Antimicrobial resistance is recognised as one the greatest threats to human health as acknowledged in a series of authoritative reports in Ireland and elsewhere[1]. It is estimated that by 2050, unless action is taken, 10 million deaths per year will be attributable to antimicrobial resistant infections[2]. The antimicrobial resistance crisis compounds the impact of infectious diseases (epidemics and pandemics) in over one-third of the world’s population. Food-borne and water-borne disease are a leading cause of morbidity and mortality globally, with antimicrobial resistant organisms making treatment increasingly difficult. The COVID-19 pandemic has made us all very aware of the power of microorganisms and the impact these tiny organisms can have on every aspect of our lives. What many people may not realise is that we have been facing the silent pandemic of antimicrobial resistance for several years.
Superbugs
So what is antimicrobial resistance? Antimicrobial agents are important drugs that we have been using to treat infection caused by microorganisms since the end of World War II. Antimicrobial agents are not only used to treat infection in humans but are also widely used in veterinary medicine, agriculture and food production. Unfortunately antimicrobial resistant bacteria, often called “superbugs” are appearing and spreading all over the world and some of these superbugs are resistant to almost all of the antimicrobial agents we have. This means we are now facing the very real threat of going back to a pre-antimicrobial era. If these superbugs continue to spread, we will no longer be able to treat infection effectively. Without effective antimicrobial agents we will not be able to safely carry out many of the medical interventions we take for granted today, such as many surgeries and cancer treatments. We use large amounts of antimicrobial agents in both human and veterinary medicine every day, and not always correctly. When antimicrobial agents are given to a person or an animal they affect bacteria throughout the body, not just the bacteria that are causing the infection. Bacteria have been around for billions of years, they are excellent survivors and as such, they have developed a rich resistance repertoire to external stressors. Therefore the more often we expose bacteria and other microorganisms to antimicrobial agents, applying selective pressure, the more likely they are to change and develop ways to survive and become resistant. Worryingly, these resistant bacteria and indeed a large proportion of the antimicrobial itself may then be shed into the environment in human and animal faeces.
The One Health Concept
Antimicrobial resistance not only impacts on human health but has major implications for our animals, food production systems, environment and economy. The One Health concept recognises that the health of humans, the health of animals and the health of our environment are interlinked. Governments around the world are taking a One Health approach to combat antimicrobial resistance. The World Health Organisation Global Action Plan on Antimicrobial Resistance5 sets out five key ways to tackle the challenge of antimicrobial resistance. The Irish government has adopted this approach and published Ireland’s National Action Plan on Antimicrobial Resistance in October 2017. Professor Morris and the Antimicrobial Resistance and Microbial Ecology (ARME) Group at NUI Galway are actively engaged in the development of the second revision of Ireland’s National Action Plan on Antimicrobial Resistance (iNAP 2)[1]. Achievement of the five key strategic objectives of iNAP reflect Ireland’s endorsement of and contribution to the EU One Health Action Plan on AMR[2] and the WHO Global Action Plan on AMR[3]. Generation of scientific evidence through One Health research is key to achievement of these strategic objectives and Ireland’s contribution to tackling this global challenge.
We all need to get involved
Tackling the global challenge of antimicrobial resistance requires everyone to get involved. Conscious of this, the ARME group are committed to translation of research into policy and effective communication with all stakeholders, including the public. As Director of the Ryan Institute Centre for One Health, Prof. Morris has established a successful outreach programme to highlight One Health issues, including antimicrobial resistance, and provide a forum to bring together national and international researchers, policy makers and the public. The ARME group are passionate about preparing future generations for a career in STEM and understand the importance of opening up a dialogue with the next generation, who will inevitably inherit a world with a severely depleted antimicrobial armamentarium. The WHO also recognises this need and has recommended introducing antimicrobial resistance as part of the current educational curriculum5. To this end the ARME group developed a workshop aimed at primary and second level students. In 2020, Dr. Georgios Miliotis joined the ARME group and immediately set about converting the schools workshop to a dedicated website (The Secret Life of Microbes). This learning portal aims to inform and inspire primary and secondary level students about the hidden world of microbiology as well as raise awareness about antimicrobial resistance. A key focus for Dr. Miliotis was ensuring key content was inclusive and accessible to all and, despite being of Greek origin, he successfully ensured key content was available both in English and Irish, in keeping with NUI Galway’s commitment to promotion of the Irish language, and serving the Gaeltacht and Irish language communities. Since its launch, the website has attracted over 620 visitors from 17 countries.
References
[1] http://www.wpro.who.int/entity/drug_resistance/resources/global_action_plan_eng.pdf
[2] O ’Neill, J. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations the Review on Antimicrobial Resistance. (2016). doi:10.1016/j.jpha.2015.11.005
[5] https://www.who.int/antimicrobial-resistance/global-action-plan/en/
Profiles
Prof. Morris and the ARME Group at NUI Galway have been applying a One Health approach to tackling the challenge of AMR for several years. Key to this is establishing successful partnerships with colleagues around the world. Through the EPA/HSE-funded AREST project and the EPA-funded PIER project, Prof. Morris is working with national and international colleagues towards a better understanding of the role of the environment in the persistence and transmission of AMR. Prof. Morris is leading NUI Galway’s participation in the One Health European Joint Programme (OHEJP), a landmark partnership between 38 institutes from 19 member states in Europe, and the Med-Vet-Net Association. The aim of the OHEJP is to enhance transdisciplinary cooperation, integration of activities and training in the fields of foodborne zoonoses, emerging threats and antimicrobial resistance. The Med-Vet-Net Association comprises 21 partners from 14 European countries and aims to promote a One Health approach to combat zoonoses and antimicrobial resistance and support a healthy and sustainable food supply chain across Europe and beyond.
Antimicrobial agents are fantastic drugs that have changed our lives for the better. International collaboration across the human health, animal health and environmental sectors is key to meeting this important global challenge. It is essential that we all work together to safeguard antimicrobial agents for future generations.
