Antimicrobials in the environment: An unregulated threat

Medicine is a vital part of human and animal survival, capable of curing deadly illnesses, easing painful conditions, and improving our quality of life. But the improper and mass disposal of antimicrobials, such as antibiotics, is resulting in dramatic changes to our environment and welfare. 

In this article, we explore the environmental and human health impacts of antimicrobial pollution, covering waste and wastewater management, harmful emissions, and the potential risks to the future of human medicine. We also dive into how businesses can mitigate these risks, with Chemical Hazard Assessments and global initiatives.

What are antimicrobials?

Antimicrobials, such as antibiotics and antifungals, are used to treat and prevent diseases, illnesses, and both temporary and long-term conditions in humans and animals. They’re also sometimes used in food production to promote healthy growth in animals, and in agriculture as pesticides to protect plants from disease.
 

What is antimicrobial pollution? 

Antimicrobial pollution occurs when industries, such as pharmaceuticals and manufacturing, or households, dispose of antimicrobial drugs. These substances then enter the environment via water and soil.  

In 2022, the Global Leaders Group on Antimicrobial Resistance urged governments to reduce the quantity of antimicrobial waste infiltrating the environment by implementing measures and frameworks to safely dispose of antimicrobial drugs. In April 2024, the Group called on UN Member States to take action, highlighting that antimicrobial resistance (AMR) had become the leading cause of death globally, with 1.27 million deaths annually.  

With both the environment and human health under threat, antimicrobial pollution is rising alongside urgent issues such as climate change.

Environmental impacts of antimicrobial pollution

When they’re disposed of, antimicrobials can enter the environment through human, animal, and plant waste via wastewater and sewage systems. Between 40-90% of antibiotic dosages are excreted in human waste, contaminating soil, water, plants, and farming fertilizer. With waste comes harmful emissions into our atmosphere, resulting in air pollution that can have devastating effects on our water, food, soil, plants, animals, and even buildings. The ongoing threat of climate change, which accelerates the rise in air pollution, could also be impacting antimicrobial resistance.   

Additionally, antimicrobials can be absorbed by plants, disrupting their physiology and potentially resulting in ecotoxicological damage. This can delay germination and reduce the efficacy of farmland. Antibiotics, for example, impact a plant’s ability to photosynthesize and damage the mitochondria. 

When antimicrobials permeate the environment, this can increase antimicrobial and antibiotic-resistant bacteria, which can transfer from the environment to humans. This brings a host of challenges for medicine, the economy, and healthcare services.

Human health impacts of antimicrobial pollution

As mentioned, antimicrobial pollution can result in antimicrobial resistance, making infections harder to treat as humans and animals develop resistance to certain drugs. Drug-resistant microbes can transfer between humans, animals, plant life, and food sources, making AMR difficult to avoid. 

If this continues, many medications used to treat infections and other diseases will become ineffective, due to overexposure. The World Health Organization (WHO) warns that this will drastically impact economies and health services around the world, potentially contributing to the emergence of superbugs resistant to antimicrobial drugs. Drug-resistant bacteria, the WHO reports, have already been found in marine waters and sediments close to aquaculture, industrial, and municipal waste.  

Chemical waste from antibiotics and other antimicrobial medicines can significantly alter human microbiomes, triggering health problems like allergic reactions, chronic conditions, and digestive system dysfunction. Approximately 33,000 people in the EU and over 35,000 people in the US die each year due to infections with antibiotic-resistant bacteria. Not only does antimicrobial pollution have a devastating impact on human life, it also increases the costs of economic and healthcare systems as medical providers must pay more for other antibiotics as we become immune to current medicine. The economic burden of infections caused by antimicrobial resistance is estimated at EUR 1.5 billion in Europe and USD 55 billion in the United States. 

Managing antimicrobial pollution

Antimicrobial use and disposal remains largely unregulated, with both the effects and methods of reducing antimicrobial overexposure mostly unknown by pharmaceuticals, farms, and manufacturing factories.  

One way of managing antimicrobial waste is by choosing more sustainable options to begin with. Pharma companies, for example, can get ahead of changing regulatory scrutiny on chemical management and waste management by making antibiotics and other drugs safer, through comprehensive Chemical Hazard Assessments (CHAs). 

Regulations in Europe, the UK, and Canada are also in place to mandate better processes, chemical usage, and waste management.
 

Chemical Hazard Assessments 

CHAs allow businesses to screen their chemicals against regulatory lists to understand the impact of their chemicals on human health and the environment. This, in turn, can help pharma companies identify current and forecasted risks, compare chemicals, and take action to mitigate damage.  

With a better understanding of chemical hazard profiles, businesses can make safer decisions, protect their market access by addressing toxicological risks, safeguard their reputation, and contribute to more sustainable products and processes.
 

Europe – One Health Action Plan

In 2022, AMR was listed as one of the top three priority health threats by the European Commission, prompting a revision of the EU’s 2018 One Health Action Plan Against Antimicrobial Resistance. 

The EU adopted guidelines on the use of antimicrobials in human health and animal health. It’s also leveraging existing proposals to strengthen the fight against AMR, including the Strategic Approach to Pharmaceuticals in the Environment, the Farm to Fork Strategy, and the Zero Pollution Action Plan.  

In April 2023, the proposed Council Recommendation on stepping up EU actions to combat antimicrobial resistance in a One Health approach was adopted, setting the foundations for future policy developments in AMR.
 

United Kingdom – Antimicrobial Resistance Plan 

In January 2019, the UK government published a 20-year vision for antimicrobial resistance to control and contain AMR by 2040. As part of this vision, the government committed to producing 5-year national action plans. The first plan, Tackling antimicrobial resistance 2019 to 2024, worked on reducing the use of antibiotics in food-producing animals, developing improved surveillance systems, and starting new payment schemes for NHS antibiotics.  

Following this, the UK published its Confronting antimicrobial resistance 2024 to 2029 plan, with the following aims: 

• Reduce the need for, and exposure to, antimicrobials through infection prevention, infection management, public education, and strengthened surveillance of AMR 

• Optimize the use of antimicrobials through stewardship and disposal for future effectiveness, and through educating the workforce most associated with AMR 

• Invest in innovation, supply, and access by prioritizing new approaches to diagnose and treat infections, developing vaccines, developing new antimicrobials, promoting more research, and identifying areas where AMR is most burdensome 

• Be a global partner by confronting AMR worldwide with sustained engagement with other groups and networks
   

Canada – Pan-Canadian Framework 

Canada has developed its own plan to fight AMR and support the WHO’s goals of reducing antimicrobial and antibiotic pollution. Tackling Antimicrobial Resistance and Antimicrobial Use: A Pan-Canadian Framework for Action builds its foundation from the One Health Approach, which connects humans, animals, and the environment into a single global health context. To strengthen Canada’s ability to reduce the risks of AMR, the framework aims to: 

• Implement integrated surveillance systems to identify, track, and monitor drug-resistant infections and organisms in both humans and animals 

• Contain the spread of antimicrobial resistant organisms and reduce AMR with standardized infection processes 

• Build awareness of the use and disposal of antimicrobials in humans and animals to phase out potentially harmful substances and find space for new antimicrobials  

• Provide researched, evidenced, innovative, and collaborative tools to understand resistance and develop new treatments and strategies moving forward
   

Global – Guidance on antibiotic pollution 

On a global scale, the WHO published guidance on antibiotic pollution from manufacturing, providing information on wastewater and solid waste management of antibiotics. The guidance details risk management practices, including audits and public transparency. This transparency aims to open a discussion between buyers, investors, and stakeholders with the public and manufacturers to better control their use and disposal of antimicrobials.