The natural environment: a critical missing link in national action plans on antimicrobial resistance

摘要

Antimicrobial resistance, that is, the ability of a microorganism to stop an antimicrobial from working against it, is one of the most important global health challenges. Antimicrobial resistance is projected to become the leading cause of death worldwide, claiming an estimated 10 million lives a year by 2050, primarily in low- and middle-income countries.1 In 2015, the World Health Assembly adopted a global action plan on antimicrobial resistance underpinned by the One Health approach.2 One Health seeks to improve health and well-being through the integrated management of disease risks at the interface between humans, animals and the natural environment. Efforts are based on closer collaboration among individual disciplines and a cross-sectoral approach to research, surveillance and response.3 The natural or biophysical environment here includes all living (biotic) and non-living (abiotic) factors affecting the survival of all organisms, including humans, at the individual, population, community or ecosystem level. In this context, an ecosystem refers to a community of plants, animals and microorganisms that live, feed, reproduce and interact within the same area or environment. Antimicrobial resistance connects human health to the health of ecosystems and the natural environment. With the global action plan on antimicrobial resistance, Member States agreed to develop individual national action plans on antimicrobial resistance by May 2017.2,4 Here we present an analysis of the extent to which the national action plans developed after 2015 have been successful in integrating the natural environment within a One Health approach. We found that the action plans feature human and animal health prominently, but that most do not specifically incorporate the natural environment, and hence fall short of achieving a genuine One Health approach. Given the key role of the natural environment in contributing to antimicrobial resistance, we call for greater integration of the natural environment in existing and new national action plans, so that we can maximize our chances of finding holistic and sustainable solutions to this global health threat.