As part of the AMR Multi-Stakeholder Partnership Platform monthly updates, we feature perspectives from experts on critical issues, progress, and key initiatives in our joint efforts against antimicrobial resistance (AMR).
This month, we spoke with Dr. Ramanan Laxminarayan, Founder and President of One Health Trust, about the role of the environment for antimicrobial resistance.
Environmental reservoirs like wastewater, soil, and agricultural runoff contribute to the AMR problem, yet national strategies often do not include them. Which environmental factors should governments prioritize in their national AMR action plans, and what concrete steps can translate this understanding into policy action?
Although it is true that environmental reservoirs are important for bacterial resistance, these reservoirs are neither harmful on their own without a conduit to humans or animals, nor are they modifiable risks. They represent hazards, rather than risks. Think of bat viruses. Bats harbor many viruses that are harmful to humans. But eliminating these viruses in bats or all bats is not feasible or desirable. What we can do is to reduce our exposure to bats and study bat populations to see which viruses may be a threat to humans in the case of spillovers, to enable us to plan accordingly.
In the case of AMR, national strategies should focus on monitoring environmental reservoirs while acknowledging that these are not modifiable hazards. Also, the quantum of resistance genes in the environment is likely so great that expending resources on sewage treatment to reduce antibiotic content or resistance genes is simply futile.
Instead, national action plans can focus on monitoring AMR-related endpoints in environmental reservoirs, which can offer a snapshot of overall resistance in human and animal populations. This includes assessing levels of resistant bacteria, antibiotic-resistant genes, and antibiotic residues. This information could inform the appropriate choice of antimicrobials in humans and animals, and design policies to reduce human and animal exposure to environmental reservoirs of resistance.
For countries beginning to track environmental drivers of AMR, what are the most practical first steps to monitor and mitigate these risks effectively?
Before designing any surveillance strategies, countries must identify their priority questions and then design objectives and endpoints that can address them. This is because surveillance data that is not linked to a specific question is not very useful.
From a broader perspective, there is a need for more research to delineate and quantify how these AMR endpoints impact human health. For instance, even if we know the levels of these endpoints in environmental reservoirs, we still need to understand the factors influencing transmission, such as exposure levels and how they might lead to colonization or disease.