Antimicrobial Resistance – A new Pandemic

 

Antimicrobial resistance (AMR) may be a term most people are unfamiliar with, as its yet to gain mainstream media headlines. But it should be on the front page of every newspaper! AMR  has been described as the “Overlooked Pandemic” (Laxminarayan 2022). New Research revealed that in 2019 there were an estimated 4.95million deaths associated with bacterial AMR (Murray et al 2022). The UK government’s Review of Antimicrobial Resistance declared that by 2050 10 million people could die every year from AMR.

AMR is caused when bacteria, that can cause infections and disease, are exposed to sublethal levels of the drugs that are used to eradicate them (Kuile et al 2016). The bacteria contrive de novo resistance and subsequent use of the antibiotics on these bacteria becomes ineffective (Murray et al 2022).

This relates to food, as agriculture is the biggest user of antibiotics, accounting globally for 50-80% of all antibiotics used (Kuile et al 2016). The administrative regime for these antibiotics are a lot less controlled than with humans, therefore there are likely to be a lot more frequent cases of sublethal levels of antibiotics being exposed to microbes (Kuile et al 2016).

From field to fork: AMR resistant’s can enter humans via a number of pathways (figure 1). Believed to be one of the most important is via consumption of meat (Kuile et al 2016). The food consumption patterns in Africa have been changing, since 2000 there has been a 64% increase in meat production on the continent (Boeckel et al 2019).

Figure 1. The complex transmission dynamics of antimicrobial resistance (Kelly and Davies 2017)

A myriad of connections exist creating direct and indirect pathways enabling the transfer of AMR into humans. Beattie et al (2020) studied AMR traits of Escherichia Coli from dairy manure in freshwater systems. Runoff from fields, on which manure fertilizer had been spread, into rivers resulted in higher rates of AMR E.coli. Contaminated freshwaters then can pose a risk to human life via entry into drinking water systems (Beattie et al 2020).

Wastewaters are considered a reservoir for AMR. Wastewater from sewage, especially from hospitals where people are taking antibiotics, and also from pharmaceutical production sites, are large inputs of AMR into the natural system (Fouz et al 2020). Increasing populations and lack of funding is putting waste water management under stress. African countries  range from upper-middle-income to lower-income countries, and the average wastewater treatment for this class of countries is between 38% and 8% of all wastewater produced (Ravina 2021). This lack of treatment is causing a pollution of AMR into freshwater systems (Elton et al 2020). As such, higher rates of AMR associated deaths were found in Sub-Saharan Africa. Western sub-Saharan Africa experienced in 2019 an estimated 114.8 deaths per 100 000, the highest rate of any region in the world (figure 2)( Murray et al 2022)

                                             

Figure 2. All-age rate of deaths attributable to and associated with bacterial antimicrobial resistance in 2019 (Murray et al 2022)

However, it is worth noting that AMR observed data is extremely low, these results were mainly based on modelling. A study by Tidesse et al (2017) showed 42.6% of countries had no AMR data available. An increase in AMR monitoring sites will be crucial in tackling the pandemic (Murray et al 2022).

There have been global responses to the discovery of AMR issues, the WHO Global Antimicrobial Resistance and Use Surveillance System (2015) and The Fleming Fund, providing AMR related aid to Africa and Asia, are a couple of the most noteworthy responses. However, responses have come under criticism and more action is being demanded.

Conclusion

Throughout this blog we have seen just some of the issues that are encompassed by food and water in Africa. Focusing on 21st century agricultural techniques, we have seen the terrible implication that intensive agriculture can have on water. Tackling agricultures associated issues to maintain water security, whilst simultaneously maintaining food security, is of the utmost importance. Issues such as AMR and climate change stand to be the biggest tests on humanity's preservations, our response in the next few years will be crucial to dealing with them.

On this note I will end my blog, I will refrain from a Nelson Mandela quote about rainbows or renaissances, and just say thank you for reading.