By 2050, more people may die of drug-resistant infections every year than of cancer, which equates to more than 10 million annual deaths globally. The World Bank estimates antimicrobial resistance could cost the global economy $1 trillion every year after 2030.
The Medical Research Future Fund, set up to generate an additional and significant funding stream for Australian medical research, last week retained antimicrobial resistance as a priority with one significant difference: the insertion of the words “One Health”.
A One Health approach recognises that the health of people, animals and the environment is intimately connected.
In 2016 the United Nations General Assembly expressed concern about antimicrobial resistance and, earlier this year, the World Health Organisation, the Food and Agricultural Organization and the body that represents the World Organisation for Animal Health, the OIE, agreed to step up joint action to combat health threats associated with interactions between humans, animals and the environment.
Globally there has been a surge of action to reduce the threat of antimicrobial resistance. It includes new schemes and funds to promote the development of new antibiotics, as well as public and health sector campaigns against unnecessary and inappropriate prescribing of antibiotics for humans and animals.
However, more can be done. Bacteria that carry multidrug resistance do not respect our geographical borders. They are consummate travellers adept at passing on their genetic cargo, passing antibiotic resistance to other bacteria.
Globally we know very little about the levels of circulating drug resistance in water or non-human antimicrobial resistance reservoirs. But we do know that the information is country-specific and dynamic: it will change from year to year, vary across a region and is inevitably increasing.
A significant proportion of antibiotics are excreted un-metabolised into the environment and many will make it past our sewage treatment plants and into our waterways. This has ramifications for production of safe fresh food, which can also be adversely affected by the use of organic fertilisers on farmland. Once we pick up drug-resistant bacteria, they can be passed easily from person to person.
Currently there are approximately 200, 000 healthcare-associated infections each year in Australia, accounting for 2 million hospital bed days. When infections are drug resistant, treatment costs soar – from time spent in intensive care units to multiple courses of antibiotics and sometimes disability.
Much of the resistance in human infections in Australia now comes from the community. People unsuccessfully treated with antibiotics through primary care may end up in hospital and receive further medications that can worsen resistance.
In this era of globalisation, Australia needs technologies that will enable us to adapt and minimise the unprecedented risk of antimicrobial resistance.
A One Health-based bacterial surveillance system, coupled with training to support judicious use of medications, would contribute to global efforts to combat antimicrobial resistance.
Fortunately, through research collaborations such as Ausgem, between UTS and the NSW Department of Primary Industries, we have the technology to be a leader in One Health surveillance of antimicrobial resistance.
Scientists have already sequenced the genomes of thousands of bacteria – both good (commensals) and bad (pathogens) – isolated from people, fresh produce, animals and the environment to track and trace the spread of antimicrobial resistance genes. This is helping to build a comprehensive picture of antimicrobial resistance.
This approach will help us to make data-driven decisions around targeted antibiotic use (in livestock and people) and outbreak risk (including the source of infection). It will also aid understanding of emerging resistance via known and (currently) unknown mechanisms.
A One Health-based bacterial surveillance system, coupled with training to support judicious use of medications, would contribute to global efforts to combat antimicrobial resistance. The intelligence gained would also be a national resource that could add value to the electronic health records system, assist monitoring of resistance in human health, and help policy makers and health professionals improve intervention strategies and allocate resources more effectively. This will save lives, reduce healthcare costs, prolong the effectiveness of our antibiotics and, ultimately, save modern medicine as we know it.
However, informed decision-making is possible only when the data includes the full spectrum of information. Without this knowledge of antimicrobial resistance, Australia will struggle to make good on its desire to be “the healthiest nation on earth”, as outlined in Innovation Science Australia’s 2030 strategic plan.
To read more about the Medical Research Future Fund’s One Health priority, click here.
Dr Branwen Morgan is general manager of the Australian Centre for Genomic Epidemiological Microbiology (Ausgem), a research partnership between UTS and the NSW Department of Primary Industries. Professor Steve Djordjevic is the UTS lead for Ausgem.