With drug-resistant infections now causing the deaths of half a million people a year, access to clean water and decent sanitation has never been more vital in the race to prevent a global antimicrobial resistance catastrophe. As Dame Sally Davies poignantly highlighted in your report (Experts issue new warning on overuse of antibiotics, 27 March), “the importance of clean water, sanitation and vaccination must not be forgotten to avoid infections occurring in the first place”. This point, alongside the critical role of hygiene, is absolutely key.
This is already a global health emergency, with 844 million people lacking access to clean water and 2.3 billion without safe, private toilets. In developing nations almost 40% of healthcare facilities do not have a water supply, 19% do not provide adequate sanitation and 35% do not have soap and water to sustain good hygiene practices. Without these basics in place, infection prevention and control in healthcare settings becomes almost impossible. So it is no surprise that hospital-acquired infections are the third major driver of antimicrobial resistance globally.
Diarrhoea, pneumonia and cholera are often preventable through basic improvements in water, sanitation and hygiene. When they strike, the pathogens that cause these infections are commonly treated with antibiotics, and are becoming increasingly resistant to available drugs.
Antibiotic use to prevent diarrhoea could be cut by 60% in India, Nigeria, Indonesia and Brazil simply by improving people’s access to water and sanitation, and improving hygiene behaviours. Disease outbreaks are harder to control when sanitation is poor and there is no clean water.
Yet progress on delivering water, sanitation and hygiene is too slow, and not sufficiently threaded throughout the efforts to tackle this looming antibiotic crisis. World decision-makers must acknowledge the pivotal role that water, sanitation and hygiene play in preventing infection and reducing the spread of resistant pathogens, before the next global health crisis hits. Investment in all three elements of water, sanitation and hygiene must be prioritised, and coordinated with other efforts to address the rise of antimicrobial resistance, globally, nationally and locally.
As the old adage goes, prevention is better than cure. Never have those words been more true and more urgent.
Margaret Batty
Director of global policy and campaigns, WaterAid
• Your report makes a strong case for concern about the rise of antibiotic-resistant superbugs. But it ignores the elephant in the room – or rather, the pig and the chicken. The developed world still uses a lot more antibiotics than developing countries, and the vast majority of these are fed to animals on factory farms. Though not taking antibiotics for a sore throat can help extend the usefulness of current antibiotics, changing the way we produce meat is much more important.
Plant-based meat from new cutting-edge companies like Beyond Meat and Moving Mountains is both delicious and sustainable, and doesn’t require any antibiotics. And clean meat – actual animal meat grown outside of the animal, with no antibiotics necessary – is rapidly approaching price competitiveness, thanks to the efforts of companies like Memphis Meats.
Moving quickly to plant-based and clean meat is the best thing we can do to avoid pandemics of antibiotic-resistant superbugs.
Matt Ball
The Good Food Institute
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