Deputy Managing Editor
sampson.nanton@cnc3.co.tt
The next major public health threat facing Trinidad and Tobago may not arrive with the visible fear and urgency of a pandemic.
Instead, it may already be quietly moving through farms, rivers, livestock, food systems and even medicine cabinets—carried by antibiotic misuse and the growing threat of antimicrobial resistance.
For medical microbiologist Dr Rajeev Nagassar, the danger is not hypothetical. It is already here.
Speaking ahead of receiving an international special recognition award for his work in One Health, Nagassar warned that T&T must begin thinking about health differently—not simply as hospitals treating sick people, but as a complex system connecting humans, animals, crops and the environment.
“People think about health only when they are sick or when they go to a doctor,” Nagassar said in an interview with Guardian Media.
“But One Health is the interconnectedness of humans, animals, crops and the environment. What happens in one part of that system can eventually affect the others.”
That interconnectedness, he said, becomes particularly alarming when antibiotics are misused—whether in humans, livestock or agriculture.
Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites evolve to resist medicines designed to kill them, making infections harder—and sometimes impossible—to treat.
The World Health Organization has repeatedly warned that AMR is one of the top global public health threats, capable of reversing decades of medical progress.
For Trinidad and Tobago, Nagassar said the concern is not abstract.
He pointed to published local research showing antibiotic misuse in communities, including over-the-counter access to medication and the presence of resistance genes found in livestock, poultry, humans and the environment.
“Some of the last-line drugs that doctors rely on when nothing else works are beginning to show resistance,” he said.
“We have found resistance genes in the environment, in poultry, in livestock and in humans. The question we are now trying to answer through research is how connected all of these things are and how they move through the system.”
That system, he explained, can be deceptively simple.
Animal waste used as manure on crops can carry harmful bacteria if not properly treated. During rainfall or irrigation, those contaminants may enter soil and waterways before eventually reaching people through food or water supplies.
Nagassar cited examples of bacteria such as E.coli, Salmonella and Campylobacter, all of which can be transmitted if agricultural practices are poor.
“If manure is not cured properly and is used too close to harvest time, pathogens can move from animals to crops,” he said.
“Then it can get washed into rivers or groundwater. Humans downstream use that water for bathing, cooking or washing vegetables. That is how diseases can spread through the ecosystem.”
The concern is not unique to T&T. Internationally, food contamination linked to agricultural systems has resulted in outbreaks tied to produce, particularly leafy vegetables.
Yet Nagassar believes One Health thinking remains poorly understood locally.
Many people associate public health solely with hospitals and clinics, overlooking the role of agriculture, environmental management and food safety.
“People overlook crops and agriculture,” he said.
“But infections can begin there, from the animal sector, and eventually affect humans. Health is not just about medicine. It is about understanding the whole picture.”
Nagassar’s work in this area has earned increasing regional and international recognition.
Last year, he received a leadership award from the Pan American Health Organisation (PAHO) for his work on antimicrobial resistance, and this year he will receive a special recognition award through the Caribbean Global Awards programme for his contribution to One Health.
The recognition reflects years of work spanning research, surveillance, policy and public health interventions.
Nagassar, who has more than 35 peer-reviewed publications and has worked alongside PAHO and the World Health Organisation, said one of the major successes in T&T has been moving beyond research into implementation.
Among those efforts is the Tailoring Antimicrobial Resistance Programmes (TAP) initiative, aimed at reducing antibiotic misuse in communities.
According to Nagassar, T&T became the first country in the Americas where this specific approach was tailored to tackle inappropriate antibiotic use.
“We’re not just generating data anymore,” he said.
“We are trying to implement programmes to reduce misuse, especially over-the-counter dispensing of antibiotics, because misuse has consequences not only for health but also for the economy.”
The economic implications are often overlooked.
Nagassar warned that antimicrobial resistance can affect trade, particularly agricultural exports.
He pointed to examples internationally where countries have faced restrictions because of antimicrobial residues in food products.
“People don’t realise antimicrobial misuse could affect trade,” he said.
“For small states like ours, that matters. If countries lose confidence in products because of antimicrobial concerns, it can have a serious economic impact.”
There is also pressure on an already strained healthcare system.
Research published by Nagassar and colleagues found that patients who contract multidrug-resistant infections may remain hospitalised for significantly longer periods.
A routine hospital stay of several days can stretch to weeks when infections become resistant to treatment.
“If somebody acquires a multidrug-resistant infection, they may remain in hospital for up to a month,” he said.
“That means greater cost to the healthcare system, more resources being used and fewer beds available. Reducing resistance would not only improve health outcomes but reduce spending.”
Still, he believes Trinidad and Tobago has made progress.
He pointed to infection prevention manuals, surveillance frameworks and growing efforts in universities and healthcare settings to strengthen infection control and antimicrobial awareness.
Hand hygiene - among the simplest interventions - remains one of the most effective.
Nagassar has also published research examining improvements in handwashing practices among university students following the COVID-19 pandemic.
“Hand hygiene is one of the cheapest and easiest ways to prevent infections,” he said.
“It is not only about antimicrobial resistance. It helps prevent infectious diseases generally.”
But challenges remain.
Greater integration between sectors, he said, is still needed if One Health is to work effectively.
The medical field, agriculture, veterinary medicine, environmental management and policymaking cannot continue operating in isolation.
“What makes One Health difficult is that it becomes very complex,” Nagassar said.
“You’re trying to understand humans, animals, crops and the environment all at once. But these are the kinds of problems we have to tackle if we want long-term solutions.”
For Nagassar, the hope over the next decade is straightforward: fewer multidrug-resistant infections, smarter antibiotic use and a health system less burdened by preventable illness.
The issue may not command headlines in the way pandemics do, but he believes ignoring it now would come at a cost later.
“I would like people to be responsible in their use of antimicrobials, pesticides and chemicals,” he said.
“Because all of these things affect animals, humans, crops and the environment. Everything is connected.”
And in that connection, he argues, lies both the warning - and the solution.
