In 2016, the United Nations General Assembly convened a high-level meeting on antimicrobial resistance (AMR) where Dr Margaret Chan, the then-director general of the World Health Organisation (WHO) paralleled AMR to a slow-motion tsunami.
What is AMR?
According to the African Institute for Development Policy (AFIDEP) factsheet on AMR:
“When the medicines known as antibiotics no longer kill the microbes they have been developed to cure, this is known as antimicrobial resistance or AMR. AMR is a threat today, and has the potential to become the biggest threat to human health in the next 50 years, with fewer and fewer effective antibiotics available to treat infections.”
The threat of AMR is well documented and recognised by experts across the board. In spite of this, not much is understood about AMR in regards to how it occurs; how microbes evolve to develop resistance; how human use of antibiotics and water, sanitation and hygiene (WASH) practices contribute to AMR transmission; how AMR affects the cost of healthcare; and how AMR policy is developed and implemented. At the centre of the spread of the AMR-bacteria is the relationship between humans, animals and the environment. Due to the multidisciplinary nature of the issue, a ‘One Health’ approach is best suited to understanding how human behaviour, environmental degradation and antibacterial usage in animals lead to the transmission of AMR. The WHO describes One Health as “an approach to designing and implementing programmes, policies, legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes.”
In 2018, AFIDEP became a part of the Drivers of Resistance in Uganda and Malawi (DRUM) consortium, a project that brings together a group of researchers seeking to understand more about the spread of AMR between humans, animals, and the wider environment in rural and urban parts of Malawi and Uganda. The project is using the One Health approach to develop agent-based models that will enable the prediction of how transmission pathways can be interrupted to design interventions to reduce AMR spread.
A key aspect of doing the project in countries like Malawi and Uganda is that low- and middle-income countries are disproportionately likely to be more severely affected due to overstretched health systems and poor access to alternative antibiotic regimes. Consequently, AMR has a negative impact on human health, food security and national economy. As such, urgent action is required across multiple sectors.
As AMR-bacteria can spread across humans, animals and the environment, there is a need for increased discourse, collaboration and innovation between stakeholders such as government, industry (e.g. agriculture and animal health), civil society organisations and researchers to address the AMR issue. In an interview Dr Joseph Nkhoma, Malawi Veterinary Association chairperson at the Department of Livestock and Animal Health in the Ministry of Agriculture, Irrigation and Water Development said;
“We see a lot of antibiotics being used in poultry in the country and poultry is a very important source of protein and livelihood for people. So we are seeing a lot of diseases that are coming in and we are failing to control them because of antibiotic resistance. We are also seeing a lot of resistance building up in dairy and other animals and that is threatening food security. We are failing to treat animals therefore our production of meat, eggs and milk is becoming a big challenge. Of importance is the fact that when we pump these antibiotics in animals we are contaminating them and they end up in the food chain so indirectly we the humans are eating antibiotics leading to antibiotic resistance in people. One thing we need to remember is that an antibiotic that is used in animals, is basically the same as one used in people. So resistance in animals means resistance in people. Underuse and abuse in animals leads to resistance in people as well and so this is raising a lot of concern.”
Watch the full interview here:
AMR is a global threat. A greater collaborative effort is required in resisting drug-resistance and preserving the future of antibiotics.
From November 18-24, 2019, organisations across the world will join in the commemoration of the World Health Organisation’s (WHO) Antibiotic Awareness Week 2019. The focus of this week is to raise awareness about antibiotic resistance and to encourage appropriate antibiotic use in all healthcare settings. This year’s theme for Antibiotic Awareness Week, like in previous years, is ‘Antibiotics: handle with care’.