THE world is fast sleep walking towards another deadly pandemic that could wipe out an entire civilisation if something is not done urgently. Antimicrobial Resistance (AMR) or the silent pandemic as many epidemiologist have dubbed it, is one of the top 10 global public health threats facing humanity, exposing both humans and animals to catastrophic consequences.
By Michael Gwarisa
Antimicrobial resistance occurs when microorganisms evolve mechanisms that protect them from the effects of antimicrobials or agents that kill microorganisms or stops their growth. Antibiotic resistance is a subset of AMR that applies specifically to bacteria that become resistant to antibiotics.
It has already been projected that if nothing is done now, by the year 2050, the world will be facing a catastrophe and Africa will lose about 4.1 million lives yearly to AMR attributable deaths and this will consequently result in countries losing an average 2 to 3.5 percent in Gross Domestic Product (GDP). According to latest data released by The Lancet, a total 1.2 million people died worldwide in 2019 from infections caused by bacteria resistant to antibiotics, according to the largest study of the issue to date.
The deaths from AMR in 2019 were more than the annual death toll from malaria or Aids and the hardest hit countries were those in little resource settings especially countries in Sub Saharan African. Already, the world is facing an AMR crises as a result of overuse and abuse of antibiotics during the COVID-19 pandemic where people could just walk into pharmacies and get antibiotics even in the absence of a prescription from the doctor.
Over the years, discussions around AMR have increased. However, the discussions seem to be happening in urban settings and at an elite level. Those at the periphery of society remain in the ark and yet that is where some harmful practices that could lead to a high AMR burden happen. For example in our villages, townships and communities, sharing antibiotics is not a big issue. It’s easy to ask for a pack of Amoxicillin tablets from a friend. In as much as this is an act of love and care, its long term implications might have negative repercussions.
Even though there are at an equal risk as their rural counterparts, access to information is not that much of a challenge for urban dwellers, as compared to rural areas in Zimbabwe. This to some extent puts urban dwellers at an advantage. In the end, it is the rural people who bear the brunt and suffer the most when the AMR pandemic hits the hardest.
To bridge this information gap, there is need to empower organizations and individuals who work directly with communities on a daily bases. AMR is a very technical issue whose message needs to be disseminated in a simplified and palatable manner. If possible, there is need to devise vernacular messages in all the country’s 16 official languages. To deliver this message, the Ministry of Health and Child Care (MoHCC), the World Health Organization (WHO) and other partners can make use of already existing Civil Society Organizations (CSOs) whose work is community centered.
Village Health Workers (VHWs) and organizations such as the Community Working Group on Health (CWGH), the Pan-African Treatment Access Movement (PATAM) and other community based CSOs can influence communities to take up responsible behavior that could greatly reduce AMR in the future. The CWGH for example has more than 20 years’ experience working in communities and communicating public health issues with communities in the grassroots. The organisation has over the years been working hand in glove with VHWs to reach out and deliver primary health care services even in hard to reach areas.
It is also critical to note that AMR in not only a human health issue but also involves environmental health as well as animal health and to win the battle against AMR, we definitely can’t afford to address it in silos. The World Health Organization adopted One Health strategy. One Health is an approach that recognizes that the health of people is closely connected to the health of animals and our shared environment. To achieve the One Health goal, there is need for collaboration across all sectors.
The role of civil society organizations is not a new phenomenon as these organizations have always been at the forefront of advocating and raising awareness on several complex issues such as HIV and AIDS, Malaria, Cholera, COVID-19 among others. Tapiwa Kujinga an AMR advocate and the Director of the Pan-African Treatment Access Movement (PATAM) believes that the role of civil society is quite multifaceted with the first role being that of advocacy at all levels.
“As a civil society organization during the HIV/AIDS era, we were involved in HIV/AIDS advocacy, though it was more on the outside than the inside. With antimicrobial resistance, it is a little bit different as I believe that to be more effective in advocacy, civil society organizations need to be part of the antimicrobial resistance response by working with crucial sectors especially education and awareness – and not only to provide external technical guidance,” said Kujinga.
He believes that in Zimbabwe, civil society is literally involved in every aspect of the response to antimicrobial resistance.
“We start right from education and awareness all the way through laboratory surveillance and infection, prevention and control. This is because it is important that we guide and work towards where we feel the response should go, rather than just dictating the response and let somebody else do it. Following this, civil society organizations play a critical role in monitoring that the response is actually going the direction it should be going.”
Community based CSOs have a number of advantages as they have the ability to get down to grass-root levels that other stakeholders such as government have struggled to reach due to a general distrust from the community. One asset that civil society possesses is goodwill, which makes it easier for people at the community level to believe what is being shared with them.
Another asset that civil society organizations have is the ability to critically analyze issues through for example, frequently conducting end-term evaluations and objective analysis which hardly happen in government. This is how come civil society organizations are able to hold government accountable on various decisions. In addition, civil society organizations are very result-oriented and focused on seeing change. Whereas with government in Zimbabwe for example, the approach is to constantly appear like something is being done to address issues when nothing is actually being done.