Containment of antimicrobial resistance for strengthening global public health security: Biorisk management perspectives

Antimicrobials have been hugely successful in improving health outcomes. However, its positive impact is threatened by worldwide increase of antimicrobial resistance (AMR). Use, misuse and overuse are the drivers of AMR. Antimicrobials are used in healthcare, poultry farming and agriculture, horticulture, food production and feed additives, growth promoters, and in aquaculture. Other major drivers are poor infection control, environmental contamination, and geographical movement. AMR is a global public health concern. Without mitigation and remedial actions, estimated mortality attributed to AMR could rise to 10 million globally by 2050. AMR is a natural phenomenon. The use of antimicrobials creates a reservoir of resistance that exists within the ecosystem. AMR is a One Health concern. To contain AMR, a collaborative effort of all the relevant sectors, working locally, nationally, and globally, is the way to attain optimal One Health. Poor biorisk management measures in healthcare, poultry farms, agriculture and aquaculture, can lead to introduction and spread of infections and AMR. Wastewater is the reservoir of pathogens capable of transmitting infections, and at the same time, releasing antimicrobial, AMR genes into the environment, contaminating the entire biosphere. Although injudicious use of antimicrobials is mostly blamed for the failure of containment, improper waste management, likely plays a greater role, superseding the crisis, created by other means. AMR originates in, and passes vertically and horizontally through, microorganisms, among the ecosystems. Thus, the implementation of required biorisk management measures will ensure the protection from unintentional release of pathogens; protect the animals and the humans from zoonosis and reverse zoonosis; protect the environment and the entire biosphere from the spread of contaminants; protect the biological agent itself from loss, theft, misuse, diversion, or intentional release. Together with implemented biorisk management measures globally, judicious use of antimicrobials may lead to the total containment of AMR, strengthening global public health security.