Antimicrobial Resistance (AMR) presents a global health threat that in recent times has taken a back seat in discussions due to the Coronavirus (COVID-19) pandemic. COVID-19 deaths are currently 2.87M worldwide. Yet the WHO warned in 2019 that drug-resistant diseases could cause 10M deaths each year by 2050. COVID-19 patients in hospital present a heightened vulnerability to secondary infections which often leads to an increase in antibiotic prescription associated with keeping these infections at bay. The potential for overuse of antibiotics on a global scale due to misdiagnoses of these infections as bacterial rather than viral has heightened concerns for the long-term impact the pandemic may have on AMR. There is a pressing need for increased research efforts and discussions surrounding AMR as we look at the long-term impact of the pandemic on resistance.
A key player in the resistance equation is the role the environment plays in facilitating the movement of antimicrobial-resistant microorganisms. Reuse water is of particular interest in this examination and presents challenges for both policymakers and treatment plants. The Australian Guidelines for Water Recycling (AGWR) acknowledges that the transfer of these microorganisms through waste into the environment is an area of emerging concern and managing these risks is problematic. In contrast, approaches for regulating and managing risks associated with conventional contaminants and pollutants are well established. In Australia, common pollutants found in wastewater prior to treatment are covered substantially by the AGWR. Yet often the same treatments which are used to remove these traditional contaminants can present challenges for the removal of antibiotic-resistant genes (ARG). By way of example, where a traditional contaminant may be treated by relying on microbial activity, this same treatment arrangement may present ideal conditions for facilitating the movement of ARGs through the system. In contrast, there is no evidence to date that intact SARS-CoV-2 viruses have been transmitted via sewerage systems.
It is known AMR is a global health threat, yet more research is required to define and confirm the role wastewater has in this resistance
It is known that AMR has the potential to cause harm to both humans and agriculture by threatening the effectiveness of antibiotic treatments. Despite following treatment processes prescribed by the AGWR, treatment plants may be dispensing water to the environment which distributes resistant microorganisms into the receiving waterways. Given ARGs can be passed both vertically and horizontally between bacteria, potential hotspots for transfer require increased regulatory consideration. It is known AMR is a global health threat, yet more research is required to define and confirm the role wastewater has in this resistance.
Under Victorian legislation, a person who negligently pollutes the environment, or permits an environmental hazard that results in a substantial risk of serious threat to human health is guilty of an indictable offence. Similar legislative provisions exist globally. If wastewater treatment plants discharge into the aquatic environment antimicrobial-resistant microorganisms, could this constitute pollution and lead to an offence under the corresponding regulation? The 2020 National AMR Resistance Strategy noted the review of regulatory measures relevant to antimicrobial usage and resistance as a key priority area for action. Yet with COVID-19 taking centre stage, are enough resources being directed towards AMR regulatory reviews? Treatment plants require security during these uncertain times until regulations are updated to reflect definitive requirements.
The task of regulating antimicrobial resistance in wastewater is beyond complex in the legal sphere, presenting a multitude of challenges for policymakers. The reduction and stabilisation of antimicrobial resistance may present more than just a ‘wicked’ problem and may prove to be a near-impossible feat. One of the biggest threats to human and animal health today should not be overlooked.