ACCORDING to the World Health Organisation (WHO), Antimicrobial resistance (AMR ) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death. Antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.
By Michael Gwarisa
As a result, the medicines become ineffective and infections persist in the body, increasing the risk of spread to others. However, over the years, the use of antimicrobials or antibiotics has surged especially in low to medium income countries like Zimbabwe where access to healthcare and health insurance is a luxury many cannot afford. The use of antibiotics is unregulated and prescribing habits have moved from the traditional way of doing when dispensing antibiotics in the absence of a prescription would attract a hefty penalty or de-registration.
In Zimbabwe, the COVID-19 has led to an upsurge in the use of antibiotics such as azithromycin and amoxicillin while in other parts of the world, antibiotics such as doxycycline, ceftriaxone, erythromycin, ciprofloxacin among others have been used to manage COVID-19 symptoms for both Intensive Care Unit (ICU) patients and even in those managing symptoms from home. The coming in of new COVID-19 variants has resulted in the overuse and over-reliance on antibiotics to manage COVID-19. However, local experts have warned against overuse of antibiotics during the COVID-19 pandemic which they say will definitely increase resistance to antimicrobials in the near future.
Dr Francis Ndowa, a venereologist said Antimicrobial Resistance is going to be higher than before COVID-19 because of the way prescribing habits have changed and there is need to regulate the dispensing and prescription of antibiotics especially during these COVID-19 times.
For fear of COVID-19, patients have not been going to hospitals, a lot of online virtual consultation is going on and a lot of whatsapp prescriptions are being given and they are prescribing antibiotics. You go to the Pharmacies as well you find that there is an increased use of antibiotics in the COVID-19 era and we are going to suffer to that, there is no two ways about it. These days, you can just walk into a pharmacy and get azithromycin. We need to change that, we need to make sure that we have the control of antibiotic dispensing and prescription,” said Dr Ndowa.
AMR has already been classified by the WHO as a global health emergency, albeit a far quieter one and by the year 2050, the world will likely be losing about 10 million people yearly at a huge cost. The coming of the COVID-19 pandemic has seen prescription and drug dispensing habits changing especially in Zimbabwe where one can now just walk into pharmacy and get an antibiotic without any prescription. Other countries such as Sweden have since banned the use of antibiotics as well as the use of antibiotics as growth monitors for livestock and animals as a means to curb AMR.
Mr Francis Kujinga, an AMR advocate and Intellectual Property Rights experts said COVID-19 will drive antibiotics resistance in Zimbabwe and other poorly resourced countries.
“The issue of COVID-19 pushing up resistance, that is without any doubt. I have seen people being prescribed antibiotics for COVID-19, I think it’s now standard. There is something that they call a COVID-19 starter pack and people are getting antibiotics for a viral disease. COVID-19 especially in this part of world is going to drive up resistance because what causes resistance is misuse, overuse and abuse of medicines, those are the main drivers so when people are taking antibiotics as a matter of course, that drives up resistance” said Mr Kujinga.
Zimbabwe has however launched National Microbiology Laboratory AMR Unit which is housed at the national Microbiology reference laboratory as well two grants which are the Fleming Fund and the Multi Partner Trust fund grant to boost the country’s capacity to test and collect AMR data.
“AMR actually creates a very dangerous situation where we are running out of options. Our situation analysis told us of what we needed to do as a country. After Zimbabwe developed a situational analysis on COVID-19, we then drafted our national Action plan and both documents were launched in September 2017. The National Action Plan lists the activities that should be followed as well as the strategic priorities.
“The National Action Plan identifies five pillars which are important in the AMR response. The first one is education and awareness, laboratory surveillance, antimicrobial use, infection prevention control and bio-security and lastly research investment and development.”
Meanwhile, developed countries have come up with robust AMR tracking and surveillance systems which have enabled them to accurately quantify the AMR burden in their countries. In the United States for example, an estimated 2.8 million people are infected every year with resistant pathogens and about 35 000 people die every year from drug resistant pathogens related infections. With the recent grants from Fleming Fund and Multi Partner grants, Zimbabwe is set to boost her AMR surveillance and data collection capacity.
