The increase in antibiotic-resistant pathogens, or “superbugs,” is probably the most concerning human health impact we face related to wastewater pollution. Antimicrobial resistance is responsible for 700,000 deaths annually, a number that is growing because of poor antibiotic stewardship (i.e., over-prescribing antibiotics), lack of sanitation, insufficient wastewater treatment, and discharge into the environment (O’Neill, 2016). Superbugs originate with illness that is treated — often liberally — with antibiotics. These antibiotics make it into wastewater, where they mingle with microbes. The antibiotics kill many microbes, while other microbes that have the genetics to resist lower doses of antibiotics, are selected for and increase in relative abundance. If not properly treated, these new superbugs make their way into the environment. It is a dangerous feedback loop of disease, antibiotics, commingling, and exposure. There is a growing realization that wastewater treatment plants are a breeding ground for superbugs (Naquin et al., 2015; Rodríguez-Molina et al., 2019). Improving sanitation and wastewater treatment is a critical component of addressing this threat to human health.
Reducing pollution and the prevalence of superbugs also benefits ocean health. With the COVID-19 pandemic, the importance of public health in even distant places has never been more appreciated. Local or regional wastewater pollution challenges have the potential to create global health crises. Taneja and Sharma (2019) document an excellent example of the severity of this situation in India. Throughout the country, there has been liberal and injudicious use of antibiotics to treat many illnesses. This practice has led to one of the highest rates of resistance to antimicrobial agents used to treat humans and food animals, and to one of the highest concentrations of drug-resistant microbes in natural water bodies. Their findings are a warning to the rest of the global community, while the containment plans now being put in place (reduction in antibiotic use and ban of wastewater sludge application to agricultural fields) serve as a model of how to abate the issue.