A recent United Nations report, *Bracing for Superbugs: Strengthening environmental action in the One Health response to antimicrobial resistance*, highlights the growing spread of antimicrobial resistance (AMR) in the environment. Issued by the United Nations Environmental Programme, the report flags several serious concerns that have now been echoed by leading South African scientists. Antimicrobials—including antibiotics, antifungals, and antiseptics—are essential for reducing infectious diseases in humans, animals, and plants, yet the UN agency notes that many of these treatments are losing effectiveness because of AMR. The World Health Organization ranks AMR in humans and animals among the top ten threats to global health, with estimates suggesting up to 10 million deaths could occur annually by 2050. The report warns that, if unchecked, AMR could severely affect agricultural production, economies, and food security, disproportionately burdening low‑income and lower‑middle‑income countries. It could shave US $3.4 trillion off global GDP each year and push 24 million more people into extreme poverty within the next decade.
The UNEP report points out that global attention to AMR has largely focused on human health, agriculture, and the overuse and misuse of antibiotics, while environmental pollution has been a neglected but major factor in the development, transmission, and spread of resistance. Pollution from hospital and community wastewater, pharmaceutical effluent, agricultural runoff, and other waste releases can contain resistant microorganisms, antimicrobials, pharmaceuticals, microplastics, metals, and chemicals that increase the risk of AMR in water, soil, and air. The report calls for stronger, multi‑sectoral measures to reduce the release of antibiotics, drug‑resistant pathogens, and other pollutants into the environment. It urges countries to adopt a “One Health” approach that recognises the interdependence of human, animal, plant, and environmental health. While some nations have incorporated environmental aspects into their National Action Plans on AMR, more than one‑third still omit the environment.
In South Africa, researchers have already warned about the impact of environmental pollution on AMR, particularly sewage discharge into waterways and the sea. Raw sewage—often containing antibiotics, other pharmaceuticals, and drug‑resistant microorganisms—is pumped from coastal towns and cities into the ocean, a problem highlighted in the country’s National Antimicrobial Resistance Strategy Framework. The framework labels AMR a major threat to public‑health security and outlines objectives such as strengthening interdisciplinary coordination, improving diagnostic use, enhancing surveillance, promoting appropriate antimicrobial use, and reforming legislation.
Epidemiologist and water consultant Dr Jo Barnes, a retired lecturer at Stellenbosch University, describes AMR as “a disaster that is slowly creeping up on us—and not receiving the attention it should.” Barnes, who has campaigned for better water‑pollution management for over 25 years, welcomes the UNEP report and urges South Africa to heed its warnings. She notes that only 10–15 % of the country’s sewerage works are functional, with more than 80 % dysfunctional and releasing untreated sewage into rivers that supply drinking water and irrigation—key routes for AMR to reach consumers. The Department of Water and Sanitation’s National Green Drop Report 2022 found 39 % of wastewater systems in a critical state, and Minister Senzo Mchunu called the situation “unacceptable.” Barnes emphasizes that sewage is an efficient carrier of antibiotic‑resistant organisms, especially where sanitation services are poor and effluent is discharged into the sea.
Professor Leslie Petrik, Emeritus Professor of Chemistry at the University of the Western Cape, reports that research from the South Africa‑Norway Cooperation on Ocean Research (SANOCEAN) has detected sewage‑related chemicals, including the antibiotic sulfamethoxazole, in the tissues of mussels, limpets, starfish, sea urchins, snoek, seaweed, and even critically endangered penguins. Some of these substances are “forever chemicals” that do not break down. The presence of antibiotics in marine life is linked to infections in rescued penguins and seals that do not respond to standard treatments, indicating resistant microbes.
Professor Sabiha Essack, South African Research Chair in Antibiotic Resistance and One Health, calls the UNEP report “a wake‑up call” that the environmental dimensions of AMR have been neglected. She notes that it remains unclear whether resistance originates in the environment and spreads to humans and animals, or vice versa, and stresses the need for research on transmission dynamics. Essack’s current work includes studying wastewater, manure‑fertilised soils, and environmental surveillance near informal settlements, hospitals, and treatment plants.
Professor Marc Mendelson, Head of Infectious Diseases and HIV Medicine at the University of Cape Town, agrees that the report is crucial. He warns that South Africa risks missing an opportunity if it does not act, as the environmental aspects of AMR have been largely overlooked. Mendelson highlights the link between AMR and climate change: climate impacts increase infectious disease transmission, leading to higher antimicrobial use and, consequently, greater resistance. He stresses that addressing AMR requires integrating human, animal, and environmental health within Sustainable Development Goals.
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