Article by Giulia Forestelli
The “silent pandemic” represents one of the major public health threats globally which, if not treated adequately, will lead to disastrous consequences for people, animals and the environment. This term refers to the phenomenon of Antimicrobial Resistance (AMR), which occurs when bacteria, parasites, fungi and viruses evolve to resist the effect of medications, making these infections harder to treat and defeat. Insurgence of AMR has been driven by the overuse and misuse of antibiotics not only in humans but also in animals and agriculture. This is why a “One Health” approach which integrates human, animal and environmental health solutions is increasingly recognized to be essential in the fight of this issue.
One Health approach: what is it and why use it?
According to the WHO, One Health is an “integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems”. This approach contributes to the security of global health by acknowledging the connections between the health of people, plants, animals, and the environment at large. It also makes it possible to handle disease control at every stage, from prevention to management of the illness.
The reason behind the necessity of a One Health approach to the AMR issue lies in the changes that have occurred recently in the way that people, animals, and the environment interact. More precisely, as humans spread into new regions, they come into touch with an increasing number of wild animals and, eventually, the diseases those animals may carry. Additionally, altered climates and habitats may facilitate the transmission of illnesses from one country to another, and greater travel and commerce of animal products facilitates the migration of animals across borders. Experts in the fields of human, animal, and environmental health must collaborate for One Health interventions to be successful, and a detailed plan must be developed to track every facet of a specific condition and- ultimately- improve public health results.
What is Antimicrobial Resistance and why did it develop?
Antimicrobial resistance arises from genetic changes -in the form of mutations or gene transfers- in bacteria over time. Indeed, this phenomenon refers the capacity bacteria gain to tolerate exposure to antimicrobial chemicals that were previously successful in treating them. Although AMR is a naturally occurring phenomena, human activity plays a major role in its development, mostly through the excessive and improper use of antimicrobials for the prevention, treatment, or management of infections in humans, animals, and plants.
AMR increases the risk of severe sickness, morbidity, and mortality by rendering multiple families of medications ineffective, including antibiotics, antifungals, antivirals, and antiparasitics. AMR was directly linked to 1.27 million deaths every year, and if current trends continue, it may be the cause of 10 million deaths annually by 2050. The World Bank estimates that the issue will inflict a $100 trillion burden on the global economy by 2050, with significant declines in global exports and livestock production if nothing changes before then.
What measures have been taken against AMR?
In order to promote AMR surveillance and provide guidance for AMR containment methods, the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) was introduced in 2015. The system began with surveillance of AMR in bacteria causing common human diseases and it was extended to encompass surveillance of antimicrobial consumption (AMC), invasive fungal infections, and a One Health surveillance model pertinent to human health. GLASS encompasses 127 nations, territories, and regions as of the end of 2022.
One of the most economical ways to maximize the use of antibiotics, enhance patient outcomes, and lower health care associated infections (HAIs) and antimicrobial resistance (AMR) is through the development and implementation of Antimicrobial Stewardship Programs (ASPs), which are guided by the World Health Organization. Antimicrobial stewardship refers to the diligent use of antimicrobial agents, especially antibiotics, to reduce the occurrence and spread of AMR. The method entails the optimization of treatment interventions for infectious diseases while simultaneously reducing the negative consequences resulting from the administration of antimicrobial drugs, notably aimed at decreasing resistance development and unpleasant reactions. To help countries achieve their antimicrobial stewardship goals, WHO supports various activities, including workshops, webinars and the development of educational tools.
In Europe, in June 2017 the European Commission adopted the EU One Health Action Plan against AMR. The plan outlines over 70 actions covering human, animal and environment health, whose progress is regularly monitored. European Countries have since been encouraged to outline National Action Plans to fight Antimicrobial Resistance.
Where do we stand in the fight of the “silent pandemic” and what more needs to be done?
Although many countries have either already implemented National Action Plans to fight AMR or are in the process of developing them, much more efforts are needed globally to effectively stop the spread of this phenomenon. One of the main focus points concerns research and innovation to find new agents that are capable of eradicating bacteria resistant to old antibacterials.
An adjourned report on antibacterial agents that are undergoing clinical and preclinical development globally was recently published by the World Health Organization. Although the number of antibacterial agents in the clinical pipeline increased from 80 in 2021 to 97 in 2023, new and innovative agents are desperately needed to treat dangerous infections and to replace those that are losing their efficacy from overuse.
Governments must really prioritize the fight against AMR, allocate the appropriate funds, and implement laws specific to tackle the issue. Collaboration across the environmental, agricultural, and healthcare sectors is something we must promote because only a multi-sector approach will enable the regulations, policies, and recommendations to produce the desired effects. Only a global effort following a One Health approach will guarantee coherence and consistency in the strategies to fight AMR and it will ultimately lead to the eradication of this global threat.
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