The Looming Threat of Antimicrobial Resistance: A Call to Action

We very often read articles or hear news about “Doomsday Theory”. We usually pretend that doomsday would be happening due to World War, Pandemic or any other crisis which would be like a last straw event, but we usually tend to ignore small events or act by counting them as trivial things or procrastinating it as farfetched scientific theory which would never happen and even if it happens, it would be dealt by government or intergovernmental bodies. One such theory that demands our attention is Antimicrobial Resistance (AMR). So, what exactly is AMR?

About Antimicrobial Resistance

According to World Health Organization, Antimicrobials – including antibiotics, antivirals, antifungals, and antiparasitics – are medicines used to prevent and treat infectious diseases in humans, animals and plants. Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability and death.

AMR is part of the evolutionary process, whenever we take medication for any issue, we are effectively providing reinforcement to our body cells to fight the bacteria, virus or pathogen. When we provide the same reinforcement frequently or even when it’s not required we end up accelerating the evolutionary process of the bacteria, virus or pathogen, due to which they become resistant to the those medication.

Knowing the facts, should we not take medication for fever or any other medical issue?

The clear answer is NO. Firstly, we should not self-medicate or overuse the dosage prescription given by medical professional. 

Due to adoption of hygiene hypothesis and also the COVID pandemic, we have tend to become over cautious, even for common fever including pain, constipation etc. we are self-medicating and rushing to over-the-counter medicines without addressing the under lying issues. For example, antibiotics are ineffective for viral illness but still we take antibiotics like azithromycin even when it won’t help.

Secondly, AMR is also accelerated when we don’t complete the prescribed dosage. Most of the medical professionals prescribes Fixed Drug Combinations (FDC) when they administer the drug dosage. These FDCs are meant for treatment of either single ailment or multiple comorbid conditions. Doctors always recommends to complete the dosage but we being ignorant don’t follow these guidelines, effect of which is that the remaining bacteria, viruses, or pathogens may not get fully eradicated. Incomplete treatment courses creates a survival advantage for the microbes, allowing them to adapt and develop resistance to the prescribed medications. 

Are only patients and common man responsible for AMR?

The clear answer is NO. The Government too is responsible. The waste water many times is released directly into water bodies, it’s the duty of government to put rules, regulation and infrastructure in place so that the waste water is properly treated.

According to a report titled Bracing for Superbugs by United Nations Environment Programme, it states that, ‘Antimicrobial agents are widely used in human medicine, aquaculture, livestock and crop production, and are also put into the feed and water of food animals. They are excreted in significant quantities into the environment as active molecules, or partially degraded, from various sources. The concentration of antimicrobials excreted unmetabolized in the faeces and urine of humans and animals is highly variable and is dependent upon the antimicrobial drug class, formulation, the route of administration, animal species and health status. Where provision of wastewater treatment is not adequate, close contact with polluted waters can result in a consumption-excretion cycle (WEF 2021). The consumption-excretion cycle occurs when containment, controls or barriers for these pollutants are lacking, such as pit latrines without confining barriers, or when inadequately treated or untreated wastewater is used to irrigate farmland, or animal manure or human waste is used to fertilize crops. This results in functional antimicrobials entering the environment unless waste management measures to address AMR development and spread are applied. Such releases transmit antimicrobial resistant microorganisms and ARGs, which can conditionally promote AMR, into the environment.’ So it’s the duty of government to have Sewage treatment Plant with proper capacity.

Secondly, having rules and regulation for over-the-counter medication also falls under responsibility of Government.

Thirdly, Climate change is also one of the driving factor behind AMR, according to National Institute of Health, Candida Auris is the first drug resistant fungal infection which is considered as consequence of Climate Change. Though talking climate change is not just government’s responsibility but lack of policy framework is.

Is there ray of hope?

Solutions exist at both national and international levels:

Solutions at national level:

1. Awareness programmes- Citizens should be made aware of this crisis which we would be facing.
2.  Policy formulation and data collection by government to understand the magnitude of the issue.
3. Scientific studies funded by government and private bodies.
4. One health approach, rather than compartmental approach or silo approach various department and ministries such Agriculture, Health, Fisheries, Scientific institution etc. should come together to address issues like AMR.

