The spread of SARS-CoV-2, the virus that causes Covid-19, has shown only too well how quickly infectious agents can move around the world. Although increasing antibiotic resistance and Covid-19 are not directly linked, there is a serious consequence for human health, since many of our last-resort antibiotics are critical to saving patients with secondary infections that can cause death.

This may drive the next major pandemic, as it exemplifies the significant chance that our suite of current antibiotics will fail to combat many new biological infections, including ones that might spread globally.

Tackling antibiotic resistance

Newcastle University’s Professor David Graham, an environmental engineer who has spent almost 20 years studying the environmental transmission of antibiotic resistance around the world, has contributed to new recommendations for tackling the environmental spread of antibiotic resistance, published jointly in 2020 by the World Health Organisation (WHO), Food and Agriculture Organisation (FAO), and the World Organisation for Animal Health (OIE).

Local “hot-spots” of antibiotic resistance are known to exist around the world, particularly in densely populated regions with inconsistent sanitation and poor water quality. The new guidance, which has since been translated into six languages, provides a framework for countries to create their own locally driven national action plans. 

It centres around growing evidence, including research at Newcastle University, which suggests the problem of increasing antibiotic resistance will not be solved by prudent antibiotic use alone and improving environmental quality around the world may be of equal or greater importance.

The research

Commencing with work analysing antibiotic resistance in water samples from the Ganges River near human pilgrimage sites, Professor Graham’s team and colleagues at the Indian Institute of Technology, Delhi, extended their research to a range of other locations and environmental contexts, including solid waste landfills in China, aquaculture facilities in Thailand, soils near the North Pole, and wastewater treatment plants and networks in many countries.

This suite of work showed that not only does environmental resistance exist around the world, but that the main driver is local antibiotic resistance evolution and spread differs from place to place. It highlighted that antibiotic-resistant genes can move fast between microbes and through many pathways, even to places where antibiotics functionally are not present, such as in polar regions, considered to be the last ‘pristine’ places on earth.

Finding a solution

“The only way we are going to win the fight against antibiotic resistance is to understand and block the environmental and other pathways that lead to spread,” explains Professor Graham. “Our work has shown that although the types and drivers of resistance are diverse and vary by region and country, there are common roots to its spread such as inappropriate antibiotic use in medicine and agriculture, industrial pollution, and inadequate sanitation, resulting in poor water quality.

“There is no such thing as a cookie-cutter solution – each country needs to have its own plan for preventing and addressing the spread of antibiotic resistance that considers that country’s particular situation.

“This means rapidly improving waste management, sanitation, and water quality on local and global scales – especially in emerging and developing countries where the social impacts of resistance are often the greatest – otherwise antibiotic resistance will continue to increase, making the next pandemic even worse.”

Professor Graham’s recent work with the UN Environment Programme, which led to the seminal 2023 report “Bracing for Superbugs: Strengthening environmental action in the One Health response to antimicrobial resistance”, shows the scale of the global problem. This report, which Graham was a co-lead author, recommends prevention of antibiotic resistance at its root and increased integrated surveillance across sectors (a One Health approach) as the two critical actions needed to start winning the fight against antibiotic resistance.

This includes using antibiotics more prudently in every context, but also encouraging governments and public health and other authorities to move towards more locally suitable actions, such as towards local, low cost, easily deployed, yet high impact solutions for human waste management.

Central to this is the importance of greater international co-operation to bring about improved water, sanitation and health (WASH) provision as a way to prevent the next global pandemic.

“Once improved sanitation and hygiene exist at global scales, as well as fairer access to clean water, our reliance on antibiotics will decline,” says Professor Graham.

ABOUT NEWCASTLE UNIVERSITY: Newcastle University, UK, is a thriving international community of more than 28,000 students from over 130 countries worldwide. As a member of the Russell Group of research-intensive universities in the UK, Newcastle has a world-class reputation for research excellence in the fields of medicine, science and engineering, social sciences and the humanities. Its academics are sharply focused on responding to the major challenges facing society today. Our research and teaching are world-leading in areas as diverse as health, culture, technology and the environment. Newcastle University is committed to providing our students with excellent, research-led teaching delivered by dedicated and passionate teachers. Newcastle University is ranked 110th in the QS World Ranking 2024 and 139th in the Times Higher Education World University Ranking 2023.

In the last 24 hours, 11,72,179 samples were tested, the highest single-day tests so far, taking the total number of tests past 4.55 crore. An additional 1,043 deaths linked to the highly contagious disease have pushed the total number of fatalities to 67,376. Over 29 lakh have recovered from the infection in the country so far. Maharashtra remains the state hit hardest by the pandemic followed by three southern states – Andhra Pradesh, Tamil Nadu and Karnataka.

The total recoveries in India have crossed 29 lakh (29,01,908) as of today.Last 10 lakh recoveries have been recorded in only 17 days in comparison to preceding 10 lakh recoveries which were recorded in 22 days.A significant feature of India’s management of COVID-19 cases is the growing rate of recovered patients. As India continues to sustain its progressively increasing rate of recoveries, a higher number of patients are recovering and being discharged from hospitals and home isolation.

