Reducing the Use of Antimicrobials as a Solution to the Challenge of Antimicrobial Resistance (AMR): Approaching an Ethical Dilemma through the Lens of Planetary Health

Abstract

Antimicrobial resistance (AMR) is one of the greatest challenges facing humanity in the 21st century. Controlled dispensation of antimicrobial drugs is the most echoed solution among many that have been postulated to counter this problem. However, the life-impacting significance of antimicrobials makes this approach a very complex one, which must be considered under the lens of health and planetary ethics. As the problem of AMR is not peculiar to only a few people, the right to know the risk, as well as decisions as to when and how antimicrobials are used should, not be granted to only a few decision makers, but be used as drivers to advance planetary health knowledge in a way that benefits individuals, society, and future generations. Within an ethical framework, implementing policies that extend the efficacy period of antimicrobials should be considered in a way that balances range, choice, and quality of drugs against stewardship activities. The challenge of AMR cannot be eliminated completely by reduced use of antimicrobials only; understanding how, where and when reduction is necessary, and social structures and patterns (as well as existing health and government systems) are required if any global/national intervention would be successful and equitable. We may well have gone past the stage of adopting precautionary principles as the danger we face presents no iota of uncertainty. The measures to control AMR’s emergence and its spread are well presented. Nevertheless, we must not ere from the path of justice and equity even in the face of certain danger.

Outcomes from the First European Planetary Health Hub Convening at ARTIS in Amsterdam

“…A key facet of this is discussing the extent to which planetary health topics should be integrated rather than displacing or replacing existing learning and training [16,17]. For example, planetary health ethics [18] could be taught alongside medical ethics [19] or could be incorporated into the teaching of topics such as antimicrobial resistance by approaching such topics through a planetary health lens [20].…”

The New Precision Stewards?

“…The broadest framings of AMR acknowledge its cross-sectoral and ecological aspects, accompanied by corresponding normative proposed solutions [ 90 , 91 ]. For example, One Health frameworks entail ethical engagement with how responsibilities for human, animal, and environmental health interact, including questions on what multisectoral policy reform is needed in recognition of such interdependence [ 21 ].…”

Antibiotics Resistance in the Food Chain: Implications on Public Health

“…Examining present public and global efforts to minimize human and creature waste, as well as transportation of animals and crops with antiinfection agents and safe microorganisms, is necessary [74,68]. Additional bio-designing methods are needed to reduce the transmission and delivery of anti-infection resistance in food handling chains [75].…”