A second pandemic unfolds in silence: antimicrobial resistance’

“We need to restore our relationship with microorganisms,” writes Myrian Dumortier of Oikos in an opinion on Knack. Because microorganisms (bacteria, fungi and also viruses) adapt their properties to their environment through mutations, so also to the means we use to fight them. They’re becoming resistant. On top of the increase in infectious diseases and non-communicable diseases, harmless infections are gaining momentum: those infected by resistant sickeners cannot rely on antibiotics or other antimicrobials.

All multicellular organisms on Earth evolve in conjunction with microorganisms. Macro- and microorganisms cannot do without each other. A human consists of more microorganisms than its own cells. And although viruses are not full-fledged organisms, we count them here for convenience with the microorganisms.

The Global Assessment Report of the International Panel on Biodiversity and Ecosystem Services (IPBES) reports on the global biodiversity crisis, including the decline of the diversity of microorganisms in the human body. Causes of this decline include the presence of antibiotics and chemicals, industrially produced food and insufficient contact with microorganisms during childhood. A reduction in that diversity contributes to numerous non-communicable diseases such as asthma, allergies, inflammatory bowel diseases, diabetes, cardiovascular diseases, obesity, certain cancers, neurological disorders, autism and depression

All multicellular organisms on Earth evolve in conjunction with microorganisms. Macro- and microorganisms cannot do without each other. A human consists of more microorganisms than its own cells. And although viruses are not full-fledged organisms, we count them here for convenience with the microorganisms.

The Global Assessment Report of the International Panel on Biodiversity and Ecosystem Services (IPBES) reports on the global biodiversity crisis, including the decline of the diversity of microorganisms in the human body. Causes of this decline include the presence of antibiotics and chemicals, industrially produced food and insufficient contact with microorganisms during childhood. A reduction in that diversity contributes to numerous non-communicable diseases such as asthma, allergies, inflammatory bowel diseases, diabetes, cardiovascular diseases, obesity, certain cancers, neurological disorders, autism and depression

In addition to this loss of beneficial microorganisms, we are experiencing an increase in pathogenic microorganisms, so pathogens. They lead to new infectious diseases. The causes of this increase are diverse, but the decline of biodiversity, the escalation of global transport and climate change play an important role. Non-communicable diseases weaken our resistance to those infectious diseases.

Race between pathogens and antimicrobials

Ever since Alexander Fleming discovered penicillin in 1928, thanks to a microorganism, we have been fighting pathogens (and other microorganisms). Antimicrobials, such as antibiotics, help us to prevent or cure infectious diseases. In surgical interventions, they reduce the risk of complications. Modern medicine received a huge boost and hundreds of millions of lives were saved.

But microorganisms are evolving. Through mutations, they adapt their properties to their environment, including antimicrobials. The development of antimicrobial resistance is therefore inevitable. Those infected by resistant pathogens can no longer count on antimicrobials.

The overconsumption of antimicrobials accelerates the build-up of antimicrobial resistance and uncommunicable diseases gain importance. The fight against new infectious diseases also drives the use of antimicrobials, and many covid-19 patients are given these drugs to prevent or treat microbial complications. The fight is already complicated by antimicrobial resistance. And this while non-communicable diseases, such as diabetes and obesity, weaken us versus covid-19.

There is a constant race going on between pathogens and antimicrobials, with the latter appearing to be on the losing side. The more resistance a pathogen builds up, the more difficult it becomes to find new antimicrobials. Moreover, investment in this type of research is declining, partly because other pharmaceuticals are proving more lucrative. The result is that, on top of the increase in infectious diseases and non-communicable diseases, harmless infections are gaining momentum again.

The situation is of great concern to the World Health Organisation. Antimicrobial resistance is spreading like a tsunami around the world and threatens to drastically scale back advances in medicine. In 2016, 490,000 people struggled with antibiotic-resistant tuberculosis. The fight against AIDS and malaria, among others, is also being dealt a blow. The European Commission estimates the number of deaths from antimicrobial resistance in Europe at 25,000 to 33,000 per year. According to a UK review, antimicrobial resistance leads to 700,000 deaths worldwide per year (the same number as Covid-19 by early August 2020). By 2050, the number of deaths from antimicrobial resistance could reach 10 million a year. Little is known about the role of non-communicable diseases in this. For several reasons, the global south is once again in danger of being the biggest sufferer.

Intensive livestock farming and cheap mass production

The current overconsumption of antimicrobials is a result of unnecessary or incorrect administration, sometimes in combination with a lack of hygiene. However, the bulk of antimicrobials is not used in humans, but in animals. There they serve not only for the treatment and prevention of infectious diseases, but also for improving the growth of healthy animals. To this end, they are mixed in low doses in animal feed. In the EU, their use as a growth stimulator is now prohibited. In the US, the livestock sector accounts for 70 to 80% of the annual consumption of antimicrobials.

Although the data is incomplete, the World Food Organization estimates global consumption in the livestock sector at more than 60,000 tonnes per year. With the increasing demand for animal protein, this volume is only likely to increase. It is mainly industrial livestock farms, especially pigs and cattle, which are large consumers. Intensification of antimicrobials and the development of resistance also lead to increasing use of antimicrobials in fish farming. These resistant pathogens threaten our food production. They can also infect humans, or pass on resistance genes to pathogens that affect humans.

75 to 90% of antibiotics administered to livestock end up in wastewater or the environment via excretions. Between 70 and 80 % of the antibiotics administered in fish farming end in the water. Humans also contribute directly to this pollution. Not only antimicrobials, but also resistant pathogens end up in the environment. Even the production of antimicrobials leads to discharges in the environment. This production is mainly done in China and India, where wastewater is not so closely affected. Antimicrobials are found in large quantities in the environment where they cause even more build-up of resistance. In an Indian lake, resistance genes were found to almost all major groups of antibiotics.

Resistant pathogens spread, including through meat, fish, manure, water, crops, animals and humans, like a pandemic around the world. We are in danger of paying a heavy toll on the cheap mass production of antimicrobials.

Restoring our relationship with microorganisms

With our science and technology, we as humanity have achieved impressive achievements, not least in medicine. However, this led to hubris. Instead of using antimicrobials carefully and in a focused way of using public health and animal health, they became a plaything of economic laws. We thought we were masters of nature, but that was beyond the complexity of nature. The increase in pathogens, antimicrobial resistance and non-communicable diseases strikes us like a boomerang in the face.

In order to get modern medicine through this crisis, not only will we have to invest more in the development of antimicrobials, we will have to deal with these resources (and other technological achievements) much more economically and with them. We have to save them to protect us when we need to. Many biovestaires take great care of their animals and their environment and hardly use antimicrobials. If they do, it’s only curative. It is perfectly possible to drastically reduce the use of antimicrobials.

We need to restore our relationship with microorganisms, by being much more careful with all chemicals, by shudling industrial food and by allowing children to play much more in nature. It will benefit our resistance to pathogens and reduce the need for antimicrobials. We can also avoid pathogens by not providing them with a breeding ground, including by guaranteeing access to clean water worldwide and by sanitifying wastewater. But in order to free us from this vicious circle of more pathogens, more antimicrobials, more resistant pathogens and less resistance to pathogens, it will above all be necessary to unwind as a society, to consume less animal proteins and to be much more caring with nature.

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