Very often the greatest challenges we face as a society are recognized in their infancy by specialists whose warnings go unheeded, allowing difficult but solvable problems to escalate into full-blown crises. The most salient case in point is climate change, which today would likely not be the existential threat that it is had we taken bolder action decades ago.
An emerging danger to humanity with potential for harm as great as climate change, anti-microbial resistance (AMR) threatens the stability of health care systems worldwide and creates the very real possibility of returning us to a world in which a simple cut to the finger can lead to severe illness or death. Fortunately, we have time to contain or even eliminate this threat, but to do so we must redouble our efforts to improve awareness and take meaningful action that strikes at the root of the problem.
Understanding Anti-Microbial Resistance (AMR)
AMR occurs when bacteria and other disease-causing microbes develop resistance to previously effective drugs. In the U.S., the Centers for Disease Control (CDC) estimates that AMR causes at least 2.8 million illnesses and over 35,000 deaths annually. As a result of AMR, antibiotics may no longer work to treat even common infections.
A wide range of medical procedures rely on effective antibiotic treatments, including organ transplants, chemotherapy, and dialysis for end-stage renal disease. Antibiotic, antifungal, antiviral and anti-parasitic medications form the backbone of modern medicine, highlighting the urgency facing the health care community in addressing AMR. The need for action is recognized by the United Nations (UN), World Health Organization (WHO), and national authorities such as the CDC.
The development of AMR occurs across multiple avenues. The use of antibiotics for growth promotion and disease prevention in livestock is of particular concern to regulators and consumers. According to the U.S. Food and Drug Administration, 70% of antibiotics prescribed in the U.S. are used in animals. The sub-therapeutic doses used for disease prevention and growth promotion are more likely to result in the development of resistance than a shorter, high-dose therapeutic course. In addition, increased presence of AMR in the food supply directly threatens human health as diseases caused by resistant bacteria tend to be more severe and have fewer treatment options.
Regulations covering antibiotic use for animals have been increasing. For example, in California, farmers must obtain a prescription to use medically important antibiotics in animals. The EU banned the use of antibiotics in animals for growth promotion and the WHO published guidelines strongly recommending a complete restriction on the use of these antibiotics for growth promotion and disease prevention, absent a diagnosis.
These encouraging first steps are partly a result of increased public awareness and concern. Surveys consistently show that a majority of consumers prefer meats raised without antibiotics. This has been reflected in the growth of antibiotic-free meat sales, estimated by data analytics firm Nielsen to have increased 28.7% each year between 2011 and 2015, compared to 4.6% for conventional meat.
But AMR has a far more insidious and less widely understood avenue for development. A landmark 2017 study showed that wastewater runoff from major overseas pharmaceutical manufacturing plants has created a virtual breeding ground for AMR. The study found that “[t]he presence of drug residues in the natural environment allows the microbes living there to build up resistance to the ingredients in the medicines that are supposed to kill them, turning them into what we call superbugs. The resistant microbes travel easily and have multiplied in huge numbers all over the world, creating a grave public health emergency that is already thought to kill hundreds of thousands of people a year.”
Weak environmental standards for overseas manufacturers make meaningful change a daunting task. A key pillar of a potential solution will be to exert pressure on domestic firms that outsource their manufacturing operations. Governments can also leverage trade and other agreements to persuade problem countries to adopt and abide by waste management best practices.
Investing in a solution
Vancity Investment Management Ltd. (VCIM), sub-advisor to the IA Clarington Inhance SRI Funds, has a robust shareholder engagement program that includes a deep commitment to finding real solutions to the problem of AMR.
Over the last decade, VCIM has engaged with companies over 200 times, with more than 30 companies engaged in 2019 alone. Our work in the area of AMR includes an active role in the Farm Animal Investment Risk and Return (FAIRR) initiative. This involves engagement with 20 global food companies to encourage the adoption of antibiotics policies and the phasing out of routine, prophylactic antibiotic use across all supply chains, with clear targets and timelines for implementation.
We believe that through these and similar actions, we can reduce the suffering caused by AMR and ensure that the benefits of over a century of medical advancements can continue to result in longer, happier lives.
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