World pays the price to AMR low risk perception

“Antibiotics are life-saving, but they should only be taken when they have been prescribed by a health worker for bacterial infections.”

By Catherine Murombedzi

Misuse, abuse and unnecessary exposure to antibiotics, when they are prescribed and used for conditions that are not caused by bacteria, like colds and flus, allows antibiotic-resistant strains to develop, this was highlighted in a recent webinar by the World Health Organisation (WHO) and experts during the World Antimicrobial Awareness Week (WAAW).

With antimicrobial resistance now ranked a leading killer among all other diseases and conditions, the world has run out of time amidst calls for urgent attention to end the AMR scourge.

A clarion call by speaker after speaker during the webinar session showed the urgency that AMR should be treated with.

The greatest burden of antimicrobial resistance is in sub-Saharan Africa and south Asia, with global annual deaths 1.27m among humans, not to talk of indirect causes, an additional 4.95 million deaths occur annually,” Dr Haileyesus Getahun, Director, Global Coordination and Partnership on AMR, and Director, Quadripartite Joint Secretariat on AMR, World Health Organisation, (WHO).

“Low-income countries will be pushed into extreme poverty by 2030,” a 2017 World Bank report warned.

Action to avert that cycle into dire poverty must be taken now, a stitch in time saves nine.
AMR is likely to cause a massive US$1.2 trillion additional health expenditure per year by 2050, pushing up to 24 million people down.

The climate crisis and antimicrobial resistance are two of the greatest and most complex threats currently facing the world. The dual threat of the climate crisis and AMR will have the most devastating impacts on low- and middle-income countries and small island developing nations.

Zimbabwe is not spared, a small nation in Southern Africa with a population of 15 million, (August 2022 preliminary Census results).

“In Zimbabwe, a total of 4.3 million people, including 2.2 million children, will be in need of life-saving health, HIV and nutrition services. More than 21 000 children with severe acute malnutrition will be in need of treatment. A total of 2.5 million people will require safe water and sanitation,” reports UNICEF.

The Government of Zimbabwe (GoZ) supported by FAO and WHO, trained trainers, (ToT), who will, in turn train more on AMR.

“Aspects of antimicrobial use in the agriculture sector and their impact on the environment and humans were shown by  the global pandemic, COVID-19. The critical linkages between the human and animal interface and the need to strengthen health systems and surveillance for humans, animals, and the environment were found wanting.

“Over the past few years, we have had diseases that we never thought we would have such as COVID-19, Marburg disease in Ghana, the monkeypox being recorded in non-endemic countries and the polio outbreak in Mozambique and Malawi threatens the Southern Africa region. All these outbreaks need us to work together as One Health, to ensure that the country is prepared to deal with such diseases that have shown us the critical link between animal, human and environmental health,” said Dr Raiva Simbi, MoHCC Laboratory Services Director in Mutare at ToT for Ministry of Health and Child Care.

FAO and WHO continue to provide crucial support to the GoZ to strengthen AMR surveillance, developing new training modules, establishing voluntary codes of conduct and best practices in food safety and production.

WHO is supporting Zimbabwe in setting up strong AMR governance structures, setting up National Hospital Acquired Infection surveillance, providing a legal framework for One Health work in Zimbabwe, supporting the use of vaccines such as typhoid vaccines to reduce antibiotic use and reviewing National Infection Prevention and Control (IPC) guidelines.

Globally, the links between AMR and the climate crisis have been neglected and require urgent attention,  “Political will, advocacy and financing are urgently needed to build resilience to both,” Dr Haileyesus Getahun, speaking during the webinar.

ONE HEALTH

One Health approach is an integrated, unifying approach that aims to sustainably balance and optimise the health of people, animals, and ecosystems. It recognises the health of humans, domestic and wild animals, plants, and the wider environment, are closely linked and interdependent. One Health approach can effectively address the challenge of AMR.

With the Third Global High-level Ministerial Conference on antimicrobial resistance set for Muscat, Oman, late November this year.

“The Muscat Ministerial Manifesto” will build up to next year’s United Nations General Assembly High Level Meeting on Antimicrobial Resistance to be held by world leaders.
Such buy-in from the highest offices is needed.

Junxia Song, Senior Animal Health officer and AMR coordinator, Food and Agriculture Organisation of the United Nations, FAO said AMR will negativity affect good health, zero poverty, zero hunger, clean water and sanitation, and responsible consumption and production.