Solutions at international level:

1. Institutions like WHO are currently working on this, they published a report Global antimicrobial resistance and use surveillance system (‎GLASS)‎, they have studied more than 127 countries and created a database to study this crisis.
2. International awareness: Medical journal like lancet have series of report on AMR and allied issues, these are helping not just citizens but medical professionals also, by providing them latest information and case studies.
3. Funding the Low Income Countries, climate change is something which knows no boundary. Events like Conference of Parties under UNFCCC serves as a platform to not just discussion but to also mobilize fund for the cause.

In conclusion, raising awareness and implementing proactive measures at both national and international levels are imperative to combat the looming threat of Antimicrobial Resistance. It's a shared responsibility that demands collective action for a healthier and sustainable future.

From Click to Carbon: Understanding Email's Eco-Impact

In today's era, most people have at least two email addresses: one for personal usage and one for professional purposes. It's a normal practise to use our email addresses to log in to numerous online services such as meal delivery, cab booking, or online shopping. Unfortunately, we frequently ignore or fail to read and comprehend the significance of the "Opt-ins" or "Email Subscription" options throughout this procedure. As a result, we are bombarded with promotional emails from these businesses. Our standard approach to these emails is to classify them as spam or delete them. We rarely bother to unsubscribe from such email lists, largely because many unsubscribe buttons redirect us to a questionnaire page in which we are not interested to participate.

We often underestimate the environmental impact of our online actions. Every promotional mail that we get has a carbon footprint. While it may seem that a few promotional emails wouldn't harm the environment, but most of us don’t even know of how the internet operates. The fundamental infrastructure behind internet mail transfer includes data centers, satellite and submarine cable infrastructure, DNS servers, local ISP infrastructure, end-user devices, and more. The critical component in this system is the electrical power supply, which serves as its backbone. When we take a broader view of climate change and clean energy, it becomes clear that our simple actions, such as unsubscribing from promotional emails or carefully considering "Opt-in" and "Email Subscription" options, can make a significant difference.

Illustrative diagram for understanding mail transfer via internet

According to an estimate as of 2023 there are nearly 4.37 billion email users which is estimated to increase nearly to 4.7 billion email users by 2026. In 2023 nearly 347 billion emails are sent every day which is 4.23% more than 2022, i.e. in 2022 nearly 333 billion emails were sent per day and it’s estimated that by 2026 the number is set to increase upto 395 billion mails per day.  According to data from Yahoofinance nearly 85% of mail which user receive are of spam category, i.e. a staggering 295 billion mails sent per day are spam. If we dissect the information more, the numbers are quite depressing. For example, according to Mike Berners-Lee, a fellow at Lancaster University who researches on carbon footprints, the footprint of an email varies dramatically, from 0.3g CO2e for a spam email to 4g CO2e for a regular email and 50g CO2e for one with a photo or hefty attachment. Multiplying these carbon footprint figures by number of emails sent per day can be eye-opening. For example, if we assume that every email has carbon foot print of 1g CO2e, and 347 billion email are sent per day then according to this nearly 347 million kg of CO2e is emitted per day and 126.6 billion kg of CO2e is emitted per year, i.e. 126.6 million tonnes per year, so if 85% of received emails are of spam category, nearly 107 million tonnes per year is the CO2e emission from spam emails. To put it in perspective, carbon emission of world per year is 34.7 billion tonnes. If we simply read the "Opt-in" and "Email Subscription" policies carefully, we can potentially reduce 107 million tonnes of carbon emission per year which is quite a lot considering the amount of effort required for click on mouse.

Storing a spam email in our inbox, we are potentially utilizing the cloud storage provided by the email platform. Cloud storage refers to the space allocated to users on server farms within data centers, which demand a substantial electric supply to operate smoothly. According to International Energy Agency, Data centers required around 260-360 terawatt hour (TWh) of electricity in 2022. And according to a research conducted by McAfee, 78% of all incoming mails are spam, around 62 trillion spam mails are sent every year, requiring use of 33 TWh of electricity and causing around 20 million tonnes of CO2e per year.  To put this in perspective, according to data from Statistics Finland's, greenhouse gas emissions in 2020 was 47.8 million tonnes of CO2e.

 

What can individual and businesses do reduce carbon footprint caused by email?

