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How should the world and the Global South control the growing 'pandemic' of antimicrobial resistance?

To mark World Antimicrobial Awareness Week 2021, experts at a series of CSE webinars present an agenda to contain the AMR crisis

Impact of AMR as catastrophic as that of COVID-19 or climate change. The world must realise this – even as it faces a new onslaught from another variant of the virus: Sunita Narain

  • Speakers at the CSE webinars agreed that food systems need to be transformed to meet development challenges of low-and middle-income countries sustainably
  • Recognised the need for conserving use of critically important antimicrobials in food systems -- low-and middle-income countries have an opportunity because their food systems are not as intensive as that of developed countries
  • Highlighted the importance of preventive approaches -- developing countries cannot afford the health, economic and development costs of AMR
  • Stressed that waste management from intensive food farms and antibiotic manufacturing industries can go a long way in containing AMR from environmental routes

New Delhi, November 27, 2021: “The success of AMR (antimicrobial resistance) containment efforts in our world will depend on how well we manage our food systems and waste. The impact of this ‘silent pandemic’ of antimicrobial resistance can be as catastrophic as that of COVID-19 or climate change, and the faster we realise that and get our act together, the better it would be – especially even as the world faces a new onslaught from another variant of the virus,” said Sunita Narain, director general, Centre for Science and Environment (CSE). Narain was speaking at the last and final webinar of a series of online interactions that CSE had organised last week to mark the World Antimicrobial Awareness Week (November 18-24, 2021).

Experts from different parts of the world came together in these CSE webinars to deliberate upon the agenda to contain animal and environmental aspects of antimicrobial resistance (AMR) crisis for developing countries. Speaking at this series of online interactions, Narain said that “AMR can only be contained if addressed by all countries – however, low-and middle-income countries have their own challenges and will have to do things differently to stop AMR.”

Speaking at the first webinar on the ‘development agenda’, which had focused on how to ensure the world can continue to increase food production without depending on chemicals, Amit Khurana, programme director, food safety and toxins, CSE, said: “Intensive food systems are in a way breeding grounds for diseases and AMR. The possibility of indiscriminate antibiotic use has led to intensification of food systems which can also impact nutrition, livelihood, biodiversity and climate.”

“Focus on intensification to address the hunger and nutrition issues has a big cost. We need to produce food sustainably with less chemicals and inputs. With limited intensification so far, LMICs have the opportunity to do so,” added Khurana.

In the second webinar on the ‘conservation agenda’, experts discussed how the world can conserve the use of critically important antimicrobials in food-animal production and crops. Highlighting the take-aways from the discussion, Rajeshwari Sinha, programme manager, food safety and toxins, CSE mentioned that “new antibiotics are not going to come easy. They will take time. The best option is to conserve those that we have, in particular, those which are critical to save human lives”.

The third webinar which was on the ‘environmental and prevention agenda’ discussed how waste from food systems, pharmaceutical manufacturing and human health systems can be effectively managed to contain AMR. It also focused on prevention strategies for overuse of chemicals and the resultant pollution.

“LMICs cannot afford to pollute first and then spend huge amount of money to clean up. This means increased focus on prevention and better waste management. Prevention in farms does not mean using antibiotics to prevent diseases. It means preventing the occurrence of a disease. Prevention also means clean water, better hygiene and sanitation,” said Narain.

“Waste from pharma industry has to be managed by a combination of approaches which include better processes, waste management and monitoring. Whereas waste from farms is an important resource as a fertilizer and should be treated for safe use,” added Sinha.

“It is clear that the global discussions and deliberations on AMR are evolving. They are more informed and inclusive while applying the One-Health lens. The deliberations give direction to the future agenda, and should push policy makers and stakeholders for an effective action against AMR,” concluded Narain.

Key takeaways from the week-long expert deliberations On the Development agenda

  • Food systems and sustainable development are strongly linked. For example, intensive food animal production systems which are aimed to meet growing food/protein demand are not only dependent on chemicals but also fuelled by indiscriminate antibiotic use. Apart from adding to the crisis of antimicrobial resistance (AMR) and zoonosis, such systems are significantly damaging the environment, biodiversity, climate, health, nutrition and livelihood opportunities of small farmers. The crop-based food systems are also heavily dependent on chemical fertilisers and pesticides which is not sustainable.
  • The food systems across the world need to be transformed to become sustainable. While low- and middle-income countries have a challenge to produce more, they also have an opportunity because their food systems are not as intensive as those in the developed world. Sustainable intensification, which is recently being discussed globally, is clearly not a real solution.
  • In the case of India, the ethno-veterinary practices in the dairy sector are proving to be a successful example wherein antimicrobial use is reduced in mastitis management. But the agriculture policies need to be relooked from the point of sustainability as the gains of Green Revolution are limited and declining.

