Antimicrobial resistance, or AMR, is the process by which microbes—including bacteria, viruses, and parasites—become resistant to antimicrobial drugs, making infections difficult or impossible to treat. In the case of bacteria, this resistance applies specifically to antibiotics. Antibiotics underpin modern medicine, and recent evidence suggests that between 1-5 million people die each year globally from antibiotic-resistant infections alone. If current trends continue, it is predicted that 10 million people will die each year globally, and that AMR will be the leading cause of death by 2050.
Overlying the core chemistry and biology of AMR are human sociocultural drivers, including large-scale use of antibiotics in medicine and food production, globalisation and the movements of people, animals and microorganisms. Resistant bacteria, and antibiotic residues that are not broken down, are present in human and animal waste that enters rivers and coastal environments, or is eventually applied onto land as fertiliser, penetrating the soil.
The large-scale and long-term shift in average global temperatures and weather patterns is known as climate change. Climate change is a natural process being rapidly aggravated by human activity. Industrialisation, mass changes in land use and human movement, pollution and biodiversity loss are all interrelated and contribute to climate change. AMR is also part of this web of cause-and-effect: heavy rainfall and flooding help transmit resistant bacteria through water systems, and there is a link between rising temperatures and AMR infections.
Pollution is the introduction of substances into the natural environment at a rate faster than the environment can process them. Pollution can be from natural causes (volcanic ash, for example), but it is largely a byproduct of human activity. Pollution contributes significantly to climate change – seen primarily through the pollution of air with greenhouse gas emissions, which are a byproduct of industrial activity. Pharmaceutical pollution – the byproduct of drug and antibiotic manufacture – increases the transmission of antimicrobials in the natural environment, affording environmental bacteria the opportunity to develop antimicrobial resistance.
The Triple Planetary Crisis refers to the three main interlinked issues that humanity currently faces: climate change, pollution and biodiversity loss. These phenomena are included within the Planetary Boundaries concept. Biodiversity – all the different forms of life on our planet – includes microbial diversity, that both underpins ecosystem function and features microorganisms that produce the antibiotics we have harnessed to treat infection. Microbial biodiversity also includes reservoirs of antibiotic resistance mechanisms that are continually emerging in human pathogens. It’s therefore critical to understand the intersection of human-induced climate change, pollution, and changes in biodiversity – three prominently breached planetary boundaries – in the context of the AMR pandemic.
Planetary Health has been described by the Lancet Commission on Planetary Health as ‘the health of human civilisation and the state of the natural systems on which it depends’. AMR and Planetary Health share an overall concern with sustainability, which is at the heart of Planetary Health’s call for ‘the ability of a society to make choices that are beneficial to its long-term survival’.
Applying a Planetary Health framework to the existing conceptual frameworks employed across other funded networks will facilitate the generation of knowledge into an understandable, logical order that is accessible to all.
Human Health is rooted in planetary health and treating these as distinct undermines improvements to both.
Prof Liam Smeeth, Dr Vanessa King and Laxman Narisimhan