Stopping antimicrobial resistance is the bedrock for advancing universal health coverage

Shobha Shukla *

Universal Health Coverage (UHC) Day is 12 December

Stopping antimicrobial resistance by promoting infection prevention, responsible and appropriate use of antimicrobial medicines in human health, livestock and food systems, is the bedrock for promoting universal health coverage. Failing this, the absence of efficacious antimicrobials will effectively return the world to the pre-antibiotic era before the 1920s when lives were lost at a far greater rate due to infection.

World leaders have committed to achieve #HealthForAll and deliver on the promise of universal health coverage (UHC) by 2030 - one of the key targets under Sustainable Development Goal-3. This implies significant increases in access to quality healthcare. Ensuring equitable access to affordable and effective medicines to treat diseases is a fundamental part of this vision. However, antimicrobial resistance (AMR) makes common infections no longer treatable by drugs and poses a serious challenge to achieving this goal.

Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organization (WHO) has rightly said recently that, left unchecked, antimicrobial resistance (AMR) will rollback a century of medical progress, damage the environment, interrupt food production, cause more people to fall into extreme poverty and imperil global health security. Tackling AMR must therefore be seen in the broader context of efforts to strengthen health systems and achieve UHC.

What is Antimicrobial resistance (AMR)?

Simply put, antimicrobial resistance occurs when bacteria, viruses, fungi, and parasites (microbes) change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death.

While AMR occurs naturally over time, usually through genetic changes, many humanmade factors have accelerated its spread through misuse or overuse of antimicrobials in humans, livestock and agriculture, poor infection control in healthcare facilities and communities, and poor access to quality, affordable medicines.

Responsible and appropriate use of antimicrobials is the lynchpin to controlling AMR

Dr Haileyesus Getahun, WHO Director of the AMR Global Coordination Department, calls AMR a humanmade problem because “antimicrobials are shared between humans, animals and plants. And we are overusing and misusing them in all these three spheres.” While agreeing that we cannot stop the development of drug resistance as it is a natural phenomenon, Dr Getahun reaffirms that we can definitely prevent, mitigate or reduce the damage caused by drug-resistant infections.

In an exclusive interview given to CNS (Citizen News Service), Dr Getahun, who is also the Director of the Tripartite Joint Secretariat on AMR, emphasised that “We must be prudent and responsible in using antimicrobials, particularly antibiotics. While all antimicrobials are important, special attention must be given to antibiotics, because they are the backbone of our health system in tackling a wide range of bacterial infections. There is also evidence that overuse and misuse of antibiotics in agriculture and animal husbandry can result in drug-resistant bacteria being transferred to human beings. We have to work together with all the sectors to preserve antibiotics for the sake of human and animal health.”

Dr Getahun emphasises the need to go back to the basics while addressing antimicrobial resistance. “Infection prevention is the gateway to mitigate antimicrobial resistance. We have to build and improve basic infection control and prevention, water, sanitation and hygiene methods. Practices that intensified during the Covid-19 pandemic- like, hand hygiene and sanitising surfaces - have to be continued in the future to address the AMR challenge. Moreover, when we are sick, we should not self-prescribe antibiotics, but do so under a clinician’s advice only”, he said.

But he also cautions that restricting irresponsible and inappropriate use of drugs should not restrict access to quality and affordable antimicrobials, including antibiotics, particularly for resource-limited settings. There has to be a balance. No child should die because of lack of quality antibiotics. The same is true for the agriculture and livestock sector, as it could also be about food security, food safety and food production.

Currently there are very few new drugs in the research and development pipeline, due to a variety of reasons, including funding shortfall. According to Dr Getahun, antibiotics should be treated as mass consumable public goods and so governments should invest more in research and development of antibiotics. There should be enhanced R&D in the animal sector to finding alternatives to antimicrobials- like vaccination. All this can go a long way to help preserve antibiotics and also reduce the risk of drug resistance.

Keeping this in mind, an AWaRe tool has been developed by the WHO Essential Medicines department to help contain the rising drug resistance and to protect and preserve antibiotics that are medically important for human health. It classifies antibiotics into three groups– Access (narrow spectrum drugs that can be used widely as they target a specific microorganism rather than several and lower the risk of bacteria becoming resistant to them); Watch and Reserve (that must be used sparingly or preserved and used only as a last resort as they are most at risk of resistance).

We have to ensure treatment as well as prevention of infectious diseases through responsible use of effective and quality assured safe medicines. We cannot achieve UHC without proper management of AMR, because without sustainable and effective treatment of infections, good quality healthcare for all cannot be reached. For a universal health coverage strategy to be successful, it has to address antimicrobial resistance.

For example, access to essential medicines and diagnostics, access to clean water and sanitation, and prevention of infections, are important elements of controlling AMR and these are also essential to improve quality of healthcare. So tackling AMR and achieving UHC go hand-in-hand. We cannot achieve universal health coverage without paying attention to controlling the spread of drug-resistant infections.