World Antimicrobial Awareness Week: Re-centering Antimicrobial Resistance in the Context of the COVID-19 Pandemic

Today marks the end of World Antimicrobial Awareness Week organized by the WHO. The 2021 theme, Spread Awareness, Stop Resistance, calls on One Health stakeholders, policymakers, health care providers, and the general public to be Antimicrobial Resistance (AMR) Awareness champions.

While the world has been captivated by the COVID-19 pandemic over the past two years, this week has given us a moment to recognize the important and impending problem around antimicrobial resistance. AIGHD has many projects focused on various aspects of AMR, many of which can be found here, but for this year’s World Antimicrobial Awareness Week, we will highlight AMR in the context of COVID-19.

Discussion of AMR had been emerging in popular discourse over the past decade, with economist Jim O’Neill offering a social scientific perspective, advocating for managing the issue of antimicrobial resistance due to the impact it would yield for the human species by the year 2050. Despite this, in 2020, political and lay focus on health sharply redirected towards COVID-19. Thus, funds that would have been directed to research on new antibiotics went into COVID-19 research instead with these changing priorities. Luisa Fernanda Toro-Alzate is working on the SoNAR-Global Project and AIGHD and commented on this shift in health prerogatives: “The problem changed. We have this kid, named antimicrobial resistance, who now we are trying to control. But then came the little brother, named COVID-19, and now we have to take care of this younger brother, who is making more noise.” Essentially, the AMR pandemic began with the use of antibiotics, and has been slowly growing since that point, but has been relegated due to the COVID-19 pandemic.

Within this project, Luisa is focusing on the relationship between these two metaphorical siblings: COVID-19, which has been a fundamental crux of our collective lives in the past two years, and antimicrobial resistance, a looming health threat which may similarly alter society in decades to come.

Luisa, a medical doctor by training who, after 10 years of working in the field, came to the Netherlands to do a Master’s in public health, focusing on antimicrobial resistance. She wanted to be more involved in the research side of public health, and applied to the SoNAR-Global Project, drawn to the fact that it not only featured a biomedical component, but also an emphasis on social science. “It was super beautiful for me, because normally, with my background, we are lacking these social science skills. It is really exciting, and I am grateful to be involved with that.”

The SoNAR-Global Project, which has been around since 2019, is broad in its scope and involves various topics and approaches to antimicrobial resistance, from providing suggestions for governance strategies, to improving networking between social scientists and biomedical researchers focusing on AMR, to assessing socially embedded vulnerabilities to AMR, to conducting community engagement and supporting capacity building. Luisa is involved in helping create a curriculum to get social scientists involved in AMR research as well as getting biomedical researchers more familiar with the social scientific data surrounding AMR. “I am proud and super grateful to be involved the project and to work with Danny [de Vries] and Karlijn [Hofstraat]. They saw something in me and said we can make something work with this project. I am happy with the institute for allowing me to build this research pathway and continue to be an advocate against antimicrobial resistance.”

Luisa recently published an article on the relationship between COVID-19 and antimicrobial resistance. This article delves into many aspects of both the COVID-19 pandemic and antimicrobial resistance more broadly. Combining a biomedical and social scientific approach, this research also delves into three different primary subthemes including economic impacts of these pandemics, environmental impacts, the role of misinformation, and the position of vulnerable populations.

With regards to economic impacts lying in the intersection of the COVID-19 pandemic and antibiotic use, agriculture is a primary focal point. The vast majority of antibiotics are used by farmers for three primary reasons. Farmers will use antibiotics to treat bacterial infections amongst livestock, but also to prevent these infections, either giving some antibiotics to a single sick cow or many antibiotics to cows surrounding them. Additionally, farmers will use antibiotics on cattle to enhance growth. Given the economic impacts of COVID-19, livestock farmers have begun giving more antibiotics to livestock in order to produce more, leading to an overall increase in resistant bacteria.

There are many environmental impacts that come with this increased use of antibiotics in agriculture in the context of the COVID-19 global pandemic. Increased antibiotic use in livestock has led to an increase of resistant bacteria in wastewater. This wastewater seeps into the soil, and changes microbiota in the surrounding environment.

Luisa also indicates that misinformation worsens both AMR and COIVD-19. Although the majority of antibiotics are used in agricultural contexts, the most potent resistant bacteria emerge from the use of antibiotics in humans for health purposes. The misuse of antibiotics to protect against COVID-19 leads to increases in resistant bacteria and delays proper treatment and prevention for COVID.

Lastly, and social science assessment of a pandemic, or in this case two, requires some emphasis on social determinants of health. The study indicates a series of populations that are in have increased vulnerability in regards to both pandemics, including migrants, and African and particularly Asian diasporas. COVID-19 has led to an increase of stigma and anti-Chinese sentiment directed at many East Asian communities abroad. Additionally, consumption of antibiotics within East Asia is high, especially on cattle farms.

Luisa Fernanda Toro-Alzate remarked the following on the study’s conclusions: “There is a lot of room for further research. We are taking baby steps now.” In general, despite our best efforts, people are not as tuned in to AMR like they are COVID-19: “Everyone knows about COVID-19 because of the impact. We have a lot of research on AMR, but nobody really knows about it. If you go somewhere and ask the first person who is passing by, “Do you know what antimicrobial resistance is?”, they are going to say, “I don’t know what you are talking about. But if you ask about COVID-19, they will go on and on about it.”

Community engagement is one thing that Luisa cites as a prime strategy in preparing for a future in which antimicrobial resistance is an increased health risk. Though laws on antibiotic use are strict in the Netherlands, there are few restraints on it in many parts of the world: “We need to start thinking globally. People need to know what is happening.” Overall, there is a demand, for education for healthcare workers to approach communities on AMR and a need for data transparency and critical thinking about how we use antimicrobials. Lastly, Luisa outlines the need for politicians to prioritize AMR and combat misinformation with accurate data. There is an issue of prolonging and delaying collective efforts to be informed about the risks of AMR, and it is best not to lose sight of this with the current COVID-19 pandemic: “COVID-19 is going to be here for a little bit longer, but we will be fine. The problem is the monster that we have in front of us, and the name is antimicrobial resistance.”