Since May 2020, there has been a 58 times hike in the number of recovered patients.As the daily recoveries increase, India registers more than 60 thousand recoveries each day, 6th day in a row. With the recovery of 62,026 cases in the last 24 hours, India’s Recovery Rate amongst the COVID-19 patients has further improved to 76.98%. This figure is demonstrating a continuous progress.The number of recovered cases has overtaken the active cases by more than 21 lakhs. There has been more than 4 times jump in the average weekly recoveries from the first week of July to last week of August.

India continues to report one of the lowest COVID Case Fatality Rates (CFR) when compared to several other countries. While the global CFR stands at 3.3% as on date, the comparative figure for India is 1.76%. The deaths per million population in India is one of the lowest in the world. While the global average is 110 deaths /million population, India is reporting 48 deaths /million population.

The comparative figure for Brazil and the UK is 12 and 13 times higher, respectively. Collaborative efforts of the Union and State/UT governments have resulted in strengthening of the health facilities across the country. 1578 Dedicated COVID Hospitals are providing quality medical care. A unique initiative to build the capacities of the ICU doctors in clinical management of critical patients towards reducing the fatality, e-ICU has been started by AIIMS, New Delhi.

Twice a week, on Tuesdays and Fridays, tele/video -consultation sessions are held by knowledge and domain experts for the doctors manning ICUs in the State hospitals. These sessions started from 8th July 2020. Till date, 17 tele-sessions have been held, and 204 institutions have participated in them.

To further build the ICU/clinical management capacities of doctors for treatment of critical patients, AIIMS New Delhi in collaboration with the Health Ministry has developed FAQs. These have been posted on the MoHFW website.

With the lockdown eased out and socio-economic activities resumed, especially with the commencement of post-monsoon working season, the water supply infrastructure activities have to be implemented on a bigger scale and with speed to achieve the goal of providing tap water connections to all rural households.

Hence, it is imperative for WASH service providers at the forefront to follow all the necessary precautions to avoid contraction and spread of the virus.

Current evidence indicates that the CoVid-19 virus is transmitted through respiratory droplets or contact, and transmission occurs when contaminated hands touch the mucosa of the mouth, nose, or eyes; the virus can also be transferred from one surface to another by contaminated hands, which facilitates indirect contact transmission. Along with physical distancing, hand hygiene is the most effective single measure to reduce the spread of infections through multimodal strategies, including access to the appropriate supplies.

To ensure hand hygiene is practiced through hand wash at regular intervals, in order to contain the spread of the Corona virus, there is an urgent need to make tap water available inside every rural household premises.

For this purpose, adequate fund has been made available under Jal Jeevan Mission. The mission presents an excellent opportunity to mitigate the ongoing pandemic situation not just by ensuring water supply but also by generating employment to labour who have migrated back home.

In this context, this supplementary advisory is issued by DDWS for assured safe water service delivery to every home with focus on various aspects.

Arrange hand-washing equipment: Hand-washing arrangements with soap and water at the entrance of every water supply establishment may be made to allow everyone to practice it before entering and when leaving. Installation, supervision and regular refilling of the hand washing equipment are the overall responsibility of PHE/ RWS Department;

Ensure potable water in quarantine/ isolation centres: Potable water arrangements are to be ensured at all camp sites, schools/ hostels that have been turned into quarantine/ isolation centres. The arrangements may include tanker water supply, providing temporary stand-posts from near-by potable water source, retrofitting/ repairing existing functional infrastructure wherever required, etc.;

Prioritize health care centres and facilities: A quick gap assessment on potable water facilities in health care centres may be undertaken and immediate arrangements may be made to ensure safe and clean water in all health care facilities;

Promote physical distancing of communities while fetching water: Wherever community members fetch water from stand posts, efforts may be made to widely communicate the importance of physical distancing by maintaining 6 feet gap (2 gaj doori), covering their mouth and nose, etc. All persons must wash hands thoroughly before fetching water;

Increase water supply duration: Given the need to practice physical distancing at stand posts, the duration of water supply may be increased for facilitating the same. Announcements may be made to spread awareness on physical distancing norms and increased water supply hours;

Provide personal protective gear to water supply service providers: Provide soaps/ sanitizers, gloves, masks, gumboots, wipes, etc. to all individuals involved in water supply service provision. All the contractors are to be briefed the precautionary measures regularly, if possible through texts or whatsapp, and ensure they make adequate arrangements for all the labour they employ. Posters of the precautions may also be circulated to GPs, water supply establishments, etc.;

Grievance redressal: Toll-free number at district/ state level may be set up (if not existing already) and the number may be widely circulated/ disseminated through social media, FM radio channels and local TV channels. Students/ volunteers from the operational PMKVY centres/ skill development centres, colleges, etc. can be quickly trained online for handling grievance calls and supporting respective district/ state administration; and

Prioritize retrofitting in schools/ anganwadis: Children will eventually return to schools and anganwadis and there is an urgent need for retrofitting of existing water and sanitation infrastructure for ensuring access to potable water and clean toilets. The ‘swachh vidyalaya’ guidelines clarify the norms in terms of requirement. Both, adequacy of the infrastructure and the appropriateness from a hygiene perspective needs to be ensured.

