Antimicrobial Resistance - Building Resilience and Sustainability To Solve Global Health Issues

There are no simple solutions to the complex health issues facing our world today, but an international research group is hoping their focus on resilience and sustainability will provide new approaches to the pressing issue of antimicrobial resistance (AMR).

Antimicrobials, including antibiotics, antivirals, antifungals and antiparasitics used to prevent and treat infections in humans, animals and plants, have been life-sustaining and critical to the maintenance of human and animal health.

Many of our current life-saving surgeries and treatments in both human and veterinary medicine are possible because of our ability to control associated bacterial infections. Furthermore, these medications have supported advances in modern agriculture by treating and controlling microbial and bacterial infections and helping ensure a safe, secure food supply.

But antimicrobial use comes with a cost when bacteria and other microorganisms become resistant to the medicines used to treat them, says Dr. Jane Parmley, an epidemiologist and One Health researcher at the University of Guelph’s Ontario Veterinary College (OVC). “As bacteria become more resistant, related infections can be harder to treat; humans and animals may be sick for longer impacting health care costs, days off work and childcare needs. How can we support behavior change to enable people to reduce antibiotic use without compromising their benefits?”

Parmley is part of a group of epidemiologists, public health experts, resilience experts and AMR experts from Canada, Switzerland and Sweden tackling this issue using a One Health lens.

The group’s study, AMResilience, is focused on learning and understanding how to build system resilience to sustainably tackle AMR. System resilience is the capacity of a system to adapt to rising levels of AMR while maintaining its core functions or to transform into an entirely different state in ways that sustainably limit AMR.

The project has two major goals: first, to identify promising interventions and the factors contributing to their success, and second, to explore elements that influence AMR in systems such as healthcare and agriculture to guide how potential interventions might work in the future.

“To do that, we need to understand what drives people’s decisions, what might be in their control and what might not be, to find solutions,” says Parmley. “To me, that means that you recognize the mess of connection. There’s not going to be one action, but we need policies that will promote health and help physicians, veterinarians, and others reduce their prescribing of antibiotics.”

The group tapped a broad array of expertise for that conversation, bringing together experts in antimicrobials, but also those with broader experience—educators, para-health professionals such as nutritionists, physicians, lawyers, food security professionals, and pharmaceutical industry personnel.

“We need to create these spaces for different professions and groups to come together and share ideas and perspectives,” adds Parmley. “I think that’s where we’re going to get some unique suggestions for how to address big challenges. Not just related to AMR, but for climate change, poverty and other global issues.”

For Parmley, this speaks to the importance of promoting health in humans and animals and enabling people to make healthy decisions. “That is the behavioral change element.”

She believes health promotion and harm reduction campaign tactics can guide the conversation for a multi-pronged approach to fight AMR. She points to lessons learned from tobacco cessation education and work to tackle opioids and other drug use.

“At the end of the day, none of those interventions will work if we don’t achieve sustainable development goals,” she adds. “If we still have people living in poverty and large parts of the global population without access to water, hygiene and sanitation, and without equitable access to healthcare, it won’t matter if we tax antibiotics or if we have better biosecurity—they’re simply not going to work.”

This study is funded through an operating grant of the 5th Joint Programming Initiative on Antimicrobial Resistance, grant #15521. The Canadian funding was provided by an operating grant from the Canadian Institutes for Health Research (Institute of Infection and Immunity, Institute of Population and Public Health). Visit the AMResilence website for more information at uoguel.ph/amresilience.

Originally published in the Fall 2022 issue of The Crest, the research, teaching and health care magazine of the Ontario Veterinary College.