What is AMR?
Antimicrobial resistance (AMR) occurs when microorganisms (such as bacteria, fungi, viruses and parasites) are exposed to antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials and anthelmintics). The microorganisms fight for survival by mutating or acquiring defence genes from other microorganisms. As antimicrobial drugs get stronger, and their use more widespread, bacteria’s resistance to antibiotics gets stronger and more widespread too, which can lead to untreatable bacteria, known as “superbugs”.
How does AMR spread?
Many people think that AMR is primarily caused by overuse of antimicrobial drugs, but environmental factors may cause the spread of AMR even more than the use of antimicrobials, especially in developing nations with limited access to clean water, poor sanitation and rudimentary waste management. This exposes people to frequent and preventable contact with faecal matter, which can host millions of resistant genes and bacteria, including potentially untreatable superbugs. Waterbodies polluted with resistant genes, bacteria and antimicrobial compounds from human and animal faeces and antimicrobial manufacturing are also an ideal environment for superbugs to emerge and spread,
So while using fewer antimicrobial drugs – in humans, animals and plant life – is critical to reducing resistance, it’s also vital to improve hygiene, provide safer water and sanitation, and better wastewater treatment on a global scale, or resistance could continue to increase, potentially creating the next pandemic.
How is WHO responding to AMR?
The response to AMR has been spearheaded through the One Health Global Action Plan, developed by WHO in collaboration with the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (OIE).
The 5 objectives of the Global Action Plan on AMR are to:
1. improve awareness and understanding of AMR communication, education and training
2. strengthen the knowledge and evidence base through surveillance and research
3: reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures
4: optimize the use of antimicrobial medicines in human and animal health
5: develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.
Because the many contributing factors of AMR vary greatly, WHO urged member countries to come up with their own national action plans. But WHO has found that WASH and wastewater management and improvement actions continue to be underrepresented in these plans. So, to encourage the implementation of WASH and wastewater management to reduce the spread of AMR, WHO has released a new technical brief summarizing the evidence and rationale for WASH and wastewater actions within AMR national action plans and sector-specific policy to combat AMR.
What are the new recommendations?
WHO’s new technical brief details 6 areas with evidence and actions to improve WASH and wastewater for AMR national action plans:
1. Coordination and leadership
Ensure WASH and wastewater management is included in national AMR policies and plans and support implementation of multilateral actions across the health, water, sanitation, animal, plant and industrial sectors.
2. Households and communities
Ensure universal access to safely managed water and sanitation services and increase wastewater and sludge treatment and safe reuse.
3. Health care facilities
Ensure universal access to safe water supply and sanitation, proper hygiene practices and health care waste management in health care facilities to support infection prevention and control.
4. Animal and plant production
Improve hygiene and wastewater and sludge management in food production, and where possible, minimize the use of antimicrobials and other chemical supplements in livestock, aquaculture and plant production operations.
5. Manufacturing of antimicrobials
Reduce releases of antimicrobials into waterways from antimicrobial manufacturing by encouraging cooperation across public and private sectors to enhance efforts to reduce pollution throughout the supply chain.
6. Surveillance and research
Advance knowledge on WASH and wastewater causes of AMR by raising awareness among politicians and health officials of the importance of all WASH and wastewater management actions to fight AMR; strengthening surveillance and identifying primary sources and transport of antimicrobials and antibiotic resistant genes in different locations and sectors through a One Health lens; and reviewing existing policies and plans to determine their feasibility and cost effectiveness to address priority risks.
The technical brief on WASH and wastewater management to prevent infections and reduce the spread of AMR can be read here.