Preventing the Next Global Pandemic

Antibiotic resistance and the associated spread of untreatable
‘superbugs’ is one of the major public health concerns of the 21st


The spread of SARS-CoV-2, the virus that causes Covid-19, has shown only too well
how quickly infectious agents can move around the world. Although increasing
antibiotic resistance and Covid-19 are not directly linked, there is a serious
consequence for human health, since many of our last-resort antibiotics are critical to
saving patients with secondary infections that can cause death.
This may drive the next major pandemic, as it exemplifies the significant chance that
our suite of current antibiotics will fail to combat many new biological infections,
including ones that might spread globally.

Tackling antibiotic resistance
Newcastle University’s Professor David Graham, an environmental engineer who
has spent almost 20 years studying the environmental transmission of antibiotic
resistance around the world, has contributed to new recommendations for tackling
the environmental spread of antibiotic resistance, published jointly in 2020 by the
World Health Organisation (WHO), Food and Agriculture Organisation (FAO), and
the World Organisation for Animal Health (OIE).
Local “hot-spots” of antibiotic resistance are known to exist around the world,
particularly in densely populated regions with inconsistent sanitation and poor water
quality. The new guidance, which has since been translated into six
languages, provides a framework for countries to create their own locally driven
national action plans.

It centres around growing evidence, including research at Newcastle University,
which suggests the problem of increasing antibiotic resistance will not be solved by
prudent antibiotic use alone and improving environmental quality around the world
may be of equal or greater importance.

The research
Commencing with work analysing antibiotic resistance in water samples from the
Ganges River near human pilgrimage sites, Professor Graham’s team and
colleagues at the Indian Institute of Technology, Delhi, extended their research to a
range of other locations and environmental contexts, including solid waste landfills in
China, aquaculture facilities in Thailand, soils near the North Pole, and wastewater
treatment plants and networks in many countries.

This suite of work showed that not only does environmental resistance exist around
the world, but that the main driver is local antibiotic resistance evolution and spread
differs from place to place. It highlighted that antibiotic-resistant genes can move fast
between microbes and through many pathways, even to places where antibiotics

functionally are not present, such as in polar regions, considered to be the last
‘pristine’ places on earth.

Finding a solution
“The only way we are going to win the fight against antibiotic resistance is to
understand and block the environmental and other pathways that lead to spread,”
explains Professor Graham. “Our work has shown that although the types and
drivers of resistance are diverse and vary by region and country, there are common
roots to its spread such as inappropriate antibiotic use in medicine and agriculture,
industrial pollution, and inadequate sanitation, resulting in poor water quality.
"There is no such thing as a cookie-cutter solution – each country needs to have its
own plan for preventing and addressing the spread of antibiotic resistance that
considers that country’s particular situation.

This means rapidly improving waste management, sanitation, and water quality on
local and global scales – especially in emerging and developing countries where the
social impacts of resistance are often the greatest – otherwise antibiotic resistance
will continue to increase, making the next pandemic even worse.”
Professor Graham’s recent work with the UN Environment Programme, which led to
the seminal 2023 report “Bracing for Superbugs: Strengthening environmental action
in the One Health response to antimicrobial resistance”, shows the scale of the
global problem. This report, which Graham was a co-lead author, recommends
prevention of antibiotic resistance at its root and increased integrated surveillance
across sectors (a One Health approach) as the two critical actions needed to start
winning the fight against antibiotic resistance.

This includes using antibiotics more prudently in every context, but also encouraging
governments and public health and other authorities to move towards more locally
suitable actions, such as towards local, low cost, easily deployed, yet high impact
solutions for human waste management.
Central to this is the importance of greater international co-operation to bring about
improved water, sanitation and health (WASH) provision as a way to prevent the next
global pandemic.
“Once improved sanitation and hygiene exist at global scales, as well as fairer
access to clean water, our reliance on antibiotics will decline,” says Professor

ABOUT NEWCASTLE UNIVERSITY: Newcastle University, UK, is a thriving
international community of more than 28,000 students from over 130 countries
worldwide. As a member of the Russell Group of research-intensive universities in
the UK, Newcastle has a world-class reputation for research excellence in the fields

of medicine, science and engineering, social sciences and the humanities. Its
academics are sharply focused on responding to the major challenges facing society
today. Our research and teaching are world-leading in areas as diverse as health,
culture, technology and the environment. Newcastle University is committed to
providing our students with excellent, research-led teaching delivered by dedicated
and passionate teachers. Newcastle University is ranked 110th in the QS World
Ranking 2024 and 139th in the Times Higher Education World University Ranking

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