Antimicrobial Resistance and Climate Change: A Global Crisis

  • The intersection of antimicrobial resistance (AMR) and climate change impacts human health, ecosystems, and socio-economic stability
  • AMR complicates disease treatment and medical procedures, while climate change alters disease dynamics, expands pathogen ranges, and threatens clean water and sanitation
  • Combined, AMR and climate change strain healthcare systems, exacerbate health disparities, and threaten food security, especially for vulnerable communities
  • Coordinated global responses integrating health, environmental, and developmental perspectives are needed to promote resilience, sustainability, and improved health outcomes
 
Antimicrobial Resistance and Climate Change: A Global Crisis
 
On September 26, 2024, the United Nations General Assembly will convene a High-Level Meeting on antimicrobial resistance (AMR) in New York. Drug-resistant infections transcend borders, making it impossible for any single country to tackle AMR on its own. This meeting offers an opportunity for global leaders to collaboratively address the threat that AMR poses to public health, food security, and the attainment of the 2030 Sustainable Development Goals. According to recent estimates, ~1.3m deaths worldwide in 2019 were caused by drug-resistant infections. If current trends continue, by 2050, AMR is projected to cause ~10m deaths annually, with costs to the global economy >US$100trn. Furthermore, this trend could force ~24m more people into extreme poverty over the next decade. These figures emphasise the threat posed by AMR, far surpassing the impact of COVID-19.

In the landscape of contemporary global health challenges, two significant and interconnected threats demand attention: AMR and climate change. These issues, though distinct in nature, share an interconnectedness that magnifies their collective impact on human health, ecological integrity, and socio-economic stability.

AMR poses a growing risk as microbes evolve to withstand the drugs designed to combat them. This phenomenon complicates the treatment of infectious diseases and jeopardises the effectiveness of medical procedures ranging from surgeries to cancer treatments. Concurrently, climate change exacerbates these challenges by altering disease dynamics, expanding the geographical range of vectors and pathogens, and compromising access to clean water and sanitation: fundamental prerequisites for health.

Moreover, the convergence of AMR and climate change intensifies the strain on vulnerable populations, exacerbates health disparities, and threatens food security and agricultural productivity. These issues transcend national borders, necessitating coordinated global responses that integrate health, environmental, and developmental perspectives. Hence, the UN meeting in September 2024, which marks only the second such gathering in its 79-year history. By recognising and addressing the interconnectedness of these dual crises, we can promote resilience, support sustainable development, and safeguard the wellbeing of present and future generations worldwide.
 
Understanding Antimicrobial Resistance

AMR refers to the ability of microorganisms - primarily bacteria, viruses, fungi, and parasites - to evolve and withstand the effects of antimicrobial agents, including antibiotics, antivirals, and antifungals. While this evolutionary process is natural, human activities have accelerated it, particularly through the overuse and misuse of antimicrobial drugs in human medicine, agriculture, and veterinary practices.
The consequences of AMR are extensive and multifaceted. In healthcare settings, infections that were once treatable with common antibiotics are becoming increasingly difficult, if not impossible, to cure. This resistance leads to prolonged illnesses, longer hospital stays, higher medical costs, and increased mortality rates. Moreover, the rise of multidrug-resistant strains poses a threat to medical procedures, such as surgeries, chemotherapy, and organ transplants, which rely on effective antimicrobial prophylaxes and treatment.
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Beyond healthcare, AMR threatens food security and safety. The widespread use of antimicrobials in agriculture to promote growth and prevent disease in livestock leads to the development of resistant bacteria that can enter the food chain. These resistant strains can then be transmitted to humans through the consumption of contaminated food, direct contact with animals, or environmental pathways, such as water and soil.

The environmental impact of AMR is also significant. Antimicrobial residues from pharmaceuticals, agricultural runoff, and waste from healthcare facilities can persist in the environment, promoting the development and spread of resistance among environmental microorganisms. This environmental reservoir of resistance genes can transfer to human and animal pathogens, further complicating the management of infectious diseases.

Addressing AMR requires a comprehensive and coordinated approach, including the promotion of responsible antimicrobial use, investment in research and development (R&D) of new drugs, and the implementation of robust surveillance systems to monitor resistance patterns. Public awareness and education on the prudent use of antimicrobials are equally important in mitigating this global threat.
 
