The Health Journalists Network in partnership with Citizens News (CNS) and other journalists media organisations was part of the 2nd Annual Global Media Forum in lead up to World Antimicrobial Awareness Week 2022 (WAAW 2022), an annual conference observed worldwide during 18-24 November.
WAAW is a global campaign, celebrated annually to improve awareness and understanding of Antimicrobial Resistance (AMR) and encourage best practices among the public, One Health stakeholders and policymakers, who all play a critical role in reducing the further emergence and spread of AMR.
This year, the theme of WAAW was “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.
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.
As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become increasingly difficult or impossible to treat.
Researchers estimated that AMR in bacteria caused an estimated 1.27 million deaths in 2019.
At a virtual conference held on 16th November, it was recognised that there is a huge loss of human life due to AMR, which is now a top killer and the greatest burden of AMR is in sub-Saharan Africa and south Asia.
It was also noted that climate crisis and AMR are two of the greatest and most complex threats currently facing the world and the dual threat of these will have the most devastating impacts on low- and middle-income countries and small island developing nations.
The links between AMR and the climate crisis have been neglected and require significantly more attention, said Dr. Haileyesus Getahun, Director, Global Coordination and Partnership on AMR, and Director, Quadripartite Joint Secretariat on AMR, World Health Organization (WHO).
“More financing, political advocacy and coordinated global action are needed to better respond to the converging threats of antimicrobial resistance and the climate crisis before it is too late. Increased political advocacy and financing are urgently needed to mainstream antimicrobial resistance as a climate crisis issue and build resilience to both,” says Getahun.
It was noted that AMR can directly affect progress on at least 6 out of 17 UN Sustainable Development Goals and can be linked indirectly to the remaining 11 as well.
Indeed, AMR will directly or indirectly adversely impact a range of UN SDGs including SDGs for good health, zero poverty, zero hunger, clean water and sanitation, and responsible consumption and production.
The United Nations FAO Action Plan on AMR (2021-2025) calls upon strengthening governance and allocating resources to accelerate and sustain progress in containing AMR; promoting responsible use to keep antimicrobials working; strengthening surveillance and research to support evidence-based decisions; and enabling good practices to prevent infections and control the spread of resistant microbes said Junxia Song, Senior Animal Health officer and AMR coordinator, Food and Agriculture Organization of the United Nations (FAO).
Speakers proposed taking the One Health approach, which is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems.
It also recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and interdependent.
It was noted that the One Health approach can effectively address the challenge of AMR, observing 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.
So from One Health context, this makes the agriculture and food pivotal to the response to the global challenge of antimicrobial resistance. We must ensure that food and agriculture sectors, dependent livelihoods, and economies are made resilient to the impacts of AMR.
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 minimize the risk of AMR in the environment.
For us, AMR is both, a cause and a consequence, of the triple planetary crisis of climate change, biodiversity loss, and pollution and chemicals, said Jacqueline Álvarez, Chief, Chemicals and Health Branch, Economy Division, United Nations Environment Programme (UNEP)
Antimicrobials released into the environment and other stressors create selective pressure on microbial communities – those with acquired resistance have evolved and proliferated.
They also alter composition of microbial communities by lowering diversity. Pollution containing selective concentrations of antimicrobial compounds can contribute to antimicrobials in the environment.
United Nations Environment Assembly has recognized that antimicrobial resistance is a current and increasing threat and challenge to global health, food security and sustainable development of all countries.
UNEP is developing 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.
According to a 2017 World Bank report, if no action is taken now, AMR is likely to cause an USD 1.2 trillion additional health expenditure per year by 2050, and push up to 24 million additional people (particularly in low-income countries) into extreme poverty by 2030.
AMR is not only a global public health problem, but also an issue of health equity and socioeconomic development.
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 and absent from work and family commitments, for longer, and require more expensive medicines and medical care. This has major implications on health-care costs and productivity, both for patients and their caregivers, as well as more broadly on the health system and national economy.
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, said Thomas Joseph, Head, Antimicrobial Stewardship and Awareness Unit, World Health Organization (WHO).
Modern medicine is dependent on the ability to prevent and treat infections using antibiotics, including during joint replacement surgery, organ transplantation, cancer chemotherapy and the treatment of chronic diseases like asthma and diabetes.
If antibiotics and other antimicrobials lose their effectiveness, we lose the ability not only to treat infections, but also to manage these other health conditions.
AMR emergence and spread is accelerated by the misuse and overuse of antimicrobials to treat or prevent infections in humans, animals, and plants.
Antibiotics are lifesaving, but they should only be taken when they have been prescribed by a health worker for bacterial infections. Unnecessary exposure to antibiotics, such as when they are prescribed and used for conditions that are not caused by bacteria, like colds and flus, allows antibiotic-resistant strains to develop.
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.
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 hand washing and vaccination, are vital in the fight against AMR. These measures reduce the likelihood of infection in the first place, so that antibiotics don’t need to be used.
It is important for all people everywhere, not just health care professionals, to be aware and have basic knowledge and understanding of AMR, so that they can play their part in minimizing its emergence and spread.
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, who are 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,” says Delfy Gochez, Data Management Officer, AMR and Veterinary Products Department, World Organisation for Animal Health (WOAH).
In Africa, and globally, we follow the WOAH (World Organisation for Animal Health)’s strategy to promote prudent use of antimicrobials, said Jane Lwoyero, Technical Officer on AMR, World Organisation for Animal Health (WOAH).
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 (during October – December 2021).
WOAH is also promoting the use of vaccines as an alternative to irrational use of antibiotics for Theileriosis in cattle and Typhoid in humans.
“We need stronger and practical antimicrobial stewardship programme for our context and ground realities so that we can effectively promote the appropriate use of antimicrobials (including antibiotics), improve treatment outcomes, reduce antimicrobial resistance, and decrease the spread of infections caused by multidrug-resistant organisms,” says Dr Prapti Gilada-Toshinwal, senior microbiologist and AMR advocate.
“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,” said Gilada-Toshinwal.
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 (such as, agroecological approaches, nature-based solutions, and efficient and safe production methods),” Scott Newman, Senior Animal Health & Production Officer for Asia and the Pacific, Food and Agriculture Organization of the United Nations (FAO).
“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.”
Third Global High-level Ministerial Conference on AMR will be held in Muscat, Oman (24-25 November 2022) hosted by Ministers of Health and Agriculture of Oman.
One of the important expected outcomes of this global meet is “The Muscat Ministerial Manifesto” with three targets to contain antimicrobial resistance.
This will pave the way for more bold and specific political commitments in the United Nations General Assembly High Level Meeting on AMR to be held with world leaders in 2024.
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