When Vanessa Carter was 25 years old, she was involved in a devastating car accident in Johannesburg. It broke all the bones on the right side of her face and led to a years-long journey through multiple reconstructive surgeries.
Six years later, Carter received a prosthetic implant to reconstruct his cheekbone. Perhaps her worst ordeal was over. But one day she noticed pus oozing from her face. It was an infection. And almost a year later, it hasn’t gone away.
“I was taking antibiotics and seeing doctors, but no one answered me,” she told DW. “And all this time, this bacterial infection was eating away at the tissues of my face.”
Many antibiotics no longer work against MRSA bacteria — strains are developing resistance Image: IMAGE POINT FR/BSIP/picture Alliance
The culprit turned out to be MRSA (methicillin-resistant Staphylococcus aureus). This is one of a growing number of superbugs for which antibiotics no longer work.
A looming global crisis that will kill 10 million people a year
Antimicrobial resistance (when bacteria, viruses, fungi, and parasites evolve to defeat drugs designed to kill them) is recognized by the United Nations as a major global health challenge.
By 2050, drug-resistant superbugs could claim 10 million lives a year. Left unchecked, it could cost $412 billion (€352 billion) a year by 2050 and reduce global GDP by $3.4 trillion a year over the next decade.
One of the reasons behind the antibiotic epidemic is the misuse or overuse of antibiotics in medicine. Another is the contamination of antibiotics in the environment.
Contaminated water sprayed onto fields can spell disaster for the food chain Image: robin utrecht/picture alliance
“Perhaps we will be irrigating crops with water containing these bacteria, and we may be consuming that crop or drinking water containing these genes,” says Alistair Boxall, a professor of environmental science at the University of York in the UK. “That resistance will come back into our bodies.”
Drugs are found all over the world
Pharmaceuticals have been detected in rivers and soil around the world. A recent study involving Boxall tested river water at more than 1,000 locations in 104 countries.
“We searched for 61 different medicines and found them everywhere but on a very small number of sites,” he said.
The only places without drug residue were in Iceland and remote villages in the rainforests of Venezuela, where indigenous peoples do not use modern medicines.
Only a testing site in Iceland and a remote village in the Venezuelan rainforest were free of drug residue. Image: Owen Humphreys/dpa/PA Wire/picture Alliance
Elsewhere, researchers found high concentrations of the diabetes drug metformin, along with antibiotics and drugs to treat depression, epilepsy, pain and allergies. A quarter of the sites showed drug levels considered harmful to wildlife.
How are drugs released into the environment?
When we take a drug, our body only absorbs a portion of it. The rest is excreted and ends up in the sewage system. Antibiotics are also often overprescribed and overused. Humans consume more than 30,000 tons of drugs annually. Approximately one-third of this water flows into rivers.
Many wastewater treatment plants are not designed to completely remove these substances, so traces end up in rivers, lakes, and soil.
Globally, just over half of all wastewater is treated before release.
Treatment systems are limited or nonexistent in many low-income countries, and pollution is often even worse in parts of sub-Saharan Africa, South Asia, and Latin America.
Pharmaceutical manufacturing factories, like agriculture, are also a source of pollution. Livestock are given large amounts of drugs. Some estimates suggest that at least twice the amount given to humans is used to treat livestock. And when their feces are spread as fertilizer, they can pollute nearby waterways.
One village’s victory could help clean waterways across Europe
To view this video, please enable JavaScript and consider upgrading to a web browser that supports HTML5 video.
The impact on wildlife can be severe.
A study in North America found that synthetic hormones in contraceptive pills caused the “feminization” of male fish in some waters, leading to reproductive failure and population collapse. Another British study found that the antidepressant Prozac caused starlings to lose their appetite and sex drive.
What are the solutions to combating antimicrobial resistance?
Improving wastewater treatment is a key part of the solution.
In many Western countries, this requires additional levels of processing, such as the use of chemicals or activated carbon filters to capture those pharmaceutical compounds.
However, advanced processing uses large amounts of energy and can increase greenhouse gas emissions. Other toxic compounds may also be produced in the process.
Coronavirus: traces in wastewater
To view this video, please enable JavaScript and consider upgrading to a web browser that supports HTML5 video.
And, Boxall added, “that costs a lot of money.”
Still, the European Union continues to make progress. Under the Urban Wastewater Treatment Directive, member states will be required to upgrade their treatment facilities over the next few years, with 80% of the costs to be borne by the pharmaceutical and cosmetics industries, but the provision has faced fierce resistance from the pharmaceutical lobby.
The EU will also introduce rules to reduce pharmaceuticals in surface and groundwater, and require member states to track antimicrobial resistance in wastewater.
In the United States, the Environmental Protection Agency moved for the first time to include pharmaceuticals on its list of drinking water contaminants.
But Boxall argues that change is not happening fast enough and advanced filtering is not practical for poorer countries, which often face the worst pharmaceutical contamination.
Do biodegradable drugs exist?
Klaus Kummerer, a professor of sustainable chemistry at Leuphana University in Lüneburg in northern Germany, believes the answer lies in designing drugs that are completely broken down after performing their function in the human body.
“The gold standard would be carbon dioxide and water mineralization,” he says.
His team has developed an anti-cancer drug that is completely biodegradable in wastewater treatment plants. They have also patented two biodegradable alternatives to the antibiotic ciprofloxacin, which is considered particularly difficult to break down.
Once the antibiotic has done its job and reaches the bladder, changes in pH or acidity trigger a breakdown process.
However, antibiotics did not reach the market.
“We are a small university working group, so we can’t develop compounds and bring them to market. Now industry has to step in,” Kummerer said.
He believes that designing cleaner medicines and not relying on expensive wastewater treatment upgrades is the real long-term solution to pharmaceutical pollution. But it is also important to reduce the number of medicines used in the first place, that is, to use them more carefully and for doctors to prescribe only what is strictly necessary.
“Antibiotics don’t kill viruses; viruses cause colds,” Kummerer said.
“My grandma used to say that if you have a cold or something like that, it will take about a week if you take medicine, but if you don’t take it, it will take about seven days.”
This article is based on an episode of Living Planet produced by Natalie Muller. please listen Click here for the full story.
Editor: Jennifer Collins