On the Conservation agenda

  • Considering that there are no new antibiotics on the anvil, the most prudent option for the world is to conserve the existing set of antimicrobials. This becomes pertinent as a big proportion of the produced antibiotics is used in food systems and such indiscriminate use is avoidable at its first place and is no more than an economical and easy substitute to good animal husbandry practices, biosecurity and preventive non-chemical disease management at farms.
  • Considering the critical nature of certain group of antimicrobials which are used to save lives, it is imperative that the world focuses on first conserving the use of critically important antimicrobials in food systems starting with highest priority critically important antimicrobials as classified by the WHO. The world needs to stop using growth promoters and phase out antimicrobial use for disease prevention so that the use of critically important antimicrobials is also reduced. This can only be achieved through coherent guidance from global agencies such as WHO, FAO and OIE on all such types of use, as well as country-level roadmaps based on specific sector and local context.
  • There are expectations from the organized food industry which has a big role to play in conserving the use of antimicrobials. So far, the fast food multinational industry have made commitments in the United States but has largely shown double standards when it comes to India and other parts of the global south.

On the Environmental and Prevention agenda

  • Understanding on different aspects of environmental AMR is emerging, but it is enough to act now. Countries are keen to address the issue and are looking forward to a clear global guidance.
  • Low-and middle-income countries (LMICs) will not be able to afford the heavy cost to clean-up the AMR pollution caused by farms and factories. They will have to do things differently which means polluting less and spending less on managing waste. They cannot afford the health and economic cost of AMR. LMICs will have to focus on preventive approaches as well as low-cost waste management and monitoring systems
  • Waste from food production farms and antibiotic manufacturing factories are among the key sources of AMR pollution which needs to be managed. The best way to mitigate AMR from farms is to reduce the need and use of antimicrobials in farms by preventing the occurrence of the disease and managing them by non-antimicrobial alternatives.
  • Waste from antibiotic manufacturing industry has to be managed through a combination of better process control measures, effective implementation of waste management approaches like Zero Liquid Discharge (ZLD) and monitoring based on discharge limits. The waste management of small scale producers through common effluent treatment plants (CETPs) is to be also carefully looked into.
  • Water, sanitation and hygiene (WASH) are an important aspect of preventive approach and should be focused upon.
  • Farm waste is a resource for LMICs from the point of view of efficiency, circularity. It saves costs, helps prevent environmental contamination but most importantly, supports agro-ecological practices based on livestock, crop integration and effective use of manures as fertilizers. It needs to be managed to be safely used.

Experts at the webinar

  • Amit Khurana, Programme Director, Food Safety Programme, CSE, India
  • Balasubramanian Ganesan, Principal Scientist-Metagenomics and Bioinformatics, Mars Global Food Safety Centre, China
  • Deepak Bhati, Programme Officer, Food Safety Programme, CSE, India
  • Ed Topp, Principal Research Scientist, Environmental microbiology and chemistry, Agriculture and Agri-Food Canada, Government of Canada
  • Meenesh Shah, Chairperson, National Dairy Development Board, India
  • Stefano Prato, Managing Director, Society for International Development, Italy
  • Pious Makaya, Director, Division of Veterinary Technical Services, Department of Veterinary Services, Zimbabwe
  • Rajeshwari Sinha, Programme Manager, Food Safety Programme, CSE, India
  • Remesh Kumar R, President Elect, Indian Academy of Pediatrics 2021, India
  • Shaikh Z Ahammad, Associate Professor, Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology Delhi, India
  • Steve Brooks, Chair-Manufacturing Working Group, AMR Industry Alliance ad Advisor to the Alliance, Switzerland
  • Steven Roach, Food Safety Program Director, Food Animal Concerns Trust, USA
  • Sunita Narain, Director General, CSE, India
  • T Nanda Kumar, Former Secretary, Union Ministry of Agriculture, Government of India

Links:

https://www.cseindia.org/amr-the-development-agenda-11049

For any other resources or information, please contact Sukanya Nair of The CSE Media Resource Centre, sukanya.nair@cseindia.org, 8816818864.

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Rethinking the AMR Agenda
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Press release:
World Antimicrobial Awareness Week, 2021