1. Not having multiple email accounts.
2. Reading the Opt-in and Email Subscription policies carefully to not get our email box flooded.
3. Unsubscribing spam email advertisements.
4. Having auto delete feature enabled in our spam mailbox.
5. Exploring alternate advertisement channels instead of email advertisements.
6. Employing email analytics tools to measure email engagement. This can help target email campaigns more effectively, reducing the number of unnecessary emails sent.

 

As individuals, we may have limited options to address the ecological impact of spam emails, but legislative bodies are better equipped to combat this issue, and governments are actively working to tackle it. For instance, the United States has enacted the CAN-SPAM Act, and the European Union has established the ePrivacy Directive (ePD). While these legislations can help in reducing the problem, but its essential to recognize that spam email is a global issue, and therefore, the solutions must also have a global reach.

International organizations such as the United Nations and the World Economic Forum play a crucial role in addressing global challenges. Their involvement is crucial in coordinating efforts to combat spam emails and their associated environmental impact on a worldwide scale. By fostering collaboration and setting international standards, these organizations can help create a more sustainable and effective framework for email communication that benefits both individuals and the environment.

Is Renewable Energy a viable solution?

 

With the recent carbon net neutrality pledges, the debate of sustainability of renewable energy and its supply chain has come in light. When we talk about renewable energy, it simply means the energy which is derived from natural sources such as solar rays, wind or tidal power. However, we usually miss its supply chain discussion, i.e. the process through which the raw material is extracted to make components for renewable energy industry. Magnets for wind turbines, photovoltaic cells for solar energy, and lithium batteries are examples of these components. Rare earth metals are made up of seventeen chemical elements, including 15 lanthanides (lanthanum, cerium, praseodymium, neodymium, promethium, samarium, europium, gadolinium, terbium, dysprosium, holmium, erbium, thulium, ytterbium, and lutetium), scandium, and yttrium.

 

Despite the name rare earth metals, these are abundantly present in earth, however the process to mining these minerals is difficult, polluting and costly. Extraction of these minerals involves land exploitation, environmental degradation and labour exploitation to say the least. Example, Democratic Republic of Congo (DRC) mines around 50% of world’s Cobalt supply. One of the largest mineral processors in the country is Huayou Cobalt subsidiary CDM. Huayou Cobalt gets more than 40% of its cobalt from DRC. According to Amnesty International at least  80 artisanal miners had died between 2014 and 2015 in underground mining, child labour is rampant and were paid 2 dollars per day or even less and approximately (as of 2015) 40,000 children were employed in these operations, if we factor in the long term health hazards according to CDC guidelines on  Workplace Safety & Health Topics: Cobalt, long term cobalt exposure can lead to respiratory sensitization, asthma, shortness of breath, and decreased pulmonary function. Sustained skin contact with cobalt can also lead to contact dermatitis. The provided example was specific to one country and one of the numerous rare earth minerals. This serves as a snapshot, the broader global perspective may reveal a much more alarming and disturbing situation.

 

According to India’s NTPC to produce 1 megawatt of energy from thermal power plant we require around 0.7 to 0.8 acre of land, similarly 1 megawatt of solar energy plant would require around 1.5 to 2 acre of no shadow land depending upon the technology and a wind farm would require at least 1 hectare to produce the same. So the question again arises, is the renewable energy really a viable solution?

 

According to Internal Energy Agency, in the year 2000 solar energy output was around 1.4GW which in 2020 has jumped to 760GW. A solar photovoltaic cells which is made up of crystalline silicon have a life span of about 30 years. According to International Renewable Energy Agency (IRENA), by 2030 panels waste is forecasted at 8 million metric tonnes, which is projected to go up to 80 million metric tonnes by 2050.

 

Do we have technology to treat the waste produced from renewable energy?

Yes, we do have technologies which involves physical to chemical processes to recycle solar panels. However, the unit economics for recycling solar panels is not attractive, according to IRENA, recycling cost of a solar panel can go up to $25 whereas dumping it on landfills cost a meagre 2 to 3 dollars, due to which nearly 10% of solar panel waste never reaches the recycling market.

 

Certainly there are many issues with renewable energy which needs to be addressed, but it is also comparatively much cleaner and green when compared to thermal energy. India’s E-Waste Management Rules 2022 and Europeans Unions Waste Electrical and Electronic equipment (WEEE) rules are few of rules and regulations which can serve as guiding principles for solar waste management and make the recycling technology cost efficient and uniform.