance, said Dr Lianne Gonsalves, WHO Technical Officer for AMR Awareness and Campaigns.

Antimicrobial resistance (AMR) being a One Health issue needs to be addressed by different sectors, emphasized Dr Gonsalves. During the Week of Antimicrobial Awareness, all of these different sectors, especially food, veterinary, human health, and environment, among others, are working together to raise awareness about antimicrobial resistance.