Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

AMR, One Health and the environment

Nature Microbiology volume 8, pages 754–755 (2023)Cite this article

Subjects

The need to consider connections between humans, animals and the environment in the management of the global antimicrobial resistance (AMR) crisis is increasingly emphasized in action plans developed by the United Nations Quadripartite, regional actors (such as the European Union) and countries across the world. All advocate a ‘One Health’ approach, which commonly recognizes that “the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and inter-dependent”, to use the exact wording adopted by the United Nations Quadripartite1,2,3. However, this framing fails to identify how AMR relates to the health of each of the One Health compartments, which may create confusion. The health of the environment can be defined as “the extent to which the environment is able to function, maintain biological and chemical processes, adapt to change or cope with the impacts of human activity”4. While AMR certainly threatens the health of people and domestic animals by making antimicrobials ineffective, it is considerably less clear how, or whether, the acquired ability to survive antimicrobial exposure (resistance) could impact the health of the environment. Direct ecological effects of antibiotic or antifungal pollution should not be conflated with the effects of AMR. While environmental antimicrobial exposure has the potential to affect diversity and ecosystem function and services5, resistance is a resilience mechanism that, if anything, would reduce the potential impact of antimicrobials on environmental microbial ecosystems and their functionality. Undoubtedly, antimicrobials select for resistant strains in the environment, but, as long as infections are not treated (for example, in wild animals and plants), it has no direct consequence whether the infectious agent is resistant to antimicrobials or not. It only becomes a problem if resistant microorganisms cause infections in humans, domestic animals or crops for which previously effective treatments fail.

While there is limited evidence that AMR directly affects the health of the environment, an ‘unhealthy’ environment can certainly contribute to risks of AMR in humans. Causes include pollution with selective agents that are known to be above selective concentrations in some cases, the environmental spread of resistant microbiota through faecal waste, and human exposure via direct contact with the environment or through food and/or drinking water6,7. The potential contribution of such anthropogenic environmental impacts on AMR is often correctly captured in various policy documents1,2,3,8. However, without explaining that the effects on AMR relate to human health rather than the health of the environment per se, the message can become confusing. When blended with more vague claims of environmental impacts of AMR, or risks of AMR to the environment, it becomes even less clear. Such statements include “Environmental impacts of AMR include pollution, both biological and chemical, that affect human, animal and plant health, as well as ecosystem services”8, or “Although the risks of AMR to human, animal and plant health and the environment are shared by all countries,”8. It might be that such statements are referring to ecological effects of antimicrobials, as explained above, but this should not be confused with AMR7.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: AMR is a threat essentially to those treated with antimicrobials, that is, humans, domestic animals and certain crops.

References

  1. One Health Basics (US Centres for Disease Control and Prevention, 2022); https://go.nature.com/3YseR7q

  2. A European One Health Action Plan against Antimicrobial Resistance (AMR) (European commission, 2017); https://go.nature.com/3Jj5bYB

  3. Tripartite and UNEP Support OHHLEP’s Definition of “One Health” (World Health Organization, 2021); https://go.nature.com/3j7w8Re

  4. One Health Joint Plan of Action, 2022–2026. Working Together for the Health of Humans, Animals, Plants and the Environment (FAO, UNEP, WHO, WOAH, 2022); https://doi.org/10.4060/cc2289en

  5. Brandt, K. K. et al. Environ. Int. 85, 189–205 (2015).

    Article  CAS  PubMed  Google Scholar 

  6. Gillings, M. R. & Stokes, H. W. Trends Ecol. Evol. 27, 346–352 (2012).

    Article  PubMed  Google Scholar 

  7. Larsson, D. G. J. & Flach, C.-F. Nat. Rev. Microbiol. 20, 257–269 (2022).

    Article  CAS  PubMed  Google Scholar 

  8. Bracing for Superbugs: Strengthening Environmental Action in the One Health Response to Antimicrobial Resistance (United Nations Environment Programme, 2023); https://go.nature.com/3INC3ra

  9. Waglechner, N., Culp, E. J. & Wright, G. D. EcoSal Plus https://doi.org/10.1128/ecosalplus.ESP-0027-2020 (2021).

    Article  PubMed  Google Scholar 

  10. Collignon, P., Beggs, J. J., Walsh, T. R., Gandra, S. & Laxminarayan, R. Lancet Planet. Health 2, e398–e405 (2018).

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Infectious Diseases, Institute for Biomedicine, University of Gothenburg, Gothenburg, Sweden

    D. G. J. Larsson

  2. Centre for Antibiotic Resistance Research in Gothenburg, Gothenburg, Sweden

    D. G. J. Larsson

  3. European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK

    W. H. Gaze

  4. One Health Trust, Washington, DC, USA

    R. Laxminarayan

  5. Agriculture and Agri-Food Canada, London, Ontario, Canada

    E. Topp

  6. Department of Biology, University of Western Ontario, London, Ontario, Canada

    E. Topp

Authors
  1. D. G. J. Larsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. H. Gaze
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Laxminarayan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Topp
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

D.G.J.L. drafted the manuscript. All authors commented on the draft and approved the final manuscript.

Corresponding author

Correspondence to D. G. J. Larsson.

Ethics declarations

Competing interests

The authors declare no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Larsson, D.G.J., Gaze, W.H., Laxminarayan, R. et al. AMR, One Health and the environment. Nat Microbiol 8, 754–755 (2023). https://doi.org/10.1038/s41564-023-01351-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41564-023-01351-9

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing