2020 marked an overwhelming pause in human history. A new virus has spread around the world after starting in a small corner of a single country, causing the biggest public health emergency in more than a century.

It was also a year that reinforced the gravity of the climate crisis that awaits us. With forest fires, hurricanes, devastating floods and extreme heat in many parts of the world, the consequences of climate change on our environment and our health have become very real. As the world continues to face a growing climate crisis, in addition to a protracted pandemic, we must recognize the health impacts of rising temperatures.

The United Nations Climate Change Conference (COP26) which just ended in 2021 brought together world leaders to deliberate and discuss issues related to international climate action. The The Intergovernmental Panel on Climate Change (IPCC) highlighted the importance of limiting the rise in global temperature, as even a tenth of an additional degree of warming could have serious consequences for people’s lives and health.

Although this increase in temperature would affect several aspects of our health, a relatively underestimated link exists between climate change and antimicrobial resistance (AMR).

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AMR occurs when bacteria, viruses, fungi, and parasites change over time and become unresponsive to medications, making infections harder to treat and increasing the risk of disease spreading, serious illness and death. Although there are many determinants of AMR, irrational use of antibiotics, due to poor prescribing and self-medication practices, unnecessary use in agriculture and animal farms (poultry, livestock, fish farming) as shortcuts to improve productivity without improving farm conditions are the main causes. In addition, antibiotics containing effluent discharges from pharmaceutical manufacturing plants and hospitals with inadequate wastewater treatment mechanisms increase their concentration in surrounding water bodies and in the living environment. in general.

According to the World Bank, 10 million people (nearly 27,000 per day) will die from AMR by 2050, far more than the lives already lost to COVID-19. The World Health Organization has previously declared AMR to be one of the main 10 global threats to public health and called for priority multisectoral action to address issues of antimicrobial resistance and work towards the achievement of the sustainable development goals.

Temperature plays an important role because it has an impact on the survival of bacteria in antibiotics and is also a factor “Environmental character” which is increasing due to climate change. Changes in temperature alter the cellular and genetic activity of bacteria, but studies indicate the broader impact of changes in temperature on the spread of AMR globally. For every 10 ° C increase in temperature, there has been a substantial increase in resistance among three common hospital pathogens: Gram-negative E. coli and K. pneumoniae and Gram positive S. aureus.

Researchers have now shown that the warmer temperatures seen in European cities have resulted in an increase in the percentage of antibiotic resistant bacteria. To examine the reasons for this phenomenon, the researchers examined the tributaries and effluents of wastewater treatment plants for bacteria and genes that are resistant to antibiotics, as sewage systems facilitate the transfer of human bacteria. in the environment. Their findings further reinforced the fact that there is not one but several ways that warmer temperatures lead to antibiotic resistance.

Unfortunately, the climate crisis disproportionately affects developing countries, exacerbating inequalities in health care. In the same way, more than 90 percent of the burden of RAM related deaths are expected to fall on countries in Asia and Africa, compounding the gains made in infant and maternal mortality.

For India, which has one of the highest burdens of bacterial infections, the consequences of AMR will further delay public health gains. Here, more than 58,000 newborns succumb to neonatal sepsis and die each year from antibiotic resistance. As the world’s pharmacy with large antibiotic production plants, the impact of untreated pharmaceutical effluents discharged into water bodies and groundwater negatively impacts our living environment. Cases of polluted water bodies and high concentrations of pharmaceutically active compounds have already been reported in several Indian states, highlighting growing concern about the development and transmission of AMR in the environment. Urgent action is needed to tackle AMR and climate change by all stakeholders including countries, multinational companies and individuals across the world.

India’s National Action Plan (2017-2022) briefly outlined the challenges and potential actions needed to tackle AMR. However, only a few states like Kerala, Madhya Pradesh and Delhi have developed individual State Action Plans (SAPs) to combat AMR. However, while the threats of climate change and AMR are pervasive around the world and in India, the scale and extent of the impact of climate change on AMR is largely unexplored. There is little research on the effects of temperature change on antibiotic resistance in the country. Likewise, while it is widely recognized that AMR is a complex threat at the confluence of health, environment, food security and economy, health policies largely ignore the imminent danger that climate change is worsening the spread of AMR.

For a comprehensive, scientific and, more importantly, timely answer to these twin problems, better evidence on the links between climate change and AMR is needed, especially in the Indian context. A comprehensive multisectoral and interdisciplinary response that converges actions towards “One Health”, including regulations and policies between different ministries, departments and at the central state level is essential.

The double burden of AMR and climate change demands an urgent and unprecedented response. Greater awareness, dedicated budgets, convergence of surveillance, better data to inform and monitor interventions are needed to stop the development and transmission of antibiotic resistance and move towards sustainable development. This requires strong leadership to guide multisectoral collaboration between stakeholders in the health, environment, animal and food sectors, to tackle this invisible, silent but devastating pandemic, exacerbated by global warming. .

The author is responsible, South Asia, Center for Disease Dynamics, Economics & Policy, New Delhi