The excessive use of antibiotics in health and agriculture is among the factors contributing to pandemics, due to the antimicrobial resistance — where diseases that were previously curable start to resist treatment and fight back.

This was recently revealed by the Minister of Health Dr Aaron Motsoaledi.

“In health and agriculture, we are using antibiotics in a way we shouldn’t. We give people antibiotics even when they don’t need them. In agriculture, they are even giving it to cows, in dairy farms, etc. And the microbes have decided to resist,” Motsoaledi said.

He added that this was unsurprising because if any living organism is attacked, it starts resisting and fighting back.

“So, organisms have decided to fight us back, because we are just showering them with antibiotics,” he said.

The minister added that antimicrobial resistance (AMR) is making diseases that “we” used to treat in the past untreatable.

“So, we are not scaring people when we say that one day you will go to the hospital walking, because you are going to do a minor operation and you get an infection there and never come out, because whatever has infected you refuse to die because it has developed resistance,” the minister said.

Professor Rajen Naidoo, head of the Department of Occupational and Environmental Health at the University of KwaZulu-Natal, described antimicrobial resistance as the failure of microorganisms (bacteria, viruses, fungi, etc.) to respond to the use of antimicrobial agents such as antibiotics.

“Thus, these agents are no longer as effective in the treatment of diseases caused by these organisms,” Naidoo said.

He added that the World Health Organization (WHO) estimates that over one million people died worldwide as a result of AMR in 2019.

“The primary cause of AMR is the misuse or overuse of antimicrobial agents. Thus, when used in clinical settings that are not appropriate for that agent – for example, use of an antibiotic when having a viral influenza, or when a patient does not complete taking the full treatment, microorganisms then adapt to the agent, and develop resistance to that agent,” Naidoo explained.

He said the WHO-affiliated report indicates that in most countries, several advanced antibiotics are now resistant to bacteria such as E.coli.

“Similar trends are seen for other diseases of global concern such as TB and malaria,” said Naidoo.

Motsoaledi said the two other contributing factors to pandemics are climate change and encroachment into other organisms’ habitats.

“As human beings, we have started encroaching into the habitats of other organisms. There was a time when we (the Department of Health) were ridiculed by everybody and on social media because RK Khan Hospital in KwaZulu-Natal was invaded by monkeys. Social media showed the monkeys running around in beds.

“It was a very sad sight. I had to rush to Durban. The reason was that the municipality wanted to develop housing somewhere near Chatsworth, where RK Khan is. And monkeys were staying there.

“Instead of relocating them scientifically, they just removed the trees and everything and built houses. Where would the monkeys go? The monkeys found their way to the hospital because their area had been taken. Now this is what human beings do,” Motsoaledi said.

He added that when Ebola started in 1976 in the DRC, it was because a man there went to tamper with a monkey looking for food.

“Today we have Ebola and it doesn’t go away because someone went to tamper with the monkeys. So, we tamper with natural organisms. We know that other pandemics are coming, and we are even doing pandemic preparedness around the world.”

On climate change, Motsoaledi said new diseases that “we” have never seen before are going to emerge because the world would have changed.

Motsoaledi added that health ministers should be included in climate change conferences, because when climate change starts affecting human beings, “it’s in health where we are going to feel it more than in any other sector”.

The WHO predicts that between 2030 and 2050, climate change is expected to cause approximately 250 000 additional deaths per year.

Professor Naidoo said that all climate-related events pose a critical threat to public health in South Africa specifically, and southern Africa generally.

“Firstly, extreme weather events (heatwaves, floods, droughts) have a direct effect on vulnerable communities, resulting in deaths, severe illnesses, poor pregnancy outcomes (extreme heat), drownings, loss of homes, loss of access to health services for emergency and chronic care, waterborne infectious diseases (floods) and immediate food insecurity leading to nutritional disorders,” Naidoo said.

He added that changing climate gives rise to non-extreme events, which generally go underreported in the media, and are non-responsive by “our” authorities (health services, weather services, etc.)

“Thus the slowly increasing everyday heat is having an impact on young, growing children, pregnant females, and their unborn children, and the diseased and elderly on a daily basis. Much of these impacts (increased admission to hospitals, inability to attend school or work because of illness and deaths) are not linked to these changed temperatures, and are therefore silent epidemics in our marginalised communities,” he said.

He said that people living in low socio-economic settings, working-class townships, particularly those living in informal settlements, and migrant communities are the most vulnerable.

He added that within these communities, very young children, pregnant women, the elderly, and those with pre-existing diseases are most at risk for succumbing to climate effects.

“The reasons for these are because within these communities, when it gets hotter, they have no resources to seek cooler environments, living in informal homes from aluminium sheeting increases heat exposure, living in flood plains increases the risk of having your home washed away or families drowning, working-class townships are poorly serviced, informal communities lack proper sanitation. In times of flooding or droughts, their clean water supply is destroyed, forcing them to access water that is likely to be infected with micro-organisms,” Naidoo said.

He said climate change in itself does not affect air quality, however, industrial emissions, such as sulphur dioxide, oxides of nitrogen, carbon dioxide, and particulate matter, which give rise to pollutants that impact air quality, consist of greenhouse gases, which then contribute to climate change.

“These emissions do not influence the changed climate in the immediate area – so for example, the emissions of the industries in south Durban, or the power stations in Mpumalanga will not cause a “greater” climate change effect in those areas. However, these emissions have a direct, immediate, and long-term impact on the health of the communities living in close proximity to those sources of emission. These health effects range from poor pregnancy outcomes, respiratory and heart problems, and learning disabilities” he said.

The increased heat (not necessarily defined as a heatwave) is likely to impact those with pre-existing lung problems such as asthma and chronic obstructive pulmonary disease, such as emphysema. The changing patterns of pollen exposure (longer pollen season, a wider geographical spread, and more intense pollen exposure) are likely to cause those with pollen-related asthma to have more severe persistent symptoms, seek medical attention more frequently, and be away from school or work more regularly, he said.

gcwalisile.khanyile@inl.co.za