Peel’s wastewater system needs better testing as global concern over antibiotic resistance grows
The discovery of penicillin almost a century ago was one of the greatest technological and medical advancements in human history.
Prior to the breakthrough, a small cut, ear infection or sore throat was enough to bring on dread. People died from much less.
In what seemed like the blink of an eye, human health had changed. Drug companies began making penicillin for commercial purposes and it was used widely in the Second World War for soldiers with battle-wound infections or pneumonia. It also saved lives in ways we now often take for granted. Before the discovery of antibiotics, common illnesses such as strep throat, or even a seemingly harmless scrape could cost a person their life. Suddenly, they were easily treatable and are now considered little more than a minor inconvenience.
But soon after the development of penicillin, in the 1940s, scientists reported a strain of E.coli that was able to resist the antibiotic. As antibiotics became more common so too did these so-called superbugs that could spread even when antimicrobials (which includes a broad spectrum of medicines that kill potentially dangerous microorganisms) were used against them.
More recently, scientists began to realize that overuse of antibiotics can lead to bacteria resistant to antimicrobial medicine.
The COVID-19 virus is not a bacteria that antibiotics like penicillin treat. Viruses can only exist and multiply within a living organism whereas bacteria can exist alone in the environment. Vaccines are used as a preventative measure against viruses whereas antibiotics are a reactive measure for bacterial infections. Certain antimicrobials, called antivirals, can be used to treat certain viruses.
Both antiviral and antibiotic medicines are critical to human health in an environment where potential enemies of the human body literally bombard us, constantly—not just one, but trillions of microorganisms that have the potential to kill us.
The variants of COVID-19 that we have all heard so much about are an example of how microorganisms evolve to resist vaccines and other medicines used against them.
Antibiotic resistant bacteria are now one of the biggest threats to human health. Misuse and overuse of antibiotics is allowing bacteria to speed up their mutation into resistant microorganisms that can cause many types of infection in humans, and, ultimately, death.
The World Health Organization (WHO) has declared antimicrobial resistance (AMR) to be one of the top 10 global threats — every corner of the globe is facing this looming health problem. In 2015 the WHO adopted the Global Action Plan to tackle growing bacterial resistance to antibiotics.
Older adults may remember when antibiotics were prescribed for pretty much anything — a common cold, a small cut — but healthcare providers are increasingly taking caution, only prescribing antibiotics when the benefits outweigh the risks. Due to our overuse, these risks are increasing.
According to Public Health Canada, it is estimated that, in 2018, over 25 percent of bacterial infections across the country were resistant to at least one first-line antimicrobial. That same year in Canada, 14,000 deaths were associated with AMR, with 5,400 of those having AMR as a direct cause.
In February, the United Nations Environmental Programme (UNEP) released a report titled “Bracing for Superbugs” that focuses on the connections between our environment and AMR, and proposes best practices and solutions for dealing with a potential health crisis that, by 2050, could have the same mortality rate that all cancers combined had in 2020. One of the main objectives of the report is detailing the connection between pollution and AMR and how these superbugs are emerging within the environment.
“Pollution of air, soil, and waterways undermines the human right to a clean and healthy environment. The same drivers that cause environmental degradation are worsening the antimicrobial resistance problem. The impacts of antimicrobial resistance could destroy our health and food systems,” Inger Andersen, Executive Director of UNEP, said. “Cutting down pollution is a prerequisite for another century of progress towards zero hunger and good health.”
There are numerous ways antimicrobials end up in the environment, but two of the most easy to grasp and find ways to control, are concentrations in natural and man-made animal and human waste run-off that enters the environment through our water systems.
Contrary to what some may believe, the greatest use of antimicrobials is, in fact, in animals, not humans. Antibiotics have increasingly been used in livestock agriculture to both treat and prevent bacterial infections and diseases that could spread to the entire group. They have also been used to promote faster growth as demand for meat has grown worldwide.
In Canada, in 2018, all labels supporting growth promotion claims were removed from antimicrobials for livestock use. Under the same legislation, all antimicrobials, which had previously been sold over the counter, became prescription based for livestock veterinary medicine. The new legislation is used as a tool to discourage the unnecessary use of antibiotics in livestock.
Around the same time the federal legislation was enacted, a new food trend emerged. Instead of “all natural”, “GMO free” or “organic”, the label to look for became “raised without antibiotics” — organic meat is also antibiotic free. With this new trend rose skeptics on how beneficial antibiotic-free meat really is. For human consumption, it makes little difference. Unless the animal was infected by an antibiotic resistant bacteria, the use of antibiotics in livestock will not harm the human consumer. But, in Canada, upward of 75 percent of all antimicrobials administered are used in livestock. So discouraging the use of antibiotics in livestock will be a major step in controlling the formation of superbugs in our environment.
Human wastewater systems are among the most concerning sources of antimicrobials. Globally, it is a major issue. According to the United Nations, over 56 percent of wastewater across the world is released with little to no treatment. Unfortunately, the majority of this is due to limited economic resources to construct wastewater infrastructure. In Canada, wastewater infrastructure is widespread, but the processes used to treat our wastewater, while better than nothing, do not fully eliminate the presence of resistant microorganisms and antimicrobial resistant genes.
According to the Ontario Ministry of Environment, Conservation and Parks (MECP), across the province, wastewater treatment plants must provide minimum treatment. This biological treatment eliminates a high proportion of the organic matter in wastewater before it is disposed. MECP also states most wastewater treatment plants across the province actually provide additional treatment or have other advanced technologies. These tertiary treatments remove inorganic compounds including bacteria, viruses and parasites from the wastewater.
“Generally the greater the treatment, the greater the reductions observed,” a spokesperson for the MECP told The Pointer in an email statement.
The spokesperson cited a study which shows some pharmaceutical compounds can be effectively reduced during the wastewater treatment process. “The concentrations of individual pharmaceuticals are in the parts per billion range in untreated wastewater and in the parts per trillion range in treated wastewater. To illustrate, one part per trillion is equal to one drop in enough water to fill 20 Olympic sized swimming pools.”
According to the Organization for Economic Co-operation and Development (OECD), less than 10 percent of antimicrobials have been tested for in wastewater from either human or pharmaceutical waste, and most medicines do not have available environmental toxicity data.
The Pointer reached out to the Region of Peel Public Works Department to ask about any research or studies it is doing on antimicrobial resistance in wastewater. A spokesperson said the Region is not currently part of any studies and there is no testing for pharmaceutical compounds in Peel’s wastewater. The spokesperson said the Region continues to “maintain awareness about these compounds and participate in research opportunities and academia studies that involve testing of lake based municipal water systems in the Greater Toronto Area”.
Despite the lack of testing and room for improvement on treatment levels in some facilities, the MECP said the concentration of pharmaceuticals in the Great Lakes is generally low.
Lower concentration of antimicrobials in water sources reduces the chance for organisms to build resistance to these compounds that kill potentially dangerous microorganisms; but their ongoing mutation and resistance to medicine is part of an evolutionary process, so modern medicine will always have to develop drugs that combat any new potentially dangerous variants of bacterias, viruses or other microorganisms.
The provincial Environment Ministry is monitoring the continuously evolving threat of antimicrobial resistance.
Testing at the local level, where wastewater is increasingly becoming a problem as antibiotics and other medicines enter these systems, allowing microorganisms to mutate and resist them, could help protect us against one of the biggest threats to global public health.
The COVID-19 pandemic has shown us the cost of not being prepared.
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Rachel Morgan, Local Journalism Initiative Reporter, The Pointer