With antimicrobial resistance (AMR) threatening development and health in Africa, six international and continental organizations are launching the first partnership of its kind to combat this public health crisis on the continent.
The partners cemented their collaboration today with a joint statement by eight senior representatives on the first day of the World Antimicrobial Awareness Week (WAAW) Campaign for Africa, noting the “silent public health threat that AMR poses in all countries in Africa” and expressed concern for the “uncontrolled antimicrobial use across the African continent.”
Antimicrobials include antibiotics, antivirals, antifungals and antiparasitics and are used to prevent and treat infections in humans, animals and plants. Antimicrobial agents have saved millions of lives, protected animal health and welfare as well as food security. But their rampant misuse in health settings and agriculture is killing 700 000 people annually around the world. In Africa, research findings estimate that 4.1 million people could die of failing drug treatments by 2050 unless urgent action is taken.
While data on AMR are sorely lacking on the continent, there are signs that resistance to commonly prescribed antimicrobials is significant. Malaria, which kills 3000 children in Africa every day, is increasingly showing resistance to once-effective treatment options. Tuberculosis is becoming resistant to the drugs typically used to treat it. Current studies indicate that drug resistance to HIV is increasing and could cause 890 000 deaths by 2030 in sub-Saharan Africa.
AMR is exacerbated by the easy availability of medicines without a prescription. An estimated one in ten medicines globally is substandard or falsified, and the African region is one of the most affected in the world. In markets and on street corners, people are buying antimicrobials of unknown quality. Without proper medical supervision, people often stop their drug course too soon or they double-dose rather than keep to a prescribed strict time interval for appropriate drug-taking. The same happens in treatment of animal diseases coupled with underdosing, disrespect to drug withdrawal periods, and use of antimicrobials as growth promoters.
The improper use of antimicrobial medicines enables bacteria, viruses, fungi and microscopic parasites to mutate into superbugs that are resistant to the drugs designed to kill them. These superbugs can travel across countries, resulting in thousands, or potentially millions, of deaths. Their treatment is resulting in prolonged hospital stays and the need for more expensive medicines, leading to huge additional costs in health expenditure by governments and individuals. The World Bank projects that the additional health care cost by 2050 could be between US$ 0.33 trillion and US$ 1.2 trillion.
AMR in agriculture reduces productivity, hinders the provision of safe food and has a direct impact on food security and sustainability of livelihoods for farming communities. Improper disposal of pharmaceutical, hospital, abattoir, human and animal waste contaminates the environment with antimicrobials and antimicrobial-resistant organisms.
AMR is not only a health issue but a complex problem that requires a united multisectoral approach. The six partners making this joint statement represent the public health, agriculture animal health and environmental sectors.
The organizations jointly committed to 10 points of actions, including fostering a One Health approach and leveraging each organization’s core competencies. The other areas of collaboration include strengthening advocacy “for the more prudent use of antimicrobials” by increasing general public and medical practitioner awareness, understanding and behaviour change; “supporting the integration of AMR action in routine infection prevention and control (IPC) measures as well as vaccination, farm biosecurity and good hygiene practices”; and “supporting compliance with international standards for the management of human, animal and industrial waste”.
Quotes from the eight senior representatives of the six partners:
“Antimicrobial resistance threatens the health, safety, and prosperity of Africa. We need immediate and sustained action from governments and all partners across the human, animal, and environmental sectors. Together, we can prevent infections, ensure antimicrobials are used appropriately, and limit the transmission of drug-resistant infections,” – Dr Nkengasong John, Director Africa Centres for Disease Control and Prevention
“Antimicrobial resistance is a matter of concern for Africa because of the public health threat on African citizens and the negative socio-economic impact on wellbeing and livelihoods. AU- IBAR Considers animal health as a critical aspect of AU’s continental development goal of ensuring public health and enhancing the competitiveness of its animal commodities for accelerated economic growth. As a continental leader in animal resources development, AU- IBAR is working with other AU institutions and partners to advocate for greater political commitment, policies, laws, good governance, and capacity building to enable long-term control of AMR,” – Prof Ahmed El-Sawalhy, Director African Union Inter-African Bureau for Animal Resources
“We are at a critical time to change the way we use antimicrobials for humans, animals and plants and reduce the emergence and spread of antimicrobial resistance. If AMR is left unchecked, the next pandemic we face could be antimicrobial-resistant, and much deadlier if the drugs needed to treat it do not work,” Abebe Haile-Gabriel, FAO Regional Representative for Africa.
“Access to and appropriate use of antimicrobials is vital for the production of safe and nutritious foods, for animal health and human welfare. Antimicrobial resistance is a threat to lives and livelihoods worldwide. If we think about the estimated amount of 700,000 humans dying from the consequences of antimicrobial resistance each year, we have to look into the practices of animal husbandry and food production of animal origin,” – Serge Nakouzi, FAO Deputy Regional Representative for the Near East and North Africa.
“Antimicrobial resistance is one of the most pressing health challenges Africa faces. If we don’t act now, we could see the continent roll back the gains in health we have made through immense effort and sacrifice. We must stop endangering our future and think before we pop a pill in our mouth,” – Dr Matshidiso Moeti, WHO Regional Director for Africa
“Antimicrobial resistance is the most complex threat to human and animal health jeopardizing the global community’s progress towards the achievement of the Sustainable Development Goals. Countries and nations must work collaboratively to curb the emergence and spread of AMR by adopting a one Health approach, enhancing human and animal health systems, promoting integrated surveillance, strengthening infection prevention and control in healthcare and farms. Let us all unite to preserve antimicrobials to ensure ” – Dr. Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean
“We all have an important role to protect the efficiency of antimicrobials to ensure animal, human and environmental health. Each country needs to make the commitment towards ensuring antimicrobials are used prudently and responsibly; by applying international standards, guidelines in national legislation for the global harmonisation, surveillance and to control unregulated production, distribution and use of antimicrobials,” – Dr. Karim Tounkara, OIE Regional Representative for Africa.
“Healthy environment provides us with efficient mechanisms to prevent and control diseases which lead to less use of antimicrobials; as human beings, animals and crops are less exposed to microbes. Restoring biodiversity and ecosystems as well as protecting wildlife habitat are fundamental to reduce the prevalence of antimicrobial resistance in Africa;” – Dr. Juliette Biao Koudenoukpo, Regional Director for Africa, UNEP.