The Rise of Climate Change

Climate change presents a distinct and significant set of challenges to global ecosystems and human societies. Primarily driven by anthropogenic activities such as the burning of fossil fuels, deforestation, and industrial emissions, climate change manifests in rising global temperatures, altered precipitation patterns, more frequent and severe extreme weather events, and sea-level rise. These changes disrupt ecosystems, endanger biodiversity, and threaten human livelihoods, particularly in vulnerable communities with limited resources to adapt.

The implications of climate change are far-reaching and complex. Increased risks of natural disasters, such as hurricanes, floods, and wildfires, lead to loss of life, property damage, and economic instability. Altered precipitation patterns can result in prolonged droughts in some regions and excessive rainfall in others, affecting agricultural productivity and leading to food and water insecurity. As these climatic conditions shift, they also change the habitats and behaviours of disease vectors like mosquitoes and ticks, altering disease patterns and potentially introducing new health threats to populations unaccustomed to such risks.

These environmental shifts have indirect effects on human health, exacerbating existing health disparities and amplifying the burden on healthcare systems already strained by other challenges, such as AMR. The displacement of populations due to rising sea levels, extreme weather events, and deteriorating living conditions further compounds these issues, creating climate refugees who require humanitarian assistance and healthcare support.
 
Convergence of Threats

The convergence of AMR and climate change amplifies their individual impacts, creating a scenario where each phenomenon exacerbates the effects of the other. This interplay is illustrated through several mechanisms. Climate change significantly alters ecological systems, influencing the geographic distribution and prevalence of infectious diseases. Warmer temperatures, for example, can expand the range of disease vectors like mosquitoes, leading to increased transmission of diseases such as malaria and dengue fever. In a context of AMR, where effective treatments for these diseases are diminishing, the burden on healthcare systems and affected populations intensifies, making it harder to manage and control outbreaks.

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Climate change-induced extreme weather events, such as hurricanes, floods, and heatwaves, pose risks to healthcare infrastructure and services. Disruptions in healthcare provision can compromise infection control measures and lead to increased transmission of resistant pathogens within healthcare settings. Moreover, displaced populations and compromised living conditions post-disaster create environments conducive to disease outbreaks, further challenging already strained healthcare resources. The vulnerability of healthcare infrastructure to climate-related disruptions emphasises the need for resilient systems that can withstand and adapt to these changes.
Agriculture is both a contributor to and influenced by climate change. Changing weather patterns impact crop yields and livestock production, leading to shifts in agricultural practices, including the increased use of antimicrobials in animal husbandry to prevent disease and promote growth under stressful conditions. Global antimicrobial use in food animal production was ~63,151 tons in 2010 and is expected to increase by ~67% to ~105,596 tons by 2030. Around 80% of food-producing animals and birds receive medication for at least part of their lives. Antimicrobials used in food animals constitute ~80% of the total antimicrobial consumption in the US each year. Most of the global rise (~67%) in antimicrobial use is driven by the growing population of animals raised for food.

Increased temperatures and altered precipitation patterns also impact food safety, with potential implications for foodborne illnesses caused by resistant pathogens. These agricultural shifts not only shape food security but also introduce resistant bacteria into the food chain and the environment, posing further risks to human health.

Climate change also affects global trade routes and patterns, influencing the movement of goods and people. This interconnectedness facilitates the spread of infectious diseases and resistant microbes across borders, complicating efforts to contain AMR on a global scale. The emergence of new pathogens and resistant strains in different regions points to the need for coordinated international efforts to address these interconnected challenges. The combined threats of AMR and climate change necessitate comprehensive, integrated strategies that involve local, national, and global collaboration to mitigate their multifaceted impacts. Addressing these interconnected challenges is essential for promoting public health, environmental sustainability, and global socio-economic stability.
 
