Experts and leaders around the world call for action against antimicrobial pollution

Untreated or improperly managed waste can contain biologically active antimicrobials, resistant organisms, and unmetabolized substances.
Antimicrobials and antimicrobial resistance factors (e.g. resistance-conferring genes) that are released into the environment. These can cause environmental contamination and increase the risk of developing antimicrobial resistance. These discharges can pollute the environment and contribute towards the spread of antimicrobial resistant (AMR).
The best way to control AMR spread from food systems to human health systems is to use sustainable antimicrobials in humans, plants/crops, and terrestrial and aquatic animals.  A number of other measures should be taken to ensure that the spread of AMR is not allowed.
It is necessary to safely dispose of all waste, including human and animal,  

GLG applauds the G7 countries’ efforts to reduce antimicrobial discharges to the environment. It encourages countries to implement Codex Code of practice and Guidelines on Integrated Microbiological Control to minimize and contain foodborne AMR.
November 2021 approval of Monitoring and Surveillance Foodborne Antimicrobial Resistance 

The Global Leaders Group recommends the following to improve management of environmental discharges that could contribute to the spread and emergence of antimicrobial resistance.  

1. STRENGTHENED GOVERNANCE and OVERSIGHT 

In general, countries should: 

• To establish safe levels, better monitor and control the release of antimicrobials, antimicrobial resistant bacteria, and antimicrobial determinants from food system, manufacturing facilities, and human health systems into our environment, or to build on existing regulatory frameworks, guidelines and standard operating procedures (SOPs), and to create or improve upon them. 
• To reduce the impact of environmental discharges, it is important to include management and prevention measures in national action programs on AMR. 

In the manufacturing sector Particularly, The following should be done by countries: 

• Establish and implement policies and legal frameworks to support antimicrobials manufacturing. This approach, which considers the entire time a pharmaceutical is active and the impact it has on the surrounding systems, would help to effectively address AMR environmental risk and ensure resilient antibiotic supply chains. It would also stimulate the design, production, manufacture, and marketing of new antibiotics and other antimicrobials. 
• Promote and develop balanced, staged environmental policies and approaches to manage manufacturing facilities and support environmental inspections. This is in recognition of the current fragility and large access gaps.  
• Encourage compliance and excellence in the industry, and highlight their contribution to the achievement and promotion of the Sustainable Development Goals. 
• National antimicrobial manufacturing pollution standards should be developed based on the best available evidence, treatment technology, and situational analysis. It is important to strengthen the ability of environmental authorities and auditors to monitor compliance.  

In the human health industry Particularly, countries should 

• In order to ensure that antimicrobial stewardship policies are implemented in human health systems, it is important to develop and implement protocols and protocols that include responsible and sustainable antimicrobial procurement and waste management. 
• Implement and enforce policies and laws that reduce or eliminate antimicrobial misuse, if not under the care of a trained health professional. 

In food systemsParticularly, countries should:  

• To effectively manage and treat waste from food-producing animals farms, aquaculture farms, crop fields and waste used to irrigate crops, develop or improve upon existing regulatory frameworks, guidelines and SOPs.
  and run-off from crops fields; 
• In fixed and mobile animal healthcare facilities, develop and implement antimicrobial management protocols and policies that include responsible and sustainable antimicrobial use and waste management. 

2. IMPROVED DATA AVAILABILITY AND SURVEILLANCE

Countries should: 

• Strengthen One Health surveillance of antimicrobial usage in, and the discharges of antimicrobials, and AMR determinants, from food systems, human healthcare systems, manufacturing facilities, and sewage systems.  This should be done taking
  Factors such as cost-effectiveness, data comparability, and the need to build upon existing systems are all important.
  (e.g. (e.g., soil microbes, aqua organisms). Priority should be given towards collecting data that can support targeted actions, such as improved understanding of environmental risks and release pathways into it.
  Supporting the development of guidance on waste management and antimicrobial discharge limits;   
• To build public trust and credibility, encourage industry data disclosure, transparency, and public access to data and mitigation practices related to waste and wastewater management. Initial data disclosure could be made to regulators or independent parties.
  Third parties (for instance, as part of certification programs), followed by efforts for wider public access to increase awareness. These efforts include ongoing studies, contributions to ongoing studies, and a reflection of environmental standards in procurement practices.   