Precautionary measures are recommended particularly for community-level service providers, viz. plumbers, electricians, motor mechanics, sanitation workers, etc. especially when leaving home for work, when at work and when reaching home. States/ UTs have been requested to give wide publicity to the supplementary advisory.

COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator, is co-led by the Coalition for Epidemic Preparedness Innovations (CEPI), Gavi, the Vaccine Alliance, and the World Health Organization (WHO) – working in partnership with developed and developing country vaccine manufacturers. It is the only global initiative that is working with governments and manufacturers to ensure COVID-19 vaccines are available worldwide to both higher-income and lower-income.

In order to be able to secure enough doses of vaccines to protect the most vulnerable populations, such as health workers and the elderly, the next step for the partnership is to confirm potential self-financing participants’ intent to participate by 31 August and to turn these into binding commitments to join the COVID-19 Vaccine Global Access Facility (COVAX Facility) by 18th of September, with first upfront payments to follow thereafter, and no later than 9th of October 2020.

“Equal access to a COVID-19 vaccine is the key to beating the virus and paving the way for recovery from the pandemic,” said Stefan Löfven, Prime Minister of Sweden. “This cannot be a race with a few winners, and the COVAX Facility is an important part of the solution – making sure all countries can benefit from access to the world’s largest portfolio of candidates and fair and equitable distribution of vaccine doses.”

The COVAX Facility is a Gavi-coordinated pooled procurement mechanism for new COVID-19 vaccines, through which COVAX will ensure fair and equitable access to vaccines for each participating economy, using an allocation framework currently being formulated by WHO. The COVAX Facility will do this by pooling buying power from participating economies and providing volume guarantees across a range of promising vaccine candidates, allowing those vaccine manufacturers whose expertise is essential to large scale production of the new vaccines, to make early, at-risk investments in manufacturing capacity – providing participating countries and economies with the best chance at rapid access to doses of a successful COVID-19 vaccine.

The success of COVAX hinges not only on countries signing up to the COVAX Facility, but also filling key funding gaps for both COVAX R&D work and a mechanism to support participation of lower-income economies in the COVAX Facility.

“COVID-19 is an unprecedented global health challenge that can only be met with unprecedented cooperation between governments, researchers, manufacturers and multilateral partners,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO. “By pooling resources and acting in solidarity through the ACT Accelerator and the COVAX Facility, we can ensure that once a vaccine is available for COVID-19, it’s available equitably to all countries.

Numbers of deaths and cases are usually lower on the weekend because of patchy reporting. Experts say the true totals are likely far higher due to a lack of testing.

More than 630 new coronavirus-related deaths were confirmed in Brazil in the past 24 hours, bringing the country’s total Covid-19 death toll up to over 72,000 according to the latest data from the Health Ministry.

In the past 24 hours, 24,831 new cases and 631 new deaths from Covid-19 were confirmed, according to Sunday health ministry data. Brazil’s total coronavirus death toll stands at 72,100, while the total number of cases is at 1,864,681.

Critics say the government of far-right President Jair Bolsonaro has failed to give a unified message on how to combat the virus, with state governors leading the response.

Bolsonaro has even gone so far as to flout containment measures such as social distancing and the wearing of face masks, and blasted governors over lockdowns that have hurt the economy.

The 65-year-old revealed last week he had contracted the virus, but said he was feeling “fine.”

He said he’d taken the anti-malaria medication hydroxychloroquine and that “it worked” – although its effectiveness has not been formally proven and the issue is deeply dividing the global scientific community.

City official Li Junjie said at a press conference that fresh cases had been found in a second wholesale market in northwestern Haidian district, and as a result, the market and nearby schools would be closed, and people living in ten communities around it placed under lockdown.

A Beijing district official the district was in “wartime emergency mode” following a spike in novel coronavirus cases centered around the major wholesale market there.

Chu Junwei, an official of Beijing’s Fengtai district, said at a briefing that throat swabs from 45 people, out of 517 tested at the district’s Xinfadi market, had tested positive for the new coronavirus.

Beijing will suspend sports events and inter-provincial tourism, effective immediately, a city spokesman said at the same briefing.

On Monday, Trump tweeted images of a letter he sent to WHO Director-General Tedros Adhanom Ghebreyesus, saying the letter was “self-explanatory.”

In the letter, Trump lists what he says are examples of the WHO’s shortcomings in managing the pandemic, including ignoring early reports of the emergence of the virus, and being too close to China.

“It is clear the repeated missteps by you and your organization in responding to the pandemic have been extremely costly for the world. The only way forward for the World Health Organization is if it can actually demonstrate independence from China,” Trump said in the letter.

If the World Health Organization does not commit to major substantive improvements within the next 30 days, I will make my temporary freeze of United States funding to the World Health Organization permanent and reconsider our membership in the organization,” he said.

Earlier Monday, the WHO said it would launch an independent review of the response to the coronavirus pandemic.

During a virtual assembly, Tedros acknowledged there had been shortcomings and told the assembly he welcomed calls for a review.