HUMAN/ANIMAL LINK

With 1.3 billion people relying on livestock for their livelihoods especially in low- and middle-income countries, the spread of resistant strains of pathogens impacts negativity on their livelihoods.

“It is important to note that 76% of the antibiotics commonly used in food animals are also important for human medicine. 73% of all antimicrobials sold globally are used in food animals. From One Health context, this makes the agriculture and food pivotal to the response to the global challenge of AMR. We must ensure that food and agriculture sectors, dependent livelihoods, and economies are made resilient to the impacts of AMR,” said Junxia Song, Senior Animal Health officer and AMR coordinator, FAO.

AMPLIFY PREVENTION

The slow pace in addressing the issue was amplified by Jacqueline Álvarez, Chief, Chemicals and Health Branch, Economy Division, United Nations Environment Programme (UNEP).

“Historically, major focus of AMR has been on the clinical setting and animal health. As a result of which research and science is still in infancy and not addressing action to prevent and minimise the risk of antimicrobial resistance in the environment,” said Jacqueline Álvarez,

“For us, AMR is both, a cause and a consequence, of the triple planetary crisis of climate change, biodiversity loss, and pollution and chemicals with the spread lowering diversity. Pollution containing selective concentrations of antimicrobial compounds can contribute to antimicrobials in the environment,” said Alvarez.

What affects the animals affects the humans also affects the environment. UNEP is working on a report on the environmental impacts of antimicrobial resistance and the causes for the development and spread of resistance in the environment, including the gaps in understanding of those impacts and causes.

Thomas Joseph, Head, Antimicrobial Stewardship and Awareness Unit, WHO bemoaned the burden of diseases and AMR on low resourced countries.

BURDEN ON POOR

“The burden of AMR is greatest in low-resource settings, particularly sub-Saharan Africa, and South Asia, which already carry much of the world’s burden of communicable diseases. AMR is therefore not only a global public health problem, but also an issue of health equity and socio-economic development,” decried Thomas Joseph.

“Drug resistance also affects medicines used in treatment of fungal, and parasitic infections, such as HIV and malaria besides TB. A person with a drug-resistant infection is more likely to be sick, absent from work and family commitments for longer, requires more expensive medicines and care. This has major implications on health-care costs, productivity, both for patients and their caregivers, as well as on the health system and national economy,” Joseph emphasised.

Drug-resistant infections often require the use of second- or third-line treatments, which are usually more expensive, not widely available and can cause serious side-effects like organ failure.

If antibiotics and other antimicrobials lose their effectiveness, we lose the ability not only to treat infections, but also to manage other conditions like diabetes, asthma, cancer treatments and a host of other health conditions. AMR is accelerated by the misuse and overuse of antimicrobials to treat or prevent infections in humans, animals, and plants. Not all people with common infections in the community should routinely receive antibiotics. In many cases infections may be caused by viruses, which do not respond to antibiotics.

CLEAN WATER

Each year, hundreds of millions of cases of diarrhoea in humans are treated with antimicrobials. Universal access to clean water, sanitation and hygiene could reduce this by 60%.

Having access to clean water, sanitation, and hygiene, as well as good infection prevention and control measures, such as handwashing and vaccination, are vital in the fight against AMR. These measures reduce the likelihood of infection in the first place.

It is important for people to minimise use of antibiotics. Self prescription and sharing of antibiotics is dissuaded.

Delfy Gochez, Data Management Officer, Antimicrobial Resistance (AMR) and Veterinary Products Department, World Organisation for Animal Health (WOAH) weighed in on prevention aspect.

POOR PRACTICES

“Antimicrobials are agents used to prevent, control, and treat infectious diseases in humans, animals, and plants. They include antibiotics, fungicides, antiviral agents and parasiticides. Disinfectants, antiseptics, other pharmaceuticals, and natural products may also have antimicrobial properties.

Antimicrobials are also used to prevent infections in animals apart from their use in treating animal diseases. But we must note that antimicrobials used in animals to prevent infections must not be done to compensate poor animal husbandry practices. Rather antimicrobials should only be used for infection prevention in animals at risk of acquiring a specific infection or in a specific situation where infectious disease is likely to occur, if the drug is not administered,” he clarified.

 COLLABORATIONS

Fallon Bwatu Mbuyi, Communication Specialist with the Food and Agriculture Organisation of the United Nations (FAO) called on collaborations to AMR issue.

“This year, the theme of WAAW is ‘Preventing Antimicrobial Resistance Together’. We call on all sectors to encourage the prudent use of antimicrobials and to strengthen preventive measures  addressing AMR, working together collaboratively through a One Health approach.

