antimicrobial resistance and the environment: implications ... · waste. • educate and train all...

UKZN INSPIRING GREATNESS

Antimicrobial Resistance and the

Environment: Implications for SDGs

Sabiha Y. Essack

B. Pharm., M. Pharm., PhD

South African Research Chair in Antibiotic Resistance and One Health

Antimicrobial Research Unit, College of Health Sciences, UKZN


Overview

• One Health

• AMR and the Environment

• AMR, the Environment and Climate Change

• Environmental AMR Implications for SDGs

• Environmental AMR: Mitigation Strategies


One Health

• Global public health strategy

encouraging interdisciplinary

collaboration and communication

on health at the human-animal-

environmental interface.

• “...the collaborative effort of multiple

disciplines – working locally,

nationally and globally – to attain

optimal health of people, animals

and our environment.”

http://www.onehealthinitiative.com/about.php

https://www.avma.org/KB/Resources/Reports/Documents/onehealth_final.pdf

https://followtheoutbreak.wordpress.com/2013/10/16/opinion-do-we-need-to-induce-stress-in-the-one-health-paradigm/

http://www.onehealthinitiative.com/about.php

https://www.avma.org/KB/Resources/Reports/Documents/onehealth_final.pdf

https://followtheoutbreak.wordpress.com/2013/10/16/opinion-do-we-need-to-induce-stress-in-the-one-health-paradigm/


One Health (2)

http://www.phac-aspc.gc.ca/cipars-picra/gfx/2b_e.gif

http://www.phac-aspc.gc.ca/cipars-picra/gfx/2b_e.gif


Courtesy of Paula Cray

One Health (3)


AMR and the Environment

https://www.unenvironment.org/resources/frontiers-2017-emerging-issues-environmental-concern



AMR and the Environment (2)





What We Know What We Don’t Know

1. How and to what extent do the do the different

sources of antibiotics and antibiotic resistant

bacteria contribute to AMR in the environment?

2. What is the role of the environment in the

evolution of resistance and how is this affected

by anthropogenic inputs?

3. What are the overall human and animal health

impacts caused by exposure to environmental

AMR?

4. What is the efficacy and feasibility of different

technological, socio-behavioural and economic

interventions to mitigate environmental antibiotic

resistance?

https://www.sciencedirect.com/science/article/pii/S0160412018300989



http://thegreentimes.co.za/health-impacts-of-climate-change-waterborne-diseases/

AMR, the Environment and Climate Change

http://thegreentimes.co.za/health-impacts-of-climate-change-waterborne-diseases/


Environmental AMR Implications for SDGs

https://www.un.org/sustainabledevelopment/news/communications-material/

https://www.un.org/sustainabledevelopment/news/communications-material/


Environmental AMR Implications for SDGs (2)

http://www.who.int/antimicrobial-resistance/interagency-coordination-group/20170818_AMR_FfA_v01.pdf

http://www.who.int/antimicrobial-resistance/interagency-coordination-group/20170818_AMR_FfA_v01.pdf


Environmental AMR: Mitigation Strategies• Implement high quality hygiene and sanitation in all hospital

operations.

• Ensure the safe disposal of antimicrobial medicines and hazardous

waste.

• Educate and train all hospital personnel on hygiene, sanitation and

safe disposal practices.

• Consider pre-treatment of of hospital waste before discharge into the

general sewage system.

• Leverage hospital stewardship and IPC programmes to limit

environmental contamination by antimicrobial residues and resistant

microorganisms respectively.

• Optimize the functioning of waste water treatment plantshttps://wellcome.ac.uk/sites/default/files/international-

environmental-amr-forum-joint-statement.pdf

https://wellcome.ac.uk/sites/default/files/international-environmental-amr-forum-joint-statement.pdf


Environmental AMR: Mitigation Strategies (2)

• Reduce antimicrobial use in food animals by

implementing vaccination, biosecurity and

good animal husbandry programmes.

• Pre-treat manure before use as fertilizer.

• Consider pre-treatment of waste across the

farm to slaughterhouse continuum before

discharge into the general sewage system.

• Ensure evidence-informed use of

antimicrobials as pesticides for crops.https://wellcome.ac.uk/sites/default/files/international-environmental-amr-forum-joint-

statement.pdf



Environmental AMR: Mitigation Strategies (3)• Enforce standards to regulate antimicrobial emissions into

the environment.

• Pharmaceutical industries should:

• Have environmental risk management strategies in place.

• Set discharge limits for antimicrobials.

• Monitor antimicrobial residues and AMR in the environment

• Implement cost and energy-efficient Best Available

Technologies (BAT) for waste management:

• WASH infrastructure and safety plans.

• Ozonation, activated carbon, bio-filters and UV disinfection.

• Socio-behavioral interventions.https://wellcome.ac.uk/sites/default/files/international-environmental-amr-forum-joint-statement.pdf


https://amrbenchmark.org/research-areas/mp/



https://amrbenchmark.org/research-areas/mp/


Conclusion

• The impact of AMR in the environment is inadequately recognized by stakeholders

and there is thus minimal effort to understand and contain it.

• Systematic generation of data and evidence on the nature and extent of AMR in the

environment as well as innovative solutions through multidisciplinary,

implementation research are urgently needed.

• This requires:

– Unequivocal political leadership and commitment,

– Strong policy and regulatory frameworks, and,

– Adequate human and other resources to enforce policy and regulations.

• It is imperative that the environment become an integral part of the AMR response.


THANK [email protected]

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