Possible linkage between global warming and drug resistance: Two imminent threats to public health

The SDGs 2030 were meticulously constructed to put an “end to all forms of poverty, fight inequalities and tackle climate change while ensuring that no one is left behind,” through global and multisectoral collaborations and interventions. The pledge taken by the 194 Member States of the United Nations, which also includes India, to act meaningfully towards the 17 Sustainable Development Goals (SDGs) is undeniably incredible.

Although SDG 3 focuses on health, it is imperative that the continuum of public health is examined more broadly. While several indicators are detailed out in the SDGs, numerous other underlying factors that hugely influence the targets also need to be tackled as a priority to ensure the goals are met. Moreover, a few factors are intertwined and should not only be viewed through a single lens; they must be addressed cohesively rather than in silos.

Mitigation of climate change (SDG 13) is one of the key pillars for realization of SDGs. However, efforts are needed to factor its health burden and impact on SDG 3. Global warming and erratic weather patterns are escalating multiple public health threats around the world. The Intergovernmental Panel on Climate Change (IPCC) has already warned that due to climate change, infectious disease epidemics are likely to be more frequent. In August 2021, the United Nations Intergovernmental Panel on Climate Change (IPCC) released a report which projected global temperature to reach or exceed 1.5°C of warming over the next two decades under all scenarios. The situation is so grim that the UN Secretary-General, Antonio Guterres has highlighted that the report is ‘a code red for humanity.’

Another life-threatening public health danger that all nations face is Antimicrobial Resistance (AMR). It is estimated that as of 2014, 700,000 people died due to AMR annually, and some estimates indicate the attributable mortality could reach up to 10 million every year by 2050.

In May 2021, during the 74th World Health Assembly, member countries gathered to address all the health emergencies, including the challenge of antimicrobial resistance (AMR). AMR has been recognized as one of the top priority focus areas for this decade by the World Health Organization (WHO). WHO has also called for convergence between stakeholders and adopting a “One-Health” approach in tackling this challenge. AMR is a growing concern on global forums such as the UN General Assembly, the UN Environment Programme (UNEP), and World Health Assembly. However, discussions linking climate change and AMR have been minimal.

A study carried out in 2018 evaluated the correlation between the role of climate (temperature) and additional factors on the spread of antibiotic resistance across the United States. The conclusion pointed that a rise in temperature of 10 °C was linked with an upsurge in three common pathogens.

Climate change also gives rise to population shifts. Migration, both inter-nation and intra-nation, may give rise to the spread of antimicrobial resistance instead of being restricted to pockets in the absence of such mass migrations. This can result in public health threats that might be unfamiliar to the local health practitioners. A meta-analysis and systematic review of studies from 2000 to 2017 indicate that migrants are often under the threat of developing AMR at some point in transit and in the country they travel to. This also ends up exposing the population that migrated to the threat of AMR. Examples like these reiterate that sustained surveillance is needed to ensure health threats like AMR are contained before it spreads widely. Interventions are also carried out by the state only when it is an emergency, more of a reactive approach than a proactive one.

Currently, most policy discussions and subsequent interventions in several parts of the world like Europe and South Asia are concentrated on controlling social causes like overuse and misuse of antibiotics or reducing antibiotics in poultry, livestock, and agriculture. Hence, the need of the hour is also to establish the linkage between climate change and AMR in policy discussions backed by data from a meta-analysis. Subsequently, policies by governments of all the countries should be planned to keep in mind the linkage of both. Additionally, policies around healthcare surveillance must be designed in such a way that the health of migrants with AMR (drug resistance) is taken care of and spread (through excreta) is minimized. The idea is to consider how migrants will fall under the ambit of AMR surveillance within the framework of governance.

Moreover, given the mayhem and devastation of COVID-19, it is in global interest that AMR is dealt with utmost priority, otherwise, it is bound to be the next pandemic with repercussions globally. Once the gravity of this public health challenge is understood, one can be hopeful that AMR will be dealt with much urgency. Correspondingly, there is a need to disseminate knowledge among policy makers/bureaucrats, especially those working on health and the environment, and highlight policy interventions that can help reduce the AMR burden. Only through a structured and integrated approach can problems like drug resistance owing to antimicrobial resistance can be dealt with effectively.

The columnist is Public Policy Consultant, Chase India. Views expressed are the author’s own.