Antibiotics, river contamination and healthcare

• Several rivers in the world, including those in India, have been reported to have high concentrations of antibiotics such as ciprofloxacin, norfloxacin, oxytetracycline and ofloxacin.
• Hundreds of sites around the world, from Thames to Tigris, are awash with dangerously high levels of antibiotics.
• Our rivers and water bodies are life-supporting assets. But river pollution has become a major cause of concern across the world in past few decades. High concentrations of chemicals, particularly drugs, in surface and ground water pose many risks.
• In a global study researchers tested 711 sites in 72 countries and found antibiotics in 65% of them. In 111 of the sites, concentrations of antibiotics exceeded safe levels, with the worst cases more than 300 times over the safe limit. Most of the polluted sites were in Asia and Africa.
• Recent reports on presence of high amounts of myriad pharmaceutical residues in water bodies in Hyderabad highlight the sordid state of affairs in which the country is handling its urban and industrial waste, and consequent pollution of water bodies.
• 59% of annual environmental costs in India are incurred due to surface water pollution.
• Infant mortality rates, which serve as a good yardstick to access susceptibility to water-borne pathogens, are higher in India than the global average.

Ecology inter-linkages

• Biomes, which are distinct communities of flora and fauna that get formed in response to a shared climate, and tissue-specific micro biomes, which are a mix of organisms that coexist in tissues, have an intimate link with each other, jointly impacting human health.
• All major civilizations in ancient times developed along the banks of major rivers.
• Water constitutes 70% of our total body composition. Apart from its use as an essential component for survival, water is required for agricultural and industrial activities, and power generation, thus playing a central role in global food supply, economic prosperity and the survival of all living organisms.
• London case of 1854: English physician John Snow was first to correctly suggest that London’s ‘Broad Street cholera outbreak’ in 1854 was caused due to leakage of sewage full of faecal bacteria into a public well.

What is the threat?

• Unfit for use: Continuous discharge of untreated fluids into rivers gradually pollutes its water and makes it useless for drinking, agriculture and further industrial use.
• Even low concentrations are dangerous: As pharmaceuticals are designed to interact with living organisms at low doses, even low concentrations affect freshwater ecosystems and endanger both marine and human life.
• Environmental harm: An OECD report estimates that 10% of pharmaceuticals have potential to cause environmental harm—hormones, painkillers and antidepressants are the biggest concerns.
• Affect algae and other organisms: Discharge of oral contraceptives is causing feminization in fish and amphibians, and residues of psychiatric drugs are altering fish behaviour.
• Antibiotic resistance: Antibiotic pollution is one of the key routes by which bacteria are able develop resistance to life-saving medicines, rendering them ineffective for human use. A lot of resistance genes seen in human pathogens originated from environmental bacteria.
  • According to the UN, rise in antibiotic-resistant bacteria is a global health emergency that could kill 10 million people by 2050.
• Lack of adequate technology: Lower-income countries often lack the technology to remove these drugs, and this makes the threat more serious.
• Has mobility: Even if wealthy countries wipe out antibiotic pollution, drug-resistant microbes can still reach to them through sick travellers from lower-income countries. They might move around the world as migrating birds. They might even arrive in imports of animal-based foods.
• The health hazard is more than only about consumption of contaminated water.
  • A study identified irrigation as a link between water pollution and health.
  • Another study highlighted bathing, food and person-to-person contact as modes of disease transmission from polluted water.
  • One-grade deterioration in Chinese river water quality was associated with a 9.7% increase in digestive cancer incidence.
  • Pregnant women being exposed to a 10% increase in agrichemical levels in Indian rivers during their first month of conception was associated with an 11% increase in likelihood of one-year mortality among new-borns.
  • Infants are also highly susceptible to water-borne pathogens.

What are the causes?

• Common causes: Common causes include industrial discharge, open defecation; untreated waste from chemical and pharmaceutical industries, waste generated by hospitals, clinics and animal husbandry units.
• Untreated industrial discharge: Indian industries discharge untreated or partially treated water into nearby water bodies or rivers, leading to severe water pollution and water toxicity.
• Drugs find their way into rivers and soil via human and animal waste, and leaks from wastewater treatment plants, and drug manufacturing facilities.

Steps taken to improve the situation in India

• In 1985, Indian government launched the Ganga Action Plan (GAP) to clean river Ganga.
  • Later GAP was extended to other rivers in Ganga basin, and all other rivers of India.
  • Currently, 190 towns in 20 states along 41 rivers are regulated under what is now known as the National River Conservation Plan (NRCP), India’s flagship water pollution clean-up policy.
• Studies suggest that providing clean water supply and sanitation to whole of India would save $3-8 billion by way of forgone earnings.
• GAP is yet to yield tangible results: While India wants to clean its rivers by 2030, the target seems difficult to achieve, as government’s own data reveal numbers of polluted stretches of rivers across country have increased in past few years.

Situation of World Rivers and other sites

• Many sites with unsafe levels of the drugs contained more than one antibiotic.
• Thames: High levels of Ciprofloxacin (treats infection of the skin and urinary tract).
• Danube: High levels of Clarithromycin (used to treat respiratory tract infections such as pneumonia and bronchitis).
• Bangladesh: Very high level of Metronidazole (used to treat vaginal infections).
• The most commonly found one was Trimethoprim (used to treat urinary-tract infections).
• Other commonly found antibiotic was

Conclusion

Unless adequate measures are taken to manage risks, the situation is set to worsen, as the use of pharmaceuticals rises with ageing populations, advances in healthcare, rising meat and fish production, and increased use of antibiotics for livestock. Improving the safe management of health and hygiene services in low-income countries is critical in fight against antimicrobial resistance.