When antimicrobial resistance (AMR) is referred to what exactly does it mean?
Antimicrobial resistance is a situation where bacteria, viruses, fungi and parasites mutate over a period of time and no longer respond to previously effective treatments. This results in the persistence of infections with a resultant increased risk of spread to others. The micro-organisms that develop antimicrobial resistance are often referred to as “super-bugs”.
Pharmaceutical pollution in this context manifests as emissions of high concentrations of antibiotics from their manufacturing sites. This results for resistant bacteria and will contribute to the emergence of new forms of resistance in pathogens. Many scientists recognize such pollution as totally unnecessary and entirely unacceptable risk to global public health.
In 2001 the European Commission identified a link between antibiotic waste and the threat of super-bugs resulting from antimicrobial resistance, yet to date, no effective measures have been taken to prevent this, as stated:
“Currently there is no legally binding legislation, not even guidelines on how companies should dispose of their waste in an adequate, safe way.”
What are the sources of antimicrobial resistance?
It is recognised that the major reservoirs of antimicrobial resistance are humans, animals, and the environment and this propagates between interconnected ecosystems.
Particularly worrying is the emergence of antibiotic-resistant bacteria and antibiotic-resistant genes in the aqueous environment – this now being considered a major and escalating environmental health issue. The pharmaceutical industry and its questionable polluting practices is particularly implicated in this sector.
The effluent from pharmaceutical plants has a devil’s brew of large concentrations of antibiotics and antibiotic resistance genes, and these particular sites act as foci for environmental contamination and the subsequent spread of antimicrobial resistance. This results from inadequate effluent treatment and irresponsible disposal of such leading to disastrous antibiotic contamination of the environment.
A recent review stated:
“There are no regulations across the globe till date for the level of antibiotic residues in pharmaceutical effluent for the growing pharmaceutical industry.”
It further stated that:
“The environment risk approach and need to have indicators to measure environment risk is a way forward for all countries engage in antibiotic manufacturing.”
Antimicrobial resistance – what is the potential cost?
In 2016, the United Nations called an urgent meeting on antimicrobial resistance with policymakers to address the issue resistance comprehensively. They were of the opinion that the total number of deaths globally from antimicrobial resistance will be of the order of 10 million per year with associated economic losses of $10 trillion dollars.
Who are the worst culprits in this appalling scandal?
To produce these pharmaceuticals on the cheap and maintain their huge margins of profit, western companies have farmed out this production to notably India and China. China produces 80-90% of the world’s antibiotic APIs and India leads the production of the final dose products. Both of these countries have been implicated in pollution scandals at their manufacturing sites.
An example, as reported in The Lancet is the recent discovery of drug resistant bacteria at a number of manufacturing sites in three Indian cities – namely Chennai, New Delhi and Hyderabad.
It is noted that in India the regulations relating to the release of pharmaceutical waste into the environment in general, are minimal.
What can be done?
Transparency
The public should have availability of information about actual origin of Active Pharmaceutical Ingredients (APIs) and genuine evidence of appropriate manufacturing practice compliance of these APIs which are subsequently imported by the EU and the USA.
Enforcement of good practice
The World Health Organisation has issued good manufacturing practice guidelines for:
● Environmental protection
● Safety of the workplace
● Prevention of pollution
● Adoption of cleaner production technology
These should be statutorily adopted and enforced consistently in all the countries that are implicated in antimicrobial resistance.
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