The public health crisis of Antimicrobial Resistance is escalating at an alarming rate in India, with 297,000 deaths directly attributed to it and an additional 1,042,500 associated with it in 2019 alone. Addressing the AMR crisis calls for comprehensive action. In this context, the role of wastewater treatment plants often takes a backseat. This report underscores that these treatment plants can be potent, yet underutilized tools in curtailing the rise of AMR.
Core Contributors to AMR
1. Injudicious Use of Antimicrobial Drugs: Overconsumption of these drugs due to improper prescription practices necessitates a reassessment to limit unnecessary usage.
2. Over-the-Counter Availability: Lack of awareness, misinformation, and economic constraints drive the rampant use of unregulated medication, highlighting the urgent need for improved medication use, education and accessibility.
3. Climate Change: Often overlooked, climate change is a significant player influencing AMR; a comprehensive, multidisciplinary approach is essential to mitigate its impact.
4. Pharmaceutical Industry Growth: The irresponsible disposal of pharmaceutical waste, along with the environmental pollution it causes, necessitates the adoption of more sustainable practices.
5. Antibiotic Use in Livestock: The extensive use of antibiotics in livestock is a significant contributor to AMR. There is an urgent need for regulatory measures to control this usage.
6. Impact on the Food Industry: The explosive 577% increase in poultry consumption in the past three decades underlines the critical need for measures to limit non-therapeutic antimicrobial use.
Potential of Wastewater Treatment Plants in AMR Mitigation
Wastewater treatment plants can play a pivotal role in the battle against AMR. The effective treatment of wastewater can reduce the concentration of antibiotic residues and lower the prevalence of antibiotic-resistant bacteria and transfer of antimicrobial resistance genes, disrupting their potential to spread. Three key benefits are:
1.Reducing Antibiotic Concentrations: The effective treatment of wastewater can reduce the concentration of antibiotic residues, limiting the exposure of microbes to these drugs and thus hindering the development and spread of resistant strains.
2. Minimizing Resistant Bacteria: Wastewater treatment processes can mechanically or chemically eliminate or reduce populations of resistant bacteria, curtailing their release into the environment.
3. Degradation of Antibiotics: High-tech treatment systems can degrade antibiotics which would, in turn, decrease their contribution to AMR.
Wastewater treatment plants hold significant potential as real-time surveillance systems in the fight against Antimicrobial Resistance. By analyzing the structure and content of wastewater, data regarding the epidemiology of antibiotic-resistant bacteria within a community can be obtained. This essentially makes these plants strategic hotspots for tracking the spread and emergence of novel antibiotic-resistant strains. The acquired data is invaluable as it provides insights that help in forecasting AMR trends, planning targeted interventions, and evaluating the effectiveness of implemented antimicrobial stewardship programs. Thus, wastewater monitoring can be instrumental in shaping informed and responsive public health policies against AMR.
Conclusion: Activating the Potential
Taking everything into account, it becomes evident that wastewater treatment plants could be indispensable in our fight against AMR. Our strategy must activate this huge potential by boosting related investment and development, and by enhancing and expanding current facilities. An effective treatment process, extensive monitoring and improved infrastructure for wastewater treatment, could enable us to fight back against the menace of antimicrobial resistance.
Key Proposals for Action: To fight against AMR effectively, strategic efforts are needed:
1. Increased Investment in AMR Research: Raising the investment in AMR related research from the current measly 0.01% of total health research expenditure is essential.
2. Creation of a Regulatory Body: A dedicated body to oversee antibiotic consumption addresses the issue of unapproved use of drugs that currently rests at 47.1%.
3. Investment in Enhanced Diagnostic Facilities: Reliable diagnostic facilities are crucial for the collection of primary data used in informed decision-making.
4. Expansion of ICMR’s Scope: Broadening the range of the Indian Council of Medical Research to include surveillance of animals, environment, and food will enable us to get a comprehensive picture of the AMR situation.
5. Strengthen Wastewater Treatment Facilities: Capital investment for the enhancement and expansion of wastewater treatment facilities, along with the incorporation of advanced technologies, is crucial in maximizing their potential in AMR mitigation.
By acknowledging and leveraging the potential of wastewater treatment plants, India can take significant strides towards mitigating the devastating effects of antimicrobial resistance. It is imperative for the collective health of the nation to prioritize and execute effective measures in this public health crisis. The time to act is now.
