Antimicrobial resistance (AMR) remains a top global public health threat affecting humans, animals and the environment. Its threats also extend to the global economy, impacting international trade, health care and productivity (WHO, 2023). Tackling this global threat, therefore, requires a holistic, comprehensive, and intersectoral One Health approach.

AMR Spread Across Human, Animal, and Environmental Health Sectors

AMR is prompted by several factors in human, animal and environmental health, which are essential pillars of the one health approach. Since human, animal, and environmental health are interconnected, it therefore holds that a problem in one sector can have far-reaching consequences in others. Animal infections, for example, can directly impact human health due to zoonotic transmission, which occurs when pathogens transfer from animals to humans. Similarly, a contaminated environment, whether caused by pollutants, garbage, or pharmaceutical residues, can harm wildlife, resulting in outbreaks of infections that may transfer to humans or destabilise ecosystems.

In animal production, for instance, excessive antibiotic use accelerates AMR development, which can then be transmitted to humans through the food chain, contaminated water, or direct contact. On the other hand, AMR associated with human healthcare can spread to animals and the environment through improper disposal of antimicrobial residues. Also, the environment plays a vital role in the spread of AMR. Mobile genetic materials like plasmids can facilitate the exchange of resistant genes among microorganisms (Tang et al., 2014). 

The Detrimental Effects of AMR 

AMR has severe effects on health care, from treatment failures and increased mortality rates to prolonged hospital stays, resulting in higher treatment costs and overall poor quality of life. AMR also has detrimental ecological implications, such as altered microbial balance where antibiotics used in agriculture, healthcare, and environmental management can alter the natural balance of microbial populations in soil, water, and water bodies. This imbalance may affect critical ecosystem services such as nutrient cycling, decomposition, and disease management. Antibiotic residues and resistant bacteria contaminating rivers, lakes, and seas via agricultural runoff, wastewater, and industrial discharge also threaten aquatic ecosystems and wildlife, resulting in disrupted food networks and biodiversity. 

Strategies for AMR Mitigation within a One Health Framework

Intersectoral collaborations between animal, human, and environmental health sectors have always been difficult to establish and sustain in addressing public health issues. For instance, collaborations are often initiated only in response to zoonotic outbreaks or emergencies in countries. The structure and systems established are usually short-lived, lasting only until a particular crisis is over, and the same process is repeated every time a new zoonotic disease emerges (Ong & Muhammed, 2015). This underlines the need for more permanent structures to work efficiently and be well-prepared to prevent and control public health issues such as the spread of AMR. There is also a need to intensify strategies such as antimicrobial stewardship, surveillance, infection prevention and control, policy development, and public awareness campaigns.

One Health Success Stories in Combating AMR and Enhancing Healthcare

Tunisia’s pioneering effort in combating AMR is a practical example of the potency of One Health in action. The country’s joint national action plan, signed in 2019 by the Health and Agriculture Ministers, demonstrates a steadfast commitment to tackling AMR. This success story highlights the effectiveness of inter-sectoral collaboration involving stakeholders from human, animal, and environmental health sectors, guided by international standards and strategies(WOAH, 2019). Similarly, Uganda’s One Health approach has contributed to the country’s effort to combat AMR by strengthening infection prevention and control, antimicrobial stewardship, multisectoral coordination, training health workers and reaching several healthcare facilities, serving as a model for other countries (Kiggundu et al., 2024).

Strengthening One Health Strategies to Combat AMR

If the current trends continue, it is projected that, by 2050, AMR could result in over 10 million deaths per year and over 100 trillion USD global economic loss (Chukwu, 2020). To effectively combat AMR, further research is needed in areas such as the impact of environmental contamination and the socioeconomic factors driving antibiotic misuse. There is also a need for more One Health-focused organisations at the international, national, regional, and local levels, with integrated missions to improve human, animal, and environmental health. Continued commitment to the One Health concept is essential to mitigating the spread of AMR and safeguarding the health of current and future generations (Kahn, 2012).

Conclusion

Understanding the interconnectedness of human, animal, and environmental health is essential for developing collaborative approaches that streamline efforts across sectors. By embracing the One Health framework, duplication of efforts will be reduced, and resources will be optimised, ensuring that all sectors work together toward the common goal of improved health. This unified approach will also foster sustainable and resilient health systems for the future.

References

Chukwu, E. E., Oladele, D. A., Awoderu, O. B., Afocha, E. E., Lawal, R. G., Abdus-Salam, I., Ogunsola, F. T., & Audu, R. A. (2020). A national survey of public awareness of antimicrobial resistance in Nigeria. Antimicrobial Resistance and Infection Control, 9(1). https://doi.org/10.1186/s13756-020-00739-0

Kahn, L. H. (2012). The Challenges of Implementing One Health. Retrieved from Science for global policy: http://scienceforglobalpolicy.org/publication/the-challenges-of-implementing-one-health/

Kiggundu, R., Waswa, J., Konduri, N., Kasujja, H., Murungi, M., Vudriko, P., Akello, H., Lugada, E., Muiva, C., Were, E., Tjipura, D., Kajumbula, H., Kikule, K., Nfor, E., & Joshi, M. P. (2024). A One Health approach to fight antimicrobial resistance in Uganda: Implementation experience, results, and lessons learned. Biosafety and Health. https://doi.org/10.1016/j.bsheal.2024.01.003

Tang, S. S., Apisarnthanarak, A., & Hsu, L. Y. (2014). Mechanisms of β-lactam antimicrobial resistance and epidemiology of major community- and healthcare-associated multidrug-resistant bacteria. Advanced Drug Delivery Reviews, 78, 3–13. https://doi.org/10.1016/j.addr.2014.08.003

World Health Organization: WHO. (2023, November 21). Antimicrobial resistance. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

World Health Organization: WHO. (2023a, June 22). WHO outlines 40 research priorities on antimicrobial resistance. World Health Organization. https://www.who.int/news/item/22-06-2023-who-outlines-40-research-priorities-on-antimicrobial-resistance

World Health Organization: WHO. (2022, May 9). One health. https://www.who.int/health-topics/one-health#tab=tab_1

World Organisation for Animal Health. (2019, October). Tunisia: A One Health success story in combating antimicrobial resistance and rabies. OIE News. https://bulletin.woah.org/wp-content/uploads/2019/10/OIE-News-October-2019-Tunisia-One-Health-success-story-on-AMR-and-Rabies.pdf