WAAW 2025: Strengthening environmental regulation to address antimicrobial resistance in the Global South

Although antimicrobial resistance (AMR) is often framed as a problem of hospitals, livestock, and antibiotic misuse, a wider set of resistance-driving pollutants plays a crucial role. Antimicrobials, metals, biocides, microplastics and chemical residues enter water, soil and air ecosystems through various environmental pathways. Specifically, aquatic environments are both major reservoirs and dissemination routes for AMR.

Given the significant impact of environmental water on human, animal, and terrestrial health, understanding the presence of pathogens and AMR determinants in source water has been essential for hazard characterisation and assessing potential risks. As the environment’s role in spreading clinically relevant AMR becomes clearer, national strategies can be strengthened by placing greater emphasis on environmental protection.

During World Antimicrobial Resistance Awareness Week this year themed, “Act Now: Protect our Present, Secure our Future,” it is timely to highlight how improvement in environmental regulation, surveillance, and accountability can significantly reduce AMR risks now and in the years ahead.

Identifying the gaps in environmental protection

Following the high-level political attention generated by the United Nations General Assembly High-Level Meeting on AMR, approximately 178 countries have developed national action plans, some with input from environmental regulators. However, less than one-fifth of these plans are funded or actively implemented. Despite increased awareness and environmental representation in national plans, substantial gaps in environmental protection against AMR persist.

AMR efforts have traditionally targeted antibiotics, focusing on hospital effluent and pharmaceutical manufacturing. While important, these sources represent only a fraction of the chemicals driving resistance in the environment. Large volumes of contaminants come from under-regulated sectors, particularly municipal and industrial wastewater. These streams often pass through overloaded or outdated treatment plants, resulting in minimal or no effective treatment.

Heavy metals such as lead, cadmium and arsenic — commonly released from mining, industry and waste streams — further accelerate the emergence and persistence of AMR. Additional contributors include land application of manure and sludge, livestock and aquaculture operations, intensive crop farming, and the improper disposal of medicines and household chemicals. Recognising and regulating these non-antibiotic drivers offers a major opportunity to strengthen national AMR strategies.

Expanding and upgrading wastewater treatment for AMR prevention

Although wastewater treatment capacity in many parts of the Global South remains limited, expanding access is essential to reduce AMR dissemination. This expansion must be paired with updated and enforced discharge standards (in relation to AMR) that account for local land-use patterns, coastal and aquaculture activities, and support water resource quality objectives. In non-sewered settings, nature-based solutions, bioremediation, phytoremediation, and decentralised systems powered by renewable energy offer alternatives that can reduce pollutant loads while remaining financially feasible. These systems can reduce pollutant loads, improve water quality, and create co-benefits such as habitat restoration or increased community resilience.

Applying the Polluter-Pays Principle and Extended Producer Responsibility (EPR)

Strengthening environmental regulation also requires clear accountability. Countries can make significant progress by adopting and operationalising the polluter-pays principle and extended producer responsibility (EPR). Adequate financing is also needed to remove micropollutants, including pharmaceuticals, personal care products, microplastics, and other contaminants of emerging concern (CEC), that contribute to the development or persistence of AMR. Microplastics in freshwater systems potentially serve as surfaces for microbial biofilms that may contain pathogens and AMR. Their microbial composition and health risks are poorly understood, and if not removed, have the potential to transport AMR to various areas downstream of wastewater treatment works.

EPR schemes can further improve the management of land-based waste and reduce harmful discharges from mining, preventing pollutants from entering water systems in the first place — an urgent need in the Global South where many countries are disproportionately affected by mining impacts. Enhancing or introducing wastewater and environmental surveillance will better track AMR emergence, hotspots and spread.

Increasing investment in strengthening data, evidence, and monitoring

Currently, most countries in the Global South lack scientific, evidence-based data on culture-dependent and culture-independent AMR surveillance across entire river systems from pristine sources to areas at high risk of faecal contamination and clinically significant pathogens (e.g. ESKAPE pathogens: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species, as well as Escherichia coli). Risk assessment studies for complete river systems are similarly scarce. Where data exist, temporal comparisons are impossible because most studies provide only a single snapshot and use methods that are not comparable.

Investment is needed to strengthen data platforms, sharing mechanisms, and analytical tools. A comprehensive and standardised representation of surveillance data across different locations is essential to inform policymakers and cross-sector stakeholders, including environmental authorities. Standardised metadata on AMR in water systems is critical for developing and implementing effective mitigation strategies.

Importantly, cost-benefit analyses should be integrated into environmental AMR research. Policymakers need clear evidence not only of where AMR is emerging in the environment, but also of the economic and ecological costs of inaction. At present, most assessments of the environmental burden of AMR are global estimations. Generating local evidence on how environmental pollution drives AMR (and the long-term costs of failing to address these drivers) can provide a compelling rationale for investing in improved regulation, treatment infrastructure, and pollution control.

Adopting a unified approach to environmental regulation and AMR prevention

Sustainable environmental regulation is a vital part of reducing antimicrobial resistance, and success depends on coordinated action across health, agriculture, mining, water, and sanitation grounded in a One Health approach. WAAW 2025 is an opportunity for governments, regulators, researchers and the private sector to commit to strengthening environmental oversight and reducing the environmental drivers of AMR. Protecting ecosystems is not an optional addition to AMR strategies; it is the foundation of long-term antimicrobial effectiveness. With shared commitment and sustained investment, countries can safeguard their natural environments, protect public health, and ensure that life-saving medicines remain effective well into the future.

Eunice Ubomba-Jaswa is a Medical Microbiologist and currently a Research Manager for Water Quality & Health at the Water Research Commission, South Africa

Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth