Alarm over rising antibiotic resistance
The World Health Organisation has declared AMR as one of the top 10 global public health threats facing humanity.
What you need to know:
- For decades, the world has relied on antibiotics to treat infections and extend the average lifespan of a person by 23 years.
- The World Health Organisation (WHO) has declared AMR as one of the top 10 global public health threats facing humanity.
In New York, UN Headquarters
Can you imagine a world where several bacterial infections cannot be treated? Minor surgery carries the risk of incurable sepsis, and childbirth infections become untreatable. Is this where the world is headed?
For decades, the world has relied on antibiotics to treat infections and extend the average lifespan of a person by 23 years.
However, global health experts are concerned about the increasing antimicrobial resistance (AMR) which poses a threat to these advancements.
This has prompted a call for a high-level meeting to address antimicrobial resistance at the United Nations General Assembly 79, an indication that it is a significant global health issue in multiple countries and requires urgent attention at the highest political level.
The World Health Organisation (WHO) has declared AMR as one of the top 10 global public health threats facing humanity.
Eight years ago, in September 2016, global leaders attended the first-ever United Nations high-level meeting on antimicrobial resistance and in the next five days, heads of state have chosen to address the same issue through the same Assembly.
During the meeting in 2016, Member States recognized the need for stronger systems to monitor drug-resistant infections and the volume of antimicrobials used, as well as adequate funding to support implementation of AMR response at the national level.
Countries pledged to strengthen regulation, promote best practices, and explore innovative approaches to developing new technologies for antimicrobials, diagnostics, and vaccines and a political declaration was adopted during the high-level meeting indicating several future milestones for AMR.
Member States committed to developing national action plans (NAPs) aligned with the Global Action Plan on Antimicrobial Resistance with the declaring calling for mobilization of adequate, predictable, and sustainable funding, which later resulted in the establishment of the Global AMR Innovation Fund, supporting projects to reduce the threat of AMR in low- and middle-income countries.
As AMR discussion returns to the limelight this week on September 26, at the 79th United Nations General Assembly meeting, many of the delegates would be keen to listen to what different countries will present in terms of achievement since AMR was declared a global health issue of urgency and countries challenges in realizing the goal.
The UN High-Level Meeting will elevate the AMR issue to the world’s largest diplomatic stage since it requires cohesion and synergy across the One Health approach including human, animal, and environmental sectors. The assembly will also contribute to both the development and implementation of solutions, as it is a forum for all countries – regardless of income or capacity – to commit to important policy decisions.
Countries will be given a chance to commit to clear and bold new targets and practical steps for tackling the issue.
The Head of State will then again sign off on a political declaration that will guide future policy initiatives at global, regional, and national levels for years to come.
The 2024 declaration contains about 106 commitments across AMR including governance, financing, research and development (R&D), and measures to expand access that build on current progress and stimulate new, innovative approaches. Perhaps most notable is the north-star target to reduce AMR-caused deaths globally by 10 per cent by 2030.
To achieve this target and several other goals by the end of the decade, countries are required to have action plans and for 60 per cent to be adequately financed.
Kenya in 2022, came up with a national action plan on antimicrobial resistance which identifies critical gaps while highlighting findings to accelerate further progress in the human health sector. The target audience includes all those concerned with implementing actions to combat antimicrobial resistance in the country.
The governments are to facilitate sustainable funding from international cooperation to support the implementation of national action plans on antimicrobial resistance, with the target of achieving US$ 100 million to catalyse the achievement of at least 60 per cent of countries having achieved funded plans by 2030.
Another important element of the declaration is the request for the Quadripartite (four-part) establishment of an Independent Panel on Evidence for Action.
If created, the panel will complete some of the governance reforms that were initiated through the 2016 high-level meeting. The panel would serve a key function by supporting Member States’ decision-making with regular guidance on the trends of science, data, and evidence across AMR-related sectors.
Countries have also declared to commit to recognizing that antimicrobial resistance is one of the most urgent global health threats and development challenges and demands immediate action to safeguard the ability to treat human, animal, and plant diseases.
It will also enhance food safety, food security, and nutrition, foster economic development, equity, and a healthy environment, and advance the 2030 Agenda for Sustainable Development Goals while emphasizing that the issue requires global solidarity, joint efforts, and international cooperation.
“Note with concern that lack of access to appropriate, safe, effective and affordable antimicrobials and diagnostic tools, particularly in developing countries, is responsible for more deaths than antimicrobial resistance while stressing that annually, about 4.95 million deaths are associated with drug-resistant bacterial infections, including 1.27 million deaths directly attributable to bacterial antimicrobial resistance, 20 per cent of whom were children under five1, and that without a stronger response, there will be an estimated average loss of life expectancy of 1.8 years globally by 20352,” says the declaration.
On human health, governments have been tasked to acknowledge that drug-resistant tuberculosis is one of the key components of the global challenge of antimicrobial resistance, and express grave concern that the scope and scale of multidrug-resistant and extensively drug-resistant tuberculosis illness and mortality place an additional burden on health and community systems, especially in low- and middle-income countries.
This poses a critical challenge that could reverse the progress made against the disease, against antimicrobial resistance and towards the Sustainable Development Goals.
“We will ensure by 2030, that the use of WHO access group antibiotics is expanded from the 2023 global target, and in that regard, taking into account national contexts, aim to achieve at least 70 per cent overall human antibiotic use globally, through investing in and strengthening stewardship programmes,” It states.
Reckless prescriptions and dispensing of antibiotics are partly to blame. Also, rising temperatures and changing precipitation patterns worsen infections, leading to more antibiotic use. Natural disasters like floods, hurricanes, and wildfires worsen overcrowding and unsanitary conditions, breeding resistant bacteria.
Globally, according to the University of Washington’s Institute of Health Metrics and Evaluation, up to 1.27 million AMR-related deaths were recorded in 2019 alone.
The antibiotics clinical pipeline grew by 21 per cent between 2021 and 2023, with the number of antibacterial agents increasing from 80 to 97. Most of the antibiotics are repurposed drugs with weak efficacy profiles, lacking the novel or innovative agents needed to treat serious infections effectively.
Also, according to the Food and Agriculture Organization (FAO) report titled “Tackling Microbial Resistance in Food and Agriculture’, misuse and overuse of antimicrobials in animals are contributing to the rising threat of drug resistance in humans with farmers accused of increasingly abusing antibiotics.
The report indicates that an estimated 70 per cent or more of the antimicrobials sold worldwide are used in food-producing animals, hence the crucial need to address antimicrobial resistance (AMR).
Antimicrobials are widely used in animals to treat infections, prevent diseases and promote growth. However, using antibiotics in animals may raise the risk of transmitting drug-resistant bacteria to humans either by direct infection or by transferring “resistance genes from agriculture into human pathogens.
In Kenya, slaughterhouses act as disease hotspots because of frequent interactions between humans and animals. According to the African Center for Disease Control, slaughterhouse workers are highly exposed to several zoonotic pathogens.
Maria Helena Semedo, deputy director-general at FAO, said the world continues to face growing challenges that threaten global food security.
“Antimicrobials play a critical role in treating diseases in both aquatic and terrestrial food-producing animals as well as in crops. They contribute to productive and sustainable agrifood systems, supporting the countless livelihoods that depend on them around the world. When overused or misused, however, antimicrobials can contribute to a rise in antimicrobial resistance,” she said.
She noted that the silent AMR pandemic is one of the global challenges the world is facing that can jeopardise human and animal health and welfare gains, the environment, food and nutrition security and safety, economic growth and development.
Antimicrobial resistance impacts everyone everywhere, and it was responsible for at least 1.3 million deaths and five million associated deaths globally in 2019, according to the data from FAO.
“It deserves to be better recognised that the all-age death rate attributable to resistance is highest in the developing countries of the global south. Antimicrobial resistance is therefore not a “first world problem” it is one that the entire membership of FAO must face together.
“Much needs to be done to generate comprehensive and robust evidence, develop and implement interventions that will reduce the need for antimicrobials, and ensure that strong and effective governance and resources are mobilised to enable sustainable action.”
According to the World Health Organization, antimicrobial resistance occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines and as a result, the infections become difficult to treat; further increasing the risk of severe illness. This results in death or a new wave of the disease spreading.
Drug resistance bacterial infection led to 1.27 million human deaths in 2019 and if gone unchecked, the spread of drug resistance pathogens and the rise of AMR may result in more than 3.4 trillion losses in global annual gross domestic product by the end of this decade. This is according to a report by the Organization for Economic Co-operation and Development.
Dr Jecinta Mwirigi, a livestock production specialist in an opinion piece focusing on poultry indicated that the current unselective use of antimicrobials in animal production systems raises safety concerns for animals, humans and the environment.
For instance, she cited the treatment of all birds when only one of them in a flock is ill and the use of drugs to prevent diseases.
Misuse and overuse of antimicrobials in chicken production is common in Kenya.
In a study carried out in Kiambu County, whose findings were published in the Pubmed Journal in January 2021, researchers from FAO, Kenya’s Ministry of Agriculture and College of Sciences in Makerere, Uganda, investigated the challenges of small-scale layer farms.
They found out that 62 per cent of farmers were constantly using antimicrobials, some of which were referred to as magic drugs. This included tetracycline and tylosin.
Furthermore, lack of clean water, proper sanitation and inadequate disease control promote the spread of drug-resistant disease-causing pathogens, which are referred to as superbugs.
