Antimicrobial Resistance: Utilizing One Health to Prevent the Next Global Pandemic
By: Kelsey Roberston, MPH, Project Coordinator, HEAT-AMR Research Group
October 21, 2021
Kelsey recently joined the HEAT-AMR Research Group as a Project Manager. She holds a Master of Public Health degree from the University of Alberta, and previously studied nursing at the University of Toronto and global development at Queen’s University. She is interested in antimicrobial stewardship, health equity, and community-based research. Outside of work you’ll find Kelsey exploring the river valley with her dog or relaxing with a good book.
Imagine a world where infections cannot be treated, a world where antimicrobials that we have relied upon for decades are no longer effective. In this world, a simple skin infection may result in significant harm, food production would be substantially reduced, and health care would be pushed to the brink, caring for patients where antibiotics no longer work. This seemingly far off, apocalyptic scenario looks more real as we live through the ongoing COVID-19 pandemic. This post-antimicrobial world may be our new reality if we do not change the way certain medications are monitored and used.
Dr. Simon Otto - Assistant Professor and lead of HEAT-AMR at the University of Alberta School of Public Health, and Thematic Area Lead for Healthy Environments at the Centre for Healthy Communities - is tackling this wicked problem and working across sectors to protect a future with access to antimicrobials.
What Are Antimicrobials?
Antimicrobials refer to a broad range of medications that treat bacterial, viral, fungal, and parasitic infections. We are most familiar with antibiotics that we use to treat bacterial infections in humans, animals, and crops. Antimicrobials are important for human and animal medicine. They are also important in agriculture for animal health and welfare and for the health of produce. Antimicrobials support healthy communities and food production systems that collectively contribute to a thriving economy. But, their overuse and misuse can lead to the development of resistance. Antimicrobial resistance (AMR) is when microorganisms are no longer killed by the antimicrobials used to treat them. This occurs over time as microorganisms change and develop the capability to overcome the antimicrobial drugs. These resistant microorganisms get stronger, spread, and persist. Experts are warning that AMR will be the next global pandemic, leading to increased disease, death, and socio-economic costs worldwide (1).
The Next Global Pandemic
Compared to the current COVID-19 pandemic, the AMR pandemic is slow-moving but with critical long-term health and economic effects that will have a direct impact on communities. A recent review of the consequences of AMR in Canada, titled When Antibiotics Fail, recognized significant human, social, and economic harm (2). Costs to the health care system increase as people require longer, more complex care when suffering from resistant infections. The economy is affected through decreased productivity and a reduced workforce, and there are negative impacts on industries including food and trade systems. The socio-economic consequences of AMR are expected to increase over time and will not be felt equitably across communities, with those most vulnerable in our society being more affected. People with weaker immune systems, those living with multiple medical conditions, and people experiencing poverty or homelessness are at higher risk of resistant infections (2).
Though COVID-19 continues to have drastic acute global impacts, vaccination and public health measures have created a future view where these impacts will decline. In contrast, the wicked problem of AMR is broad and cumulative with a complexity that resembles climate change due to the global nature of the issues, the involvement of decision-makers from different sectors, importance of resources, and the severity of consequences that will continue to increase in the future (3).
A One Health Approach
As many sectors rely on antimicrobials, we must adopt an inclusive One Health approach to develop solutions. One Health acknowledges the interconnections between human, animal, and environmental health, and calls for sectors to work together to develop comprehensive solutions to pressing public health concerns. Dr. Otto advocates for the importance of One Health to frame conversations and, ultimately, solutions for AMR.
As Dr. Otto reports, “Antimicrobial resistance does not respect species boundaries and can spread easily between humans, animals, and the environment. Using a One Health approach to address AMR is crucial to promote healthy human and agricultural communities.”
The Need for Integrated Surveillance and Policy
Comprehensive monitoring systems are needed to generate information on how and why antimicrobials are being used to inform decisions about the best way to protect these precious resources. Dr. Otto recently led a team in partnership with the National Collaborating Centre for Infectious Diseases to evaluate the current landscape of antimicrobial use and resistance surveillance in Canada, resulting in the report Progress on Integrated Antimicrobial Resistance and Antimicrobial Use Surveillance in Canada (2014-2019) (4).
Through this project, a novel tool was developed to evaluate progress towards creating a sustainable and integrated surveillance system (5). The team identified limited monitoring capacity in community, animal, and environmental health, and limited resources to make the system truly integrated across One Health sectors. These limitations lead to gaps and challenges in how antimicrobial use and resistance are monitored and how information is shared between different levels of government.
This work highlights the need for integrating a One Health approach in policy-making. Human, agricultural and animal health should all be considered when developing solutions to tackle the wicked problem of AMR. Adequate funding and commitment by multiple stakeholders are needed to promote and sustain healthy communities through protecting current and future access to antimicrobials. Find out more about the work of Dr. Otto and his team by checking out the website: www.heat-amr.com.
References:
1) Nadimpalli ML, Chan CW, Doron S. Antibiotic resistance: a call to action to prevent the next epidemic of inequality. Nature medicine. 2021 Feb;27(2):187-8.
2) Finlay BB, Conly J, Coyte PC, Dillon JA, Douglas G, Goddard E, Greco L, Nicolle LE, Patrick D, Prescott JF, Quesnel-Vallee A. When Antibiotics Fail: The Expert Panel on the Potential Socio-Economic Impacts of Antimicrobial Resistance in Canada.
3) Harring N, Krockow EM. The social dilemmas of climate change and antibiotic resistance: an analytic comparison and discussion of policy implications. Humanities and Social Sciences Communications. 2021 May 21;8(1):1-9.
4) Otto SJ, Miazga-Rodriguez M, Saxinger L. Progress on Integrated Antimicrobial Resistance and Antimicrobial Use Surveillance in Canada (2014-2019). Winnipeg, MB: National Collaborating Center for Infectious Diseases. 2020 Dec:47.
5) Haworth-Brockman M, Saxinger LM, Miazga-Rodriguez M, Wierzbowski A, Otto SJ. One Health Evaluation of Antimicrobial Use and Resistance Surveillance: A Novel Tool for Evaluating Integrated, One Health Antimicrobial Resistance and Antimicrobial Use Surveillance Programs. Frontiers in Public Health. 2021:1119.