AMR is a major global challenge to health, and our capacity to prevent and treat common infectious diseases is at risk. The World Health Organization (WHO) states that AMR is driven by the misuse and overuse of antimicrobials (among other factors) [1], and weak regulation of over-the-counter medicines and inappropriate prescribing of AMs are identified as key health system challenges [2]. Whilst modern expectations of health and longevity have been made easier because of antibiotics, the achievements of modern medicine may be compromised as major surgery, cancer chemotherapy and organ transplants will become much more dangerous in the absence of effective antibiotics. 1.27 million deaths were caused by bacterial antimicrobial resistance (AMR) globally in 2019, with AMR infections associated with almost 5 million more [3]. In 2050, 1.91 million deaths attributable to and 8.22 million deaths associated with AMR may occur globally [4] with estimated annual costs of $2 trillion USD [5]. AMR has been identified as a “One Health” challenge, which means that the interactions between the health of humans, animals, plants and the wider environment must be addressed through multisectoral and interdisciplinary approaches. (N.B. The One Health field has long recognised the importance of human, animal and environmental interactions in AMR, but Planetary Health goes further, considering aspects of intergenerational justice and future risk, for example.) 73% of global AM use is for livestock, [6] and antibiotics continue to be used to promote animal growth [7]. It is important to understand how human health is impacted by other challenges of life in the ‘Anthropocene’ – a term used to describe the modern, human-modified world that has deviated from the natural environment we are adapted to through evolution – and how these intersect with AMR and climate change. For example, longer lives mean more people live into older age, when immune systems may be weaker and more at risk from pathogens; food may spoil more quickly in hotter temperatures leading to greater risk from foodborne pathogens; conditions such as cystic fibrosis can be lived with but at a cost to antibiotic usage.
[2] World Health Organization (2023b). People-centred approach to addressing antimicrobial resistance in human health: WHO core package of interventions to support national action plans. Geneva: World Health Organization; 2023.
[3] Murray, C. J. L. et al. (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet, 399(10325) 629–655.
[4] Naghavi, M. et al. (2024). Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050. The Lancet, 404(10459) 1199–1226.
[5] Morel, C. M. et al. (2020). A one health framework to estimate the cost of antimicrobial resistance. Antimicrob Resist Infect Control 9(187).
[6] Van Boeckel, T. P. et al. (2019). Global trends in antimicrobial resistance in animals in low- and middle-income countries. Science 365(6459).
[7] World Organisation for Animal Health. (Nov 2023). Use of antimicrobials as growth promoters: WOAH urges Veterinary Authorities and the animal industry to live up to their commitments.
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