From Frying Pan to Fire: The Case of Food Insecurity and Antimicrobial Resistance

Introduction

Food insecurity is a complex problem aggravated by multiple threats, such as climate change, population growth, poverty, conflicts, and natural disasters. According to the United Nations, billions of people worldwide are food insecure and exposed to nutrition-related diseases (1). Several approaches have been used to mitigate food insecurity, including improving agricultural productivity, strengthening social safety nets, and reducing food waste. Improving agricultural and livestock productivity has largely been done using antimicrobials as growth promoters and for therapeutic and prophylactic uses. Due to the increased demand for agricultural and livestock products, intensive farming has been instigated resulting in the irrational use of antimicrobials which is a major factor responsible for the development of drug-resistant pathogens. Studies have shown the transmission of antimicrobial-resistant bacteria/genes from animals and agricultural products to humans through food, water, and direct contact with the environment (2). Thus, developing and spreading drug-resistant bacteria from agriculture to humans is a tenacious global health crisis. According to the WHO, by 2050, drug-resistant microorganisms could account for more than 10 million deaths yearly, shave US$ 3.4 trillion off global GDP annually, and push 24 million more people into extreme poverty (3). Therefore, in addressing food insecurity through the unsustainable use of antimicrobials in farming to increase production, more lethal drug-resistant microorganisms are propagated leading to what could be described as a leap from frying pan to fire.

Several public and private organizations have recognized the unrelenting spread of drug-resistant microorganisms and have been calling for action from governments, non-governmental organizations, and the public. For example, the World Health Organization (WHO) declared antimicrobial resistance among the top three global health issues (3). Yet, efforts to manage these global health issues have generally remained insufficient in the face of the magnitude of the problem. Thus, the critical concerns are that antimicrobial resistance genes are a challenge to modern medicine and could jeopardize human existence on Earth. Drug-resistant pathogens respect no international boundaries and no country or individual is immune. Even though the rising trend of antimicrobial resistance may not be receiving much media or popular attention, the illnesses and deaths related to drug-resistant pathogens could surpass those of more projected diseases like tuberculosis and HIV/AIDS. Therefore, we aim to intensify advocacy, increase public awareness, and bring under the floodlight the consequences of irrational use of antimicrobials in farming, and to reiterate prudent and multi-sectoral stakeholder collaboration, most especially among farmers and end users of agriculture products in low-middle-income countries where policies and regulatory measures on drug use in agriculture are still wimpy.

Antimicrobials and Rising Resistance

Antimicrobial medicines such as antibiotics, antivirals, antifungals, and antiparasitics are the cornerstones of modern medicine due to their wide use in treating and preventing diseases (4), including their prophylactic and therapeutic uses in modern-day surgery. Also included are disinfectants and sanitizers, which are antimicrobial agents applied to non-living surfaces to prevent contamination. Antimicrobials are broadly classified according to the microorganisms they act against. These include antibiotics (used against bacteria), antifungals (used against fungi), antivirals (used against viruses), and antiparasitics (used against parasites). Based on function, they are classified into chemo-prophylactic agents (used to prevent infections) and chemotherapeutic agents (used to treat infections). Irrespective of the classification, resistance has been reported to almost all classes of antimicrobials. Resistance is said to occur when germs develop the ability to defeat the drugs designed to kill them. As a result of resistance, antimicrobials become ineffective, and diseases become difficult or sometimes impossible to treat, increasing the risk of severe illness, disease spread, and death. Even though microorganisms develop resistance naturally, the process is facilitated by the irrational use of drugs in humans, animals, and agriculture (4).

The Irrational Use of Antimicrobials in Agriculture

The use of antimicrobial drugs in agriculture and livestock to improve production has been documented, but the amount used has been difficult to estimate, especially in low and middle-income countries, due to lack of surveillance, control, and regulation. According to global estimates, more than 60,000 tons of antimicrobials are used yearly in crop production and 63,151 tones in animal production which is significantly more than the quantity consumed by humans (5). In the United States of America alone, approximately 80% of medically important antibiotics are used in farming (6). In crop production, these drugs are used to control pests and weeds and to manage fungal diseases affecting cereals, grapes, and tulip production (7). Apart from these drugs being used as growth promoters and to treat sick animals, a large quantity is added to healthy animal feed and drinking water as prophylaxis to elevate feed efficiency. In aquaculture and apiculture, antimicrobials have been used in fish farms to prevent or treat bacterial and fungal infections, especially in hatcheries, while other sources of antimicrobial contamination in fish farming result from runoff from animal husbandry and from inappropriately disposed of chemicals from farms, homes, hospital, and industries into fishponds.

Of great concern, the types of antimicrobials being used in agriculture and veterinary practice have similar modes of action and belong to the general classes of drugs prescribed to humans (8). For example, one of the widely used antibiotics in animal farming worldwide is colistin, a critical last-line antibiotic for treating severe infections in humans (2). The transfer of resistant pathogens from animals to humans could occur through direct contact, via the food chain, or from animal waste products with resistant genes that are metabolized and excreted into the environment. As the environment is tainted with antimicrobials, it creates additional selective pressure that leads to the development of more and more drug-resistant pathogens.

