Antimicrobial resistance is not a silent pandemic

Shobha Shukla *

Antimicrobial Resistance directly kills more than 1 million people and is associated with almost 5 million deaths every year, that are expected to increase by 50% in the next 25 years. It also threatens our economies, with an estimated global annual cost of up to US$ 3.4 trillion by 2030 and 28 million people pushed to poverty by 2050. Every death and suffering due to antimicrobial resistance (AMR) is unacceptable and is essentially preventable.

Human health and AMR

Thomas Joseph, Head, AMR Awareness, Campaigns and Advocacy, at the World Health Organization (WHO), and Chairperson of AMR Awareness Working Group for the Quadripartite Joint Secretariat on AMR, explains that antimicrobials are different kinds of medicines- like antibiotics which treat infections caused by bacteria like TB; antiviruses which treat infections caused by viruses like HIV; anti parasitics that treat infections caused by parasites like malaria; antifungals that treat infections caused by fungi like ringworm.

When these medicines stop working we say antimicrobial resistance occurs. In other words, AMR occurs when bacteria, viruses, fungi and parasites no longer respond to medicines. As a result, infections (sometimes even minor ones) become difficult or even impossible to treat.

Speaking at the 4th Edition of the Annual Global Media Forum around World AMR Awareness Week (WAAW), Thomas listed the drivers of AMR. Misuse and overuse of antimicrobials; lack of access to quality, medicines, vaccines and diagnostics; lack of access to clean water, sanitation and hygiene; poor infection and disease prevention and control in healthcare facilities; improper waste disposal by healthcare facilities, pharmaceutical units and farms; coupled with lack of awareness and knowledge- all of these contribute to AMR and lead to increase in sickness, morbidity and mortality in humans and animals, as well as huge economic and productivity losses and increased healthcare expenditure, he said.

AMR is reversing the gains made by modern medicine

It threatens our ability to treat common infections and to perform life-saving procedures including cancer chemotherapy and caesarean section, hip replacements, organ transplant, and other surgeries.

“The problem is further compounded by the use of substandard and falsified medicines which are widely prevalent, especially in low and middle- income countries. Substandard and falsified medicine is a form of misuse that is often invisible to the provider,” opined Alexandra Cameron, Unit Head, Impact Initiatives and Research Coordination, Antimicrobial Resistance Division, WHO.

She pointed out that overuse of antimicrobials can also lead to medicine stock outs, making effective treatments unavailable to other patients who need them desperately. “We also have the paradox that misuse and overuse of antimicrobial medicines coexists alongside a lack of access to effective antimicrobials. In low and middle-income countries, lack of access to medicines is causing more deaths than AMR itself.”

AMR can affect anyone. None are immune from it. It can happen to anyone, anywhere. Even a minor injury, routine surgery, or a common lung infection could unexpectedly escalate into a life-threatening situation.

‘AMR is invisible, but I am not’- So goes the slogan by WHO Task Force of AMR Survivors - who have survived drug-resistant infections or cared for those with such infections.

Felix Liauw, a pediatrician from Indonesia and a member of WHO Task Force of AMR Survivors, shared the traumatic story of his 3 month old son who passed away due to delay in diagnosis and extensive misuse of medicines. Right after his birth, Liauw’s son suffered from chronic diarrhoea and fever. He was initially diagnosed with sepsis.

His sepsis treatment changed from first-line to second-line and eventually to third-line antibiotics (meropenem) but with no improvement in his condition. Then a genetic test was done and it took 6 weeks to get the results that he had congenital short bowel syndrome- a rare genetic condition. It took a very long time to make this correct diagnosis, and by then it was too late. He also had hospital acquired infections.

While there is no cure for this disease, the disorder usually can be treated effectively. So timely and correct diagnosis is key.

"As a pediatrician and caregiver, I would like to share that we should give antibiotics or other antimicrobials only when we have a confirmed diagnosis. We should be aware of hospital-acquired infections and do all what we can to stop the transmission of infections”, advises Liauw.

Animal Health and AMR

Yu Qiu, Animal Health Officer, at Food and Agriculture Organization of the United Nations (FAO) rightly points out that AMR is a One Health issue because it represents the growing challenge to the agriculture and food sector with serious consequences for human health, animal health, food safety and global food security. Drugs used to treat infections in livestock and companion animals are becoming less effective.

More and more animals are not getting timely diagnosis and treatment against the infectious diseases, resulting in increased mortality and reduced productivity. The World Bank projects that livestock production in low- and middle-income countries could decline by 11% by 2050. This could pose a significant challenge to food safety and livelihood of farmers whose income also relies on food producing animals for their household, said Yu Qiu.

Agrees Ana Luisa Pereira Mateus, Scientific Coordinator at the Antimicrobial Resistance and Veterinary Products Department, World Organisation for Animal Health (WOAH): "Untimely mortality and morbidity in animals due to emergence of AMR is having an adverse impact on livelihoods of those who depend on food producing animals, because of decreasing productivity. AMR also impacts local economies. Up to one in five people in the world depend on food producing animals to secure their livelihoods. The cumulative global gross domestic product (GDP) loss due to AMR in livestock is predicted to be US$ 575 billion by 2050."

Environment and AMR

According to Wondwosen Asnake Kibret, Policy and Partnerships Coordinator, United Nations Environment Programme (UNEP), the environment plays a key role in the development, transmission and spread of AMR. Increased use and misuse of antimicrobials and other microbial stressors, such as pollution, create favourable conditions for microorganisms to develop resistance from sources such as sewage.

The environmental dimensions of AMR include pollution from hospital and community wastewater, effluents from pharmaceutical production, and waste originating from agriculture and livestock. These may contain not only resistant microorganisms, but also antimicrobials, microplastics, metals and other chemicals, all of which increase the risk of AMR in the environment, he added.

A future sans the threat of AMR

All of us, including the youth of today, want a future which is free from the threats of AMR.

“AMR warrants a whole of society approach to address it. The role of youth, who represent a significant part of our population, is crucial as key stakeholders in achieving joint action against AMR. Empowering the next generation through effective communication is not just a necessity but a powerful tool to inspire learning, advocacy, and action,” said Augusto Baron, member of Quadripartite Working Group for Youth Engagement on AMR.

And as Wondwosen emphasized, using the 'One Health' approach, which recognises that the health of people, animals, plants and the environment are closely linked and interdependent, can go a long way in addressing AMR. All hands have to be on deck to preserve the effectiveness of medicines for the treatment, control and prevention of infectious diseases in animals, humans and plants when needed.

We have to end inequity and injustice in health responses. Be it infection control, or access to early and accurate diagnostics for a range of diseases and linkage to effective standard medicines without any delay, along with universal access to existing vaccines for everyone with equity and rights – is critical if we are to walk the talk on Health For All and All for Health. Failure is not a choice when it comes to challenges like AMR. We must ensure health security for everyone with equity and justice.