Abstract
Antimicrobial resistance (AMR), the ability of a micro-organism to stop an antimicrobial from working against it, is one the greatest global health challenges. It is projected to be the leading cause of death worldwide, claiming an estimated 10 million lives a year, by 2050, primarily in low- and middle-income countries (1). In 2015, the World Health Assembly (WHA) adopted a global action plan on AMR underscored by the One Health approach (2). One Health seeks to improve health and well-being through the integrative management of disease risks at the interface between humans, animals and the natural environment, based on closer collaboration among individual disciplines and an integrated, cross-sectoral approach to research, surveillance, and response (3). The natural or biophysical environment here includes all living (biotic) and non-living (abiotic) factors affecting the survival of all organisms (including humans) at the individual, population, community or ecosystem level. In this context, an ecosystem refers to a community of plants, animals and microorganisms that live, feed, reproduce and interact in the same area or environment. AMR connects human health to the health of ecosystems and the natural environment, in terms of both drivers and consequences. Concurrently with the WHA action in 2015, member states agreed to publish individual national action plans (NAPs) on AMR by May 2017 (2), (4). Here we present the first analysis of the extent to which these post-2015 NAPs have been successful in integrating the natural environment within a One Health approach. We found that NAPs feature human and animal health prominently but that most do not specifically incorporate the natural environment, and hence fall short of achieving a genuine One Health approach. Given the key role of the natural environment in contributing to AMR, we call for greater integration of the natural environment in existing and new NAPs, so that we can maximise our chances of finding holistic and sustainable solutions to this global health threat.
Highlights
Resistance in the environmentAntimicrobial resistance develops in, and is maintained and transmitted across humans, animals and the natural environment
Antimicrobial resistance, that is, the ability of a microorganism to stop an antimicrobial from working against it, is one of the most important global health challenges
The national plan of Sri Lanka provides an example of a cross-sectoral approach including expertise from rural economy, fisheries, aquatic sciences, veterinarians and public health, and the national plan of India includes an objective on reducing the environmental spread of antimicrobial resistance
Summary
Antimicrobial resistance develops in, and is maintained and transmitted across humans, animals and the natural environment. Resistance is an ancient and naturally occurring phenomenon, but anthropogenic antibiotic use since the 1930s has been linked to the increasing occurrence of antimicrobial-resistant microorganisms, bacteria.[5,6] The natural environment presents a transmission route and a reservoir for resistant microorganisms and plays a significant role in the development of, and response to, antimicrobial resistance.[7] Antimicrobial use in the livestock industry is driving the selection of resistant bacteria in farm animals, and while the causal link between antimicrobial use in livestock and the selection of resistance in humans is difficult to establish, there is evidence of an association.[8] Resistant bacteria of animal origin can be transmitted to humans directly via food or indirectly via the natural environment. Wastewater treatment plants, manure from farm animals and spill-over from the pharmaceutical production industry contribute to an environmental reservoir of resistance.[7] The natural environment should be a key consideration in understanding and developing strategies to control antimicrobial resistance, as acknowledged through the One Health approach.[9]
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