In many developing countries these drugs are bought over the counter without a prescription and are unregulated. The over-reliance on antimicrobials in agriculture is due to ineffective or non-existent biosecurity measures on farms to prevent disease and the lack of awareness of the relationship between irrational drug use and the development of drug resistance, including the propagation of endemic or emerging diseases caused by drug-resistant microorganisms is of great concern. In addition, poor infrastructure and hygienic practices elevate the risks of diseases. This is further aggravated by the lack of systems to monitor antimicrobial use in food production and allied industries, including fragmented and weak food control systems to track contaminants. Some countries have chosen to limit or ban antimicrobial use in agriculture as growth promoters due to excessive chemical residues in these products, however, the practice is still widespread in many developing countries.

The impact of drug-resistant microorganisms on humans

Drug-resistant microorganisms severely impact individuals, the health care system and the economy. Compared to non-resistant pathogens, resistant microorganisms increase the chances of affected individuals developing severe illness and death. In 2019 alone, more than 1.27 million people died as a result of drug-resistant microorganisms, and according to the WHO, by 2050, the number could rise above 10 million (9). The emergence and spread of drug-resistant bacteria causing tuberculosis, HIV/AIDs, and malaria have sabotaged global efforts to tackle these diseases. In sub-Saharan Africa, for instance, 60% of patients with HIV have developed resistance to antiretrovirals and are prone to adverse health outcomes, threatening the global goal of putting an end to AIDS by 2030. Also, Plasmodium falciparum, the causative agent of malaria, has become resistant to most conventional anti-malarial medicines ((9,10).

Drug-resistant microorganisms have been associated with a higher risk of invasive infection, higher frequency and duration of hospitalization; and increased risk of death as compared to infections caused by susceptible strains. According to global estimates, antimicrobial-resistant organisms could cost more than $1 trillion annually by 2050, shaving US$ 3.4 trillion off global GDP annually and pushing 24 million more people into extreme poverty (10,11). If left unchecked, drug-resistant pathogens will elevate the poverty rate and impact low-income countries compared to the rest of the world and the inequality gap between developing and developed countries will become more pronounced as many households will be impoverished due to decreased workforce and human capital. Also, drug-resistant pathogens in agriculture and livestock will make the treatment of plant and animal disease difficult, leading to decreased production, elevated prices, and worsening food insecurity.

Conclusion

In a nutshell, antimicrobials are the pillars of modern medicine and have substantially contributed to the progress of health care during the past decades. However, the emergence and spread of drug-resistant pathogens, including superbugs as a result of irrational drug use in agriculture is a complex global public health problem that could jeopardize global efforts towards attaining the SDGs. Therefore, there is a multi-sectoral collaboration and a coordinated approach involving experts and organizations from various sectors, including public health, agriculture and livestock, environment and communication, etc. This unifying approach will achieve optimal and sustainable health outcomes for people, animals, and ecosystems.

Recommendations

  1. Promote sustainable agriculture practices and encourage integrated Pest Management (IPM), which emphasizes natural pest control methods and minimizes reliance on chemical pesticides.
  2. Implementing good hygiene practices in animal production, including ensuring good air and water supply quality, appropriate ventilations, and space allocation during all phases of animal production, transport, and slaughter, will reduce diseases and the need for farmers to use drugs as prophylaxis.
  3. Promote the use of organic means of agriculture, such as the use of biochar to improve soil fertility and productivity.
  4. Develop Novel Antimicrobial Agents by investing in research and development of novel antimicrobial agents.
  5. There is a need to increase public awareness, especially among farmers, by organizing workshops, conferences, and training highlighting the danger of antimicrobial resistance and demonstrating sustainable organic agricultural practices.
  6. Regulate the sales of over-the-counter antimicrobials and strengthen Surveillance Systems to monitor the spread of AMR pathogens in the environment and food chain.
Evrard Kepgang
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Kepgang Evrard is a young research and humanitarian passionate. He holds a master’s degree in Public health and epidemiology at the University of Dschang.

Regina Sinsai
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Regina Sinsai holds a Bachelor of Arts Degree in Psychology from the United States International University – Africa, in Nairobi and an HND in General Nursing from the Humanity Health Professional Training Center (HHPTC) in Yaoundé.

Dr Valery Ngo
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Dr. Ngo Valery Ngo is a Medical Doctor and a Senior Health Researcher at Nkafu Policy Institute, a think tank at the Denis & Lenora Foretia Foundation in Yaoundé, Cameroon. Before his appointment, he was a volunteer research assistant under Professor Bright Nwaru at the Krefting Research Centre in Gothenburg, Sweden, during which he conducted various researches in global health and contributed to various systematic reviews to synthesize existing evidence on major global health issues.

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