FOCUS ON AFRICA

Jane Lwoyero, Technical Officer on AMR, World Organisation for Animal Health (WOAH) spoke on research and surveillance in Africa.

“In Africa, and globally, we follow the WOAH’s strategy to promote prudent use of antimicrobials. This includes improving awareness and understanding of antimicrobial resistance and its prudent use, strengthening knowledge through surveillance and research; supporting good governance and capacity building; and encouraging implementation of international standards for preventing antimicrobial resistance.
“We have also disseminated farm biosecurity guidelines in Kenya and Ethiopia to curb AMR. We also helped pilot the information and alert system for substandard and falsified veterinary products in October – December 2021.

VACCINES

WOAH is also promoting the use of vaccines as an alternative to irrational use of antibiotics for Theileriosis in cattle and Typhoid in humans.

With Zimbabwe annually battling Theileriosis during the rain season, thousands of livestock lost can be minimised using the 2021 guidelines from WOAH.

Scott Newman, Senior Animal Health & Production Officer for Asia and the Pacific, Food and Agriculture Organisation of the United Nations (FAO) emphasised the need for sustainable environment.

“Loss of biodiversity and ecosystems, as well as natural habitat for agriculture, have also led to an increase in antimicrobial use and pathogen spread.
“We need to switch to sustainable production, such as by promoting climate smart agriculture,” said Scot Newman.

The need to have sustainable solutions to the environment, nature-based solutions, efficient and safe production methods is called for.

 HARM REDUCTION

“We have to ensure that levels of antimicrobial resistance are reduced and the emergence and spread of resistance is slowed across the food chain and for all food and agriculture sectors.
“Antimicrobial efficacy needs to be preserved while we sustain food and agriculture production,” Newman added.

With India among the AMR burdened countries,
Kamini Walia, Senior scientist, Indian Council of Medical Research, spoke on the strategy the country is using.

 EVIDENCE

“The government of India had launched a National Action Plan to respond to the challenge of antimicrobial resistance (AMR) in 2017 which laid the strategy to strengthen six pillars: raising AMR awareness and understanding, generating knowledge and evidence; promoting infection control and prevention; opitimising use of all antimicrobials in all sectors (human health, animal health, food sector, others), encouraging innovation, research and development, and demonstrating leadership at global, national and state levels.
“To contain AMR, we need better evidence, and evidence-backed actions; we need to improve diagnostic stewardship; we need to have good infection control practices in the hospitals and the community; and without these pillars — we cannot truly practice antimicrobial stewardship.

Diagnostic stewardship and infection control – both are significant challenges in our country because we have sub-optimal investment in the healthcare system, and we do not have good diagnostic laboratories in secondary and primary healthcare services with good laboratories limited to tertiary care health services,” said
Kamini Walia, Senior scientist, Indian Council of Medical Research.
India mirrors Zimbabwe, in aspects listed above hence the growing burden of AMR.

“Being a tropical country, we have a significant burden of infectious diseases. This further leads to sanitation and hygiene problems, and most of the antimicrobials which are prescribed are to compensate for poor sanitation and hygiene — both in communities and in hospitals. So, if we really want to make progress on antimicrobial stewardship we have to improve the basics, such as improving diagnostics, infection control, and other necessary actions,” said
Walia.

Dr Prapti Gilada-Toshinwal, senior microbiologist and AMR advocate in India showed the misappropriate use of antibiotics.

OVER THE COUNTER

“Studies done in India show that almost half of all prescriptions audited in the study, were of antibiotics, and over 55% of antibiotic use was prescribed for uncomplicated respiratory symptoms. More alarmingly, less than 1% of these patients had any microbiological diagnosis done. Many of these prescriptions show the levels of inappropriate use or higher use of antibiotics. Also, over two-third of these drugs are available over the counter. We need to prevent over-the-counter dispensing of antimicrobials.

We need to boost diagnostic capacities at all levels. Access to accurate, rapid, and point-of-care diagnostic facilities for different diseases and conditions, should be scaled up,” Dr Prapti Gilada-Toshinwal.

With the silent AMR war simmering in the ground, the low risk perception and appreciation to the One Health approach requires media advocates to amplify the burden to communities.
What affects the animal kingdom surely affects the humans.
Let us all preserve this environment, we got no spare one to emigrate to.

● Feedback: cathymwauyakufa@gmail.com

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