A report released today by the United Nations says that we’ve neglected a major component of the superbug problem: the environment. It serves as a reservoir for bacterial genes that create antimicrobial resistance, and it receives farm run-off and pharmaceutical effluent that let new resistance emerge.

“The same drivers that cause environment degradation are worsening the antimicrobial resistance problem,” Inger Andersen, executive director of the UN Environment Programme, known as UNEP, said in a statement. “The impacts of antimicrobial resistance could destroy our health and food systems.”

The 120-page policy document, “Bracing for Superbugs,” recognizes the environment as a place where antibiotic resistance both arises and wreaks havoc, causing as many as 1.27 million deaths per year. It’s a problem that public health planners have already recognized for hospitals and urgent care centers, as well as farms that produce livestock, fish, and crops. The report gives researchers a framework for understanding pathogens that don’t stay confined within those economic sectors, such as resistant bacteria that appear downstream of hospital sewage plants and agricultural fungicides that transform common hospital infections into untreatable ones. It says that governments should write regulations to curb antibiotic pollution, lean on food producers to reduce antibiotic use, improve sanitation systems to remove resistant bacteria from sewage, and create monitoring programs to verify whether environmental protections are working. 

Practically speaking, it elevates UNEP as a leader in the global struggle to control resistant bacteria, connecting it to other UN agencies—the World Health Organization, World Organization for Animal Health, and Food and Agriculture Organization—in a “One Health” approach linking human, animal, and environmental concerns. That’s significant, because nations are already developing plans for controlling antibiotic resistance via a UN process that began in 2016. Now countries are being urged to consider environmental protection as they try to reduce resistant infections in people.

It’s a long-overdue move that reframes the superbug problem, transforming it from an issue created by misbehaving users to a shared responsibility for an imperiled planetary microbiome.

“The environment is the one thing that connects the different sites of selection for antimicrobial resistance in a meaningful way,” says Claas Kirchhelle, a historian of science and medicine and an assistant professor at University College Dublin. “And long term, it’s where stewardship of antimicrobials should be heading, not just over the next two to three years, but 20 to 30.”

It seems remarkable that the role of the environment has been neglected until now, given that the first antibiotics were refined from the products of organisms found in nature. Yet two years ago, when Kirchhelle and researchers from six other countries looked through 75 years of international policy statements on drug resistance, they found only two—out of 248—in which the environment merited sustained concern. “It was legitimate to think of this solely from a human health perspective—after all, people die from AMR in the millions,” he says, referring to antimicrobial resistance. “But we’ve been talking about how to regulate AMR for half a century, yet we still have rising antimicrobial usage and rising antibiotic resistance. So it is time to really think broader.”