Latin America and the Caribbean is facing a convergence of risks that threaten the delicate relationship between human health and ecosystem health due to antimicrobial resistance. Having an integrated health approach from the early stages of a project’s lifecycle allows us to prevent the exposure of populations and ecosystems to the risks and impacts arising from these resistances, thereby promoting broader benefits.
What are antimicrobial resistances?
Antimicrobials are medications such as antibiotics, antivirals, or antifungals used to treat infections in humans, animals, or plants.
Antimicrobial resistance occurs when bacteria, viruses, fungi, and parasites evolve over time and no longer respond to medications, making it more challenging to treat infections and increasing the risk of the spread of pre-existing diseases, the emergence of severe forms of diseases and death.
Due to drug resistance, antibiotics and other antimicrobial drugs become less effective, making it difficult or even impossible to treat infections.
Why is it a global concern?
Antimicrobial resistances are permeating every corner of our environment, from our oceans to our soil, directly affecting the flora, fauna, and human populations, and making them a serious threat to our planet. The prevalence of antimicrobial resistances has reached alarming levels, with an estimated toll of more than 700,000 annual deaths. According to PAHO, projections indicate that by 2050, antimicrobial resistances could be responsible for up to 10 million annual deaths worldwide and result in economic losses surpassing $100 trillion.
Antimicrobial resistances not only affect humans and animals but also disrupt the natural processes of decomposition and recycling of essential nutrients, which primarily occur in soils and watercourses that provide ecosystem services to the population.
What factors accelerate their emergence and spread?
The statistics reveal that the livestock sector is accountable for 70% of antibiotic use, with the health sector contributing the remaining 30%. These sectors, in turn, have ripple effects on others. For example, the manure generated by the livestock sector is widely used as fertilizer in agriculture. Additionally, inadequate waste management practices may lead to contamination of our valuable ecosystems.
Concerning the health sector, urban areas emerge as critical points in the antimicrobial resistance cycle due to the frequent use of antibiotics. Wastewater treatment plants and landfills are not always equipped with the necessary systems to properly treat these waste products, not to mention cases where these waste products are not even transported to treatment areas and come into direct contact with soil and water, which then distribute antibiotics through runoff. As a result, antimicrobials find their way back into ecosystems, perpetuating a closed loop where people and animals are once again exposed.
What can we do?
Efforts to prevent the emergence and spread of antimicrobial resistance must address the interconnections between different sectors, such as livestock, aquaculture, food systems, pharmaceutical production, waste management, sewage management, drinking water quality management and human health. Antimicrobials can move throughout the ecosystem, facilitating the emergence and spread of resistances. Awareness of this issue must increase, promoting the adoption of sustainable and responsible practices in sectors that manage antimicrobial products and their waste. Additionally, there is pressing need for a comprehensive framework to address antimicrobial resistance that recognizes the delicate relationship between the health of humans, animals, and the environment.
An increasing number of countries in the region are implementing initiatives based on One Health principles and formulating national action plans on antimicrobial resistance, which include interventions in the health, agriculture, and livestock sectors. They are also prioritizing ongoing and active surveillance, where cooperation between different disciplines and actors enables the identification of emerging patterns and outbreaks of antimicrobial resistance to limit their occurence and swiftly respond to contain their spread.
Another approach is to promote strong policies and regulations for antibiotic use, both at the national and international levels. This includes promoting good agricultural practices, regulating veterinary medicines, and strengthening healthcare systems to ensure proper management of antimicrobial resistances. To implement this approach effectively, a holistic and multisectoral approach is necessary. This entails addressing challenges such as enhancing intersectoral communication, optimizing the utilization of limited resources, and promoting education and behavioral changes across various sectors.
The IDB and Antimicrobial Resistances
The IDB’s Environmental and Social Policy Framework (ESPF) promotes the protection of health from an integrated risk and impact assessment perspective for humans, animals, and ecosystems in various sectors. Instead of focusing solely on disease control, we are adopting a broader perspective that considers the interconnections with other sectors.
Health impacts are integrated across different ESPF standards from a systemic perspective, under the impact mitigation hierarchy approach. This includes tools to address these impacts, such as health impact assessments, which guide the adoption of good practices to identify, assess, and manage the health impacts a project may have on the population and ecosystems; as well as the development of corresponding mitigation and monitoring plans. The ESPF also has an exclusion list for the use of hazardous substances detrimental to health.
The implementation of health and environmental impact assessments envisaged in our ESPF becomes an indispensable tool, instrument, recognizing the crucial interplay between the environment and health that significantly contributes to our well-being.
Do you know of any actions that are being implemented to prevent or mitigate these risks that threaten the health of humans and ecosystems? Let us know in the comments.
Photo: Roberto Sorin – Unsplash
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