Step up fight against drug resistance to safeguard future generations

By Dr Kelvin Osore, Business Development Manager, Kenchic Limited

In 1854, with the city of London experiencing a cholera outbreak, Dr John Snow, a British physician, conducted ground-breaking research suggesting that contaminated water, not "miasma" or foul air as was commonly believed at the time, was the source of the epidemic.

Despite Dr Snow's compelling evidence, his findings were largely dismissed, and the government continued to ignore the link between contaminated water and the spread of the disease. The result was the Broad Street cholera outbreak, where a public water pump on Broad Street (now Broadwick Street) became a focal point for the transmission of the disease.

The outbreak claimed 616 lives in the Soho district, as residents continued to consume the contaminated water. It was only after the local authority removed the pump handle following further investigation and acceptance of Snow’s findings, that the epidemic began to subside. But by then, hundreds of people had needlessly succumbed to the infection.

The World Antimicrobial Awareness Week that is marked every November serves as a reminder to the global community to reflect on the growing threat of AMR and the urgent need for collective action. This silent pandemic, often overshadowed by more visible health crises, poses a severe threat to public health, agriculture, and the overall well-being of our nation.

First, let us take a look at some grim statistics. According to the Institute for Health Metrics and Evaluation, 4.95 million people who died in 2019 suffered from drug-resistant infections, such as lower respiratory and bloodstream infections. In 2019, 1.27 million deaths were directly caused by anti-microbial resistance, according to the Lancet, one of the oldest peer-reviewed medical journals. One in five people who died from AMR was a child aged under five, often from previously treatable infections.

The Review on Antimicrobial Resistance, published in 2016, estimated that as many as 10 million people could die annually from AMR by 2050. By the same year, it is estimated that the cumulative cost of AMR could be as high as $100 trillion if significant actions are not taken to halt this crisis.

Antibiotics have undoubtedly played a pivotal role in revolutionising healthcare and the livestock sector, contributing to good human and animal health and food security. However, the overuse and misuse of these crucial drugs have given rise to a global crisis. The AMR phenomenon occurs when bacteria, viruses, parasites, and fungi develop resistance to the drugs designed to kill them, rendering once-powerful medicines ineffective. If left unaddressed, AMR could undermine the progress we've made in healthcare, making routine infections and minor injuries potentially fatal.

In Kenya, where infectious diseases remain a significant public health concern, the implications of AMR are particularly grave. Diseases such as malaria, tuberculosis, and bacterial infections are common, and the success of our healthcare system relies heavily on the effectiveness of anti-microbial drugs. The rise of drug-resistant strains threatens to unravel decades of progress, leaving us vulnerable to previously treatable illnesses.

One of the chief contributors to drug resistance is the inappropriate use of antibiotics. In both human and animal health, antibiotics are often prescribed and administered without proper diagnosis or adherence to treatment guidelines. Patients sometimes demand antibiotics for viral infections, against which these drugs are ineffective, leading to unnecessary use and contributing to resistance.

Farmers often administer antibiotics routinely, even in the absence of clinical symptoms, contributing to the acceleration of resistance development. To address this issue, we must adopt a multi-sectoral approach that leverages diverse stakeholders to combat this menace.

Firstly, regulations must be strictly enforced to curb the non-therapeutic use of antibiotics. Current regulations are sufficient to deter this practice. However, the Veterinary Medicines Directorate and the Pharmacy and Poisons Board must enforce them strictly.

Strengthening regulatory frameworks, enforcing antibiotic prescription guidelines, and monitoring antibiotic sales are vital steps to curb misuse. Emphasis must also be placed on the importance of entrusting oversight of medicines to relevant professionals. Therefore, maintaining control of veterinary medicines in the hands of veterinary professionals, as is the case in most commonwealth jurisdictions such as the UK and Canada, also enhances the fight against AMR. Simply put, the professional who prescribes a drug and knows the conditions it can be used against in the field is the one with the best chance of limiting its misuse through monitoring and enforcement. That’s why the current push to move the regulation of veterinary medicines from the Veterinary Medicines Directorate is ill-informed and bound to worsen the AMR crisis in Kenya.

Additionally, the capacity of the two organisations to carry out pharmacovigilance must be enhanced as the current inadequacy of inspectorate staff, especially at the Veterinary Medicines Directorate is hindering the fight against AMR. Related to this, the government must also play a pivotal role in shaping policies that promote responsible antibiotic use. Despite the existence of a robust policy and the National Action Plan developed in 2017 aimed at reducing the burden of AMR in Kenya, the country’s capacity for implementing infection prevention and control (IPC) interventions is still inadequate due to weak monitoring and support systems. Investing in surveillance systems to track the spread of resistant strains is crucial for timely intervention and containment.

Investing in research and development of alternative methods for disease prevention and treatment is crucial. Innovations in vaccines, postbiotics, enzymes, prebiotics, probiotics, phytogenics, and other non-antibiotic interventions can provide viable alternatives to minimise the reliance on antimicrobials.

Moreover, the importance of biosecurity and biosafety in reducing the burden of diseases and the need for antibiotics is an often overlooked concept. This is because most antibiotics are used as a shortcut in place of good animal husbandry and biosecurity. Adhering to strict biosecurity measures, such as using footbaths at the entrance of poultry units, and the use of personnel protective equipment such as gumboots, can prevent many infectious agents from causing diseases in one’s flock. That is why efforts to capacity-build farmers through training carried out under projects such as the USAID Transformational Strategies for Farm Output Risk Mitigation by Cargill and Kenchic, should be applauded.

As a veterinarian, I understand the economic pressures and challenges faced by farmers in ensuring the health and productivity of their flocks. However, the long-term consequences of unchecked AMR pose a far greater threat to the sustainability of poultry farming. It is in our collective interest to prioritise the health of our animals, safeguard our food supply, and protect the efficacy of antibiotics for future generations.

The World Antimicrobial Awareness Week reminds us that the time for action is now. We cannot afford to be complacent in the face of a crisis that jeopardises not only the livelihoods of our farmers, but also the health and well-being of our communities. Let us use this opportunity to re-evaluate our practices, embrace sustainable solutions, and ensure that we do not jeopardise the well-being of future generations. The choice is ours – to act responsibly today or face the consequences of inaction tomorrow.