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Dr Lovleen Bhullar, Assistant Professor in Environmental Law at the Department of Land Economy at the University of Cambridge discussed her research on the role of regulation in combatting antimicrobial resistance (AMR) in the environment.
For 80 years, antimicrobials have underpinned the growth of our societies by treating human diseases and extending lives. We are familiar with these benefits and the threat presented by AMR. A recent report by the GRAM Project estimated that AMR was the direct cause of more than a million deaths each year between 1990 and 2021, and the World Health Organisation now classifies AMR as one of the top ten public health threats facing humanity.
We are less familiar with the widespread use of antimicrobials in farming and agriculture, both for disease prevention and to increase yield. The combination of human, animal and environmental health impacts means AMR poses significant risks beyond human capital and healthcare, threatening GDP loss and disruption to food security. So, what can be done to contain the risks? Dr Bhullar’s research focuses on how understanding the spread of AMR in water bodies could inform regulation.
Dr Bhullar emphasised the need for a One Health approach to combat the interconnected causes of AMR. Human overuse and misuse of antibiotics presents a major challenge, but the excessive use of antibiotics in farming exacerbates the issue, and the environment is an important source and sink of AMR. Resistant bacteria build up in the soil and water sources because of runoff from excessive use of antimicrobials as pesticides and growth stimulants in farming, and inappropriate disposal of effluents from manufacturing processes in the pharmaceutical industry as well as from households. Moreover, these disease vectors cross borders and AMR cannot be tackled by any one country alone. A One Health approach to combatting AMR recognises this complexity, and should lead to holistic policies rather than prioritising any single aspect.
Dr Bhullar has therefore explored the role that regulation can play in minimising the risks of AMR developing in water bodies. She has studied regulations introduced at international, supranational and national level. In 2015, the World Health Organisation introduced a Global Action Plan on Antimicrobial Resistance, while more recently, the UNEP issued guidance on wastewater and solid waste management. However, the impact of this ‘soft law’ is limited - advisory guidance rather than binding rulings. Meanwhile, the EU’s 2000 Water Framework Directive and 2008 Environmental Quality Standards Directive can be used as tools to address water pollutants that produce AMR. There are now proposals to include antimicrobials in the list of priority substances but to date these rulings only address AMR indirectly. Finally, Dr Bhullar discussed the state of regulation in the UK. The British government began to address AMR comparatively early and has introduced a series of five-year plans, with the latest running until 2029.
This all amounts to considerable existing regulation that recognises the threat of AMR and lays the foundations for a One Health approach. Dr Bhullar suggested that regulators should now establish standards around antibiotic effluents to prevent their release into the environment and limit the further development of AMR. She stressed that some resistance will always emerge naturally and argued that policies should therefore aim to reduce spread. But regulation has a role beyond deterrence. Dr Bhullar suggested it can unlock public awareness about the gravity of the issue by encouraging the dissemination of information. Regulation also acts as a cautionary influence on pharmaceutical industries while the potential impacts of AMR remain unclear. Moreover, Dr Bhullar made clear that government is not the only source of regulation. Already, private actors and industry bodies have voluntarily introduced best practice frameworks for the disposal of antibiotic effluents from pharmaceutical manufacturing units.
Questions from the policy fellows asked Dr Bhullar to consider what other, more positive, measures government could implement to tackle AMR, the carrot to a regulatory stick. She emphasised the way that private sector actors are increasingly organising themselves to establish frameworks for best practice around antibiotic pollution, and to share more information on their processes. But while regulation might compete with immediate growth imperatives, Dr Bhullar underscored the growing evidence that, in the longer term, AMR poses a significant threat to health, the economy and the natural environment.
Reported by Samuel Houlberg, Policy Fellowships Coordinator
Photo from Mark Fletcher-Brown via Unsplash
Dr Lovleen Bhullar
Department of Land Economy, University of Cambridge