Projected Impact and Future Scenarios

The projected impact of the combined threats of AMR and climate change paints a distressing picture for global health and wellbeing. As AMR reduces the effectiveness of existing treatments, healthcare systems face increased pressure to develop new antimicrobial agents. However, the pipeline for new antibiotics is limited due to scientific and economic challenges. Climate change-induced health crises further strain these systems, potentially overwhelming their capacity to respond effectively. The economic burden of AMR is substantial. The World Bank estimates that AMR could result in ~US$1trn additional healthcare costs by 2050, and ~US$1trn to ~US$3.4trn gross domestic product (GDP) losses per year by 2030. Climate change exacerbates these costs through disruptions to agricultural productivity, healthcare expenditures, and labour productivity. Socio-economic disparities are likely to widen as vulnerable populations bear the brunt of these combined impacts, leading to increased poverty and reduced access to essential services.

Ecosystems, which provide services such as water purification, carbon sequestration, and biodiversity maintenance, are also under threat. Climate change and AMR compromise these services, undermining environmental resilience and exacerbating the vulnerability of both natural and human systems. The degradation of ecosystems can lead to the loss of biodiversity, further disrupting ecological balance and increasing the spread of resistant pathogens. As these environmental and health challenges intensify, the global community faces a future where traditional methods of disease control and prevention may no longer be effective, necessitating innovative approaches and robust international cooperation to safeguard human health and maintain ecological stability.
 
Mitigation and Adaptation Strategies

Tackling the intertwined challenges of AMR and climate change requires well-coordinated, comprehensive strategies implemented at local, national, and global levels. Enhanced surveillance and monitoring systems are important for tracking resistant pathogens and infectious diseases, allowing for early detection and response. Integrating environmental and climate data into these surveillance frameworks provides a more detailed understanding of disease dynamics and antimicrobial use patterns, helping to identify and address emerging threats more effectively.

Promoting the sustainable use of antimicrobials in human medicine, agriculture, and veterinary practices is essential to mitigate the spread of resistance. This involves advocating for responsible prescribing and use, implementing regulations to curb overuse and misuse, and promoting alternative practices such as vaccination and improved hygiene. These measures can reduce reliance on antimicrobial agents and slow the development of resistance.

Building resilient healthcare infrastructure capable of withstanding climate-related disruptions is critical for maintaining health services during crises. This includes enhancing infection prevention and control measures, improving disaster preparedness, and ensuring access to essential healthcare services during and after extreme weather events. Strengthening healthcare systems' capacity to cope with both AMR and climate impacts can prevent service disruptions and manage disease outbreaks more effectively.

Mitigating climate change through emissions reduction and adaptation strategies is crucial for reducing the frequency and severity of climate-related health impacts. Investing in renewable energy sources, promoting sustainable agricultural practices, and developing resilient urban planning are integral to these efforts. Such investments address climate change and support broader efforts to combat AMR by reducing environmental pressures that contribute to resistance.

International collaboration and governance frameworks are indispensable in addressing the global challenges posed by AMR and climate change. These frameworks should promote information sharing, capacity building, and equitable access to resources. Global health agencies, such as the World Health Organisation (WHO) and the Food and Agriculture Organisation (FAO), play pivotal roles in facilitating collaboration and setting international standards for antimicrobial use and climate resilience.

An approach that integrates health, environmental, and socio-economic considerations is necessary to effectively tackle these threats. By investing in R&D, promoting sustainable practices, and fostering international cooperation, the global community can develop strategies to mitigate the impacts of AMR and climate change. Such an approach will help safeguard public health, enhance ecological stability, and ensure socio-economic resilience, ultimately securing a healthier and more sustainable future for all.
 
Takeaways

The interconnected threats of AMR and climate change demand urgent and coordinated global action. Each poses challenges to human health, the environment, and socio-economic stability, but their convergence magnifies the impact, creating a complex web of risks that transcends borders and disciplines. Addressing these threats requires integrated strategies that recognise their interconnectedness, fostering resilience through sustainable practices, robust healthcare systems, and international cooperation. By enhancing surveillance, promoting responsible antimicrobial use, and mitigating climate change, we can build a future that not only curbs the rise of resistance and mitigates environmental degradation but also strengthens the foundations of global health and ecological integrity. The path forward necessitates innovation, investment, and a unified global commitment to safeguard the wellbeing of current and future generations. Let us hope that the United Nations General Assembly meeting in September 2024 to address this issue will energise international responses.

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