3. IMPROVED DISCHARGE CONTROL

In general, all countries should: 

• Effective infection prevention and control measures can reduce the need to use antimicrobials in all sectors. This includes water, sanitation, hygiene (WASH), vaccination, biosecurity, animal husbandry, welfare measures, and biosecurity.  
• Develop, implement and monitor systems for proper segregation, treatment and/or disposal of antimicrobials and antimicrobial-containing substances in all sectors (including antimicrobial feed and human and animal waste); 
• Create mechanisms to collect expired and unutilized antimicrobials from individuals and organisations;  
• Make sure there are affordable, environmentally safe incinerators available. Also, ensure that you have access to innovative technologies to destroy and degrade expired antimicrobials. 

In general, relevant International technical organizations and their associates should provide guidance and showcase best practices for waste management across all industries. 

In food systems 

All countries should: 

• Create and implement manure, wastewater, runoff and farm waste management plans, SOPs, guidance, standards and measures such as composting for manure and its application into agriculture fields; and
• Implement evidence-based management strategies for manure so that manure can still be safely used in agriculture fields as an organic fertilizer.
  Antimicrobial resistance or resistant bacteria determinants. 

International technical organisations should: 

• Rapidly develop tools and guidance to support implementation of the Codex Code of practice in order to minimize and contain foodborne AMR. food processing and production facilities, wet markets, slaughterhouses)  to minimize the impacts of antimicrobial discharge into the environment.   

Companies involved with the slaughter and processing food animals should:  

• Assess current food production practices in order to implement measures to reduce emissions of byproducts, including biocides into the environment, and to meet legal standards. 

In the manufacturing sector 

Manufacturing companies should: 

• To minimize the environmental impacts of manufacturing emissions, you must take preventive and management steps. This can be achieved through the adoption and implementation of effective waste management practices and technologies, as well as the adoption and maintenance of the Common
  Framework for antibiotic manufacturingand the AMR Industry Alliance’s proposed independent certification schemes.  

All stakeholders should: 

• Assess options and support efforts to create an environment that encourages and supports investment through incentives and efforts for pharmaceutical waste management, without jeopardizing antimicrobial access. Such evaluations may include an assessment of sustainable procurement policies, inclusion of environmental considerations in good manufacturing practices, environmental risk assessment before antimicrobial authorization and an independent product-certification scheme.  

4. RESEARCH and DEVELOPMENT 

International partners and organizations that provide technical, financial and research and development support should: 

• Coordinate and enhance research to gain a complete understanding of the risks to human health from environmental antimicrobials, resistance microbes, and mobile genetic elements in discharges.  
• Encourage research and development in the public and private sectors to develop cost-effective, greener waste management technology solutions. This includes methods to remove antimicrobial residuals, resistance genes, and organisms.
  incinerators and measurement technology) and standardized monitoring methodologies, and support mainstreaming best practices in waste and process management across sectors;  
• To support evidence-based policymaking, policy briefs should be developed on antimicrobial resistance. Policy dialogues between policymakers should be organized. 

Background of the Global Leaders Group on Antimicrobial Resistance

The Global Leaders Group on Antimicrobial Resistancewas established in November 2020. It is an independent global advisory and advocacy function with the primary purpose of maintaining
The group’s mission is to create urgency, public support and political momentum in order to make the AMR challenge visible on the global agenda. The group’s mission will be to work with governments, agencies, civil societies, and the private sectors worldwide through a One Health approach.
To advocate for and advise on political action to reduce drug-resistant infections by responsible and sustainable access and use of antimicrobials.

The group is co-chaired jointly by Their Excellencies, Sheikh Hasina and Mia Amor Mottley Prime Ministers of Bangladesh and Barbados. It is made up of former or serving ministers and/or senior officials of the government acting in their stead.
Individual capacities, as well as senior representatives of foundations and civil society organizations. It also includes principals of Tripartite organisations – the Food and Agriculture Organization of United Nations
(FAO), the World Organisation for Animal Health, (OIE), and the World Health Organizations (WHO) – in an ex officio capacity.

The Secretariat Support for the Group is provided by the Tripartite Joint Secretariat, a joint effort of FAO, OIE, WHO and UNEP.