Antimicrobial resistance (AMR) stands out as one of the most pressing and intricate global health threats of our time. This escalating crisis bridges human, animal, and environmental health, threatening not only healthcare systems but also economies, ecosystems, and communities worldwide. At its root lies the unchecked and improper use of antibiotics across various sectors, creating a challenge that demands breaking down traditional boundaries.
The One Health framework, which recognises the interconnected nature of health threats shared by humans, animals, and the environment, offers the most comprehensive solution to combating AMR. However, despite growing acknowledgment of its importance, translating this approach into meaningful, tangible actions remains a significant hurdle.
AMR’s complexity stems from its multifaceted drivers. In human health, the overuse of antibiotics in clinical settings continues to fuel the rise of resistant pathogens. This issue is particularly severe in regions with inadequate healthcare infrastructure, where limited access to proper treatments often leads to the misuse of antibiotics.
Beyond clinical settings, AMR is deeply embedded in agricultural practices. The widespread use of antibiotics in livestock production to promote growth and prevent disease has led to the emergence of resistant bacteria, which can spread to humans through food chains, direct contact, or environmental exposure. The environmental impact is equally alarming, with antibiotic residues from pharmaceutical and agricultural waste polluting water and soil, creating reservoirs for resistant bacteria and facilitating the global dissemination of resistant genes.
Complicating matters further, AMR is intrinsically linked to broader global crises such as climate change and transformations in food systems. Climate shifts are altering ecosystems, impacting infection patterns, and driving the misuse of antimicrobials. Meanwhile, AMR exacerbates the burden of non-communicable diseases (NCDs) by restricting effective treatments for infections that occur as complications of chronic illnesses.
Global action: successes and gaps
Although AMR has garnered global attention, significant deficiencies persist in addressing it comprehensively. The recent UNGA Declaration on AMR highlighted the urgency of coordinated action across human, animal, and environmental sectors. However, it fell short of the ambitious targets required to combat the crisis effectively. For instance, proposals to reduce antimicrobial use in agriculture by 30% over six years were diluted into vague commitments, largely due to pushback from powerful agricultural and pharmaceutical industries. This compromise underscores the persistent tension between public health priorities and economic interests.
Civil society advocates have consistently warned that voluntary pledges alone will not suffice. Without enforceable targets and robust regulations, progress in curbing AMR will remain uneven and insufficient to address the crisis.
The promise of the One Health approach
Despite these challenges, the One Health framework presents a pathway for transformative change. By adopting an integrated approach that aligns human, animal, and environmental health efforts, the following “win-win” outcomes can be achieved:
- Economic Gains: Modelling studies suggest that by 2050, AMR could disrupt food supplies for over two billion people and add $159 billion annually to healthcare costs. Investments in innovation and healthcare can yield a return of $28 for every dollar spent, as highlighted by the EcoAMR series.
- Environmental Protection: Implementing better waste management and regulating antibiotic use in agriculture can reduce environmental contamination, protecting ecosystems and biodiversity.
- Equity and Human Rights: AMR disproportionately affects low- and middle-income countries, where healthcare systems are already fragile. Addressing AMR through One Health promotes health equity by ensuring access to life-saving treatments and reducing global health disparities.
The role of Civil Society
Civil society organisations (CSOs) play a pivotal role in advancing the fight against AMR. In Europe, groups such as the European Public Health Alliance (EPHA), Health Care Without Harm (HCWH), and ReAct have been instrumental in raising awareness, fostering collaboration, and advocating for AMR to remain a policy priority. These organisations contribute through:
- Educating the public and healthcare professionals on antimicrobial stewardship.
- Building narratives that emphasise the importance of the One Health approach.
- Advocating for its prioritisation on national, regional, and global agendas.
- Promoting transparent and evidence-based policymaking.
- Developing communities of action to drive One Health initiatives globally.
To sustain this vital work, it is imperative that governments and international bodies provide long-term funding and support. The recent resolution on Social Participation for Universal Health Coverage offers hope, as it commits member states to strengthen civil society involvement in health policymaking.
Conclusion
Antimicrobial resistance is a test of our collective ability to tackle interconnected and complex challenges. A One Health approach provides a comprehensive framework for addressing AMR but demands bold leadership, enforceable commitments, and steadfast collaboration among governments, industries, and civil society. With the right actions, AMR can be curbed, protecting lives, ecosystems, and economies for generations to come.
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Disclaimer: the opinions – including possible policy recommendations – expressed in the article are those of the author and do not necessarily represent the views or opinions of EPHA. The mere appearance of the articles on the EPHA website does not mean an endorsement by EPHA.