Members of Action for Global Health say it’s time for renewed action on antimicrobial resistance, calling for a greater focus on basic infection protection
By Cameron Boyle
It’s dubbed the silent pandemic. Directly responsible for 1.27 million deaths per year, and a contributor to five million, its impact is set to spiral. Without urgent action, it will account for three deaths every minute between 2025 and 2050.
What are we talking about? Antimicrobial resistance (AMR), when bacteria, viruses, fungi, and parasites no longer respond to antimicrobial medicines. It was the subject of September’s UN High-Level Meeting (HLM) – a forum where world leaders gather to address serious threats to humanity. And a serious threat it is – ripping through communities across the globe, with people in low- and middle-income countries (LMICs) worst affected. Estimates hold that up to 90 per cent of AMR-related deaths by 2050 will be in Africa and Asia, and 93 per cent of the additional 28 million people facing extreme poverty due to AMR will be in LMICs.
Hoped to be a reset moment in the fight against it, the HLM had positives and negatives. In this article, we will discuss these outcomes, the devastating and multifaceted nature of AMR, and how to build a healthier future.
A big-picture problem
The impact of AMR is far from limited to human health. In fact, it is rife within animals – domestic and wild – as well as the environment, such as waterways and farms. Animals excrete 75-90 per cent of antimicrobials without being metabolised, dispersing them back into the environment and fuelling further resistance.
If AMR is to be overcome, our health systems must adapt to reflect its all-encompassing nature. This is called a One Health approach. A cornerstone is improving global surveillance of drug resistance. In low- and middle-income countries (LMICs), where the burden of bacterial infections is highest, surveillance is constrained by myriad factors, including scarce financial resources, weak laboratory capacity and lack of skilled personnel.
This thwarts global efforts to stem the tide. To quote Helen Hawkings, Senior Social and Behaviour Change Specialist at Malaria Consortium: ‘AMR knows no borders, neither should our response.’ Strengthening health systems in LMICs is vital in acquiring the data needed to track, map, detect and set effective policy.
AMR is a multisectoral problem, and demands a multisectoral response. But what does this mean in practice? Combining data is key. To fully understand emergence and spread, insights from hospitals and agricultural and environmental sources must be collated and aggregated. As with surveillance, this requires an equity approach to ensure LMICs are not left behind. Innovative computational methods exist which can integrate big data streams, accelerating our understanding. But for this technology to be accessible to all, science funding must be distributed equitably, and issues such as geopolitical and cultural variation navigated successfully. Only then can all sectors work in unison.
Want to know more? Check out our related reads…
Water, sanitation and hygiene
Arguably the most significant prevention strategy is simply to prevent infection in the first place. A key breeding ground is perhaps where you’d least expect: healthcare facilities. Research from WaterAid reveals that 9.5 million people die from hospital-acquired infections in low-income countries every year – a third of whom are children. These statistics not only lay bare the inequitable burden of AMR – children in sub-Saharan Africa are already 58 times more likely to die from AMR than those in high-income countries – but show the significance of WASH in tackling it.
The hospitals seeing this rise in infection – leaving them with no choice but to prescribe antibiotics – are those lacking essentials such as clean water, handwashing facilities, waste management and environmental cleaning. To compound this issue, half of these infections are becoming resistant to antibiotics and first-line drugs.
One such facility was Busolwa Dispensary in Tanzania. But in the words of Clinical Officer Joseph Siame: ‘The antibiotic use is lower now because our clinic is clean so both mother and child leave without any infection… I haven’t used antibiotics in 5 months’.
Improving WASH could reduce infections by 50 per cent. Yet, in recent years, Official Development Assistance (ODA) spending on WASH has halved, hamstringing global efforts to address the silent pandemic. This is just one reason why increasing funding for AMR action was a demand brought to the UK Government by global health organisations in the run-up to the HLM.
So, what’s next?
Based on the political declaration that emerged from discussions, this demand was heeded – the declaration calls for sustainable national financing and US$100 million in catalytic funding, to help achieve a target of at least 60 per cent of countries having funded national action plans on AMR by 2030.
Only 11 per cent of countries have dedicated funding in their national budgets at present, and leaders stressed the need to explore innovative incentives and financing mechanisms, with public-private partnerships central to this. But this approach could place financial burden on countries shouldering the burden of AMR, deepening existing inequities. The demands and voices of affected communities must take precedence if we are to ensure equitable progress.
A One Health approach, too, is reflected in the declaration. It is acknowledged that AMR is a complex problem, and therefore requires a multisectoral response:
‘The intersectoral challenge of AMR demands a One Health systems approach that unites human, animal, plant, and environmental health, backed by robust and accountable global AMR governance.’
Director-General QU Dongyu, Director-General at the Food and Agriculture Organization of the United Nations
Robust governance is key. Rhetoric is all well and good, but if all sectors are to truly work in tandem, monitoring, evaluation and accountability must be the bedrock. Whether this will lead to strengthened health systems in LMICs remains to be seen – so consultation with – and advocacy from – civil society will prove crucial.
WASH – the world’s first-line defence against AMR – was notably overlooked. Considerably more attention went to areas such as research and development, which, while vital, are far more costly and reactive rather than preventive. In the words of Tim Wainwright, CEO of WaterAid UK: ‘The Declaration grossly fails to put enough emphasis on the role of water, sanitation, and hygiene in averting AMR-related deaths, overlooking urgent calls from low-income countries for a greater focus on basic infection prevention, as well as clear evidence showing the benefits of prevention alongside treatment.’
The clock is ticking, and resistance is growing. The HLM was a pivotal moment for concentrating minds on the threat of AMR, but to overcome it, ongoing consultation with civil society and affected communities is critical. Grandiose statements serve a limited purpose; If we are to make tangible progress – before it’s too late – people with lived experience and technical expertise must be at the heart of discussions.
Cameron Boyle is Senior Digital Campaigns and Media Advisor at Action for Global Health, a membership network comprising more than 50 organisations working in global health.
