Opinion: Break down barriers to deal with drug resistance

The COVID-19 pandemic has thrown a spotlight on the growing crisis of antibiotic resistance and the urgent need for global efforts to prevent this challenge from taking root. Much attention has been focused on how humans misuse antibiotics — either because they lack access to appropriate treatment or fail to complete antibiotic treatment due to lack of funds.

But unless we start looking beyond humans and recognize how the use of antibiotics in animals impacts our broader effort to reduce human antibiotic resistance, then we are unlikely to succeed in the long term.

The indiscriminate use of antibiotics for COVID-19 patients could lead to 10 million deaths by 2050, by some counts, if nothing is done about the menace of antimicrobial resistance. Most of the deaths are likely to occur in Asia and Africa. The COVID-19-exacerbated abuse of a wide array of broad-spectrum antibiotics will no doubt promote the spread of resistant microorganisms, especially in developing countries where such drugs are often readily available over-the-counter.

Antimicrobials cover all drugs used to treat bacteria, fungi, protozoa, etc., while antibiotics just act on bacterial agents. Last year’s World Health Organization antimicrobial resistance surveillance report revealed an alarmingly high level of antimicrobial-resistant infections with high levels of resistance to last-resort antibiotics such as carbapenems. These carbapenems are a class of highly effective antibiotic agents commonly used for the treatment of severe or high-risk bacterial infections.

The COVID-19 pandemic has illustrated the potential long-term dangers when variants emerge, which is a critical concern at the core of rising drug resistance. There are many drivers of antibiotic resistance but key among these are the abuse and misuse of medicines in human, animal, and environmental sectors — and the spread of already resistant bacteria within and between these sectors.

Rarely regulated, this overuse in agriculture to prevent diseases or even promote growth is a cause of great concern as these medications eventually enter the food system.

I was involved in a 2017 study assessing the antibiotics resistance profile of the bacteria isolated from live catfish obtained from a market in Ibadan, Nigeria. We found a range of bacteria with multiple antibiotic resistance. These products with antibiotic resistance, in turn, enter the food chain for humans and livestock.

Another blind spot was antibiotic resistance bacteria in slaughterhouse runoff coursing into a river in Abeokuta. The study confirmed that the untreated wastewater had huge potential for transmitting antibiotic resistant bacteria with real risks for public health and food safety.

The rising rate of emerging and reemerging infectious diseases — especially in view of well-documented antibiotic misuse related to COVID-19 treatment — has heightened concerns about antimicrobial resistance.

Additionally, COVID-19 has led to increased usage of disinfectants and antimicrobial soaps, which contain antimicrobials. This may lead to an increase in their concentration in wastewater with a potentially negative impact.

As with all virus infections, lowered immunity makes patients susceptible to opportunistic bacterial infections. The paradox, therefore, is that an increase in antibiotic resistance would mean that COVID-19 patients would succumb to such infections because the antibiotics being administered are no longer effective.

We must consequently work across disciplines — human, animal, and agricultural — to limit the use of these antimicrobials. If we want to curb the scourge of antibiotic resistance, our only hope is to use the One Health approach. Employing such an approach at the local, regional, national, and global levels recognizes the interconnection between people, animals, plants, and their shared environment.

With most resources being deployed toward combating COVID-19, it is important to allocate funding and support for related antimicrobial resistance that is spreading in the pandemic panic.

If we want better antimicrobial stewardship, then a workable strategy must be holistic, with interventions directed toward different professions and disciplines involved in the issue. Sustainable solutions will involve everybody from the health workers, veterinarians,  pharmacists, policymakers, professional societies, and the pharmaceutical industry.

Reducing the use of antibiotics in food-producing animals and banning the use of antibiotics as growth promoters will preserve the current and future benefits of antibiotics for humans and animals.

Antibiotic resistance is one of the major challenges facing animal and human health. If we do not act now, we miss an opportunity for a cost-effective intervention that can support long-term coalition building to promote health for all.