Young people do not want a future with looming threat of antimicrobial resistance

Shobha Shukla/Bobby Ramakant *

Who would we ever want to deal with infections that are difficult (or impossible) to treat! Young people are right when they call on world leaders to ensure a future where antimicrobial resistance is no longer a threat to global health security and food security.

“When I was a pharmacy student, antimicrobial resistance (AMR) used to be an abstract concept to me. I was taught about AMR and how to identify it by using drug susceptibility test, and how to look at the resistance pattern among other parts of our curriculum. But when I started working as a pharmacist, I saw more and more patients who were dealing with microbes resistant to medicines. AMR was no longer something I learnt about in school but a major challenge I need to deal with because patients rely on us to tell them what medications they can take. When we look at tests, then often we realise that they may have one or two options left of medicines that can respond (as they could be resistant to all other medicines for the disease they have),” said Dr Audrey Wong, Chairperson of Quadripartite Working Group for Young Engagement on AMR.

Quadripartite is a historic alliance comprising four global agencies that have come together to address AMR: global UN agency on human health (World Health Organization – WHO), global UN agency on food and agriculture (Food and Agriculture Organization of the United Nations – FAO), global UN agency on the environment (United Nations Environment Programme – UNEP), and World Organisation for Animal Health – WOAH.

Antimicrobial resistance (AMR) is among the top 10 global health threats today. It is associated with an estimated 4.95 million deaths annually, mainly in low- and middle-income countries. AMR affects human health, animal health, plants and also our environment. Without a stronger response to prevent AMR, there would be an estimated average loss of 1.8 years of life expectancy globally by 2035. Financially, AMR would cost the world US$ 412 billion a year in additional healthcare costs and US$ 443 billion per year in lost workforce productivity.

In addition to causing deaths, which are projected to increase to 10 million a year by 2050, other expected impacts of AMR include increased morbidity due to infectious diseases, longer hospital stays, escalation of health expenditure, a fall in agricultural productivity (when food security worldwide is already threatened by the dire consequences of the climate crisis) and poor animal health and welfare, exacerbating animal suffering and loss.

Dr Audrey Wong was speaking with CNS (Citizen News Service, a founding member of Global AMR Media Alliance or GAMA) on the sidelines of the historic second-ever United Nations General Assembly High-Level Meeting on AMR. A political declaration was endorsed by heads of nations which is many shades stronger than the one adopted 8 years ago at a similar meet.

AMR affects our animals too

We at CNS also spoke with Karina Khatic, a final year Veterinary student from Trinidad and Tobago who currently serves as a trustee member of the International Veterinary Students' Association which focuses on all aspects of veterinary medicine, including One Health. She is also a part of the Quadripartite Working Group for Youth Engagement on AMR.

“We are so proud to get space to share our voices on AMR [at the UNGA HLM on AMR and other such spaces] and how AMR affects us and risks our present and future. We will continue to call for a change till the AMR threat looms,” said Karina.

“I am a veterinarian, and I work with animals of so many species. AMR can also affect our animals. It is important to remember that AMR does not just affect human beings but also animals. So, we the veterinarians and others involved in animal health and livestock need to be aware and do what-we-can-do (and what we know works) to reduce misuse and overuse of medicines in our sector,” said Karina.

She added: “AMR is a challenge not limited to one sector like human health, but its threat is looming over many other sectors, such as animal health and livestock, food and agriculture, and our environment. We need to engage and work collaboratively with many other sectors to prevent AMR with One Health approach - that is key.”

Misuse and overuse of medicines is rampant in human health, animal health and livestock, food and agriculture, and reaches our environment too. That is why One Health approach remains the bedrock to advance progress towards effective prevention of AMR.

“There needs to be more awareness. The accessibility to medicines is far from ideal in my country,” Karina said.

Unless ALL people have access to timely and accurate diagnostics (for all diseases, infectious and non-communicable diseases alike), and linkage to standard treatment, care and support, how can we avert AMR? In addition, standard infection control practices in all healthcare settings, communities and homes and universal access to vaccines for vaccination-preventable diseases is key. We must keep disease prevention in a people-centred and rights-based gender transformative manner as mainstay.

Agrees Karina: “We need people-centred responses to AMR. This includes people-centred communications around AMR because we do not have to engage only medical professionals but a range of other sectors and communities.”

Agrees Dr Audrey too: “A lot of times AMR may seem like a big and complex thing for a lot of people, but in fact it is not. AMR can affect anyone! There is a lot what a person can do at an individual level to reduce the risk of AMR: like washing hands and maintaining sanitation and hygiene, getting vaccinated, preparing food safely, among others", says Dr Audrey.

Youth manifesto

Dr Audrey mentions an important youth-led organising earlier this year which led to the launch of a youth manifesto in lead up to this high-level meet of world leaders on AMR.

The preamble of youth manifesto called for:
- Meaningful youth engagement in policy, advocacy and programme implementation to achieve integration into local and national AMR action plans.
- Fostering multi-stakeholder collaboration to establish capacity-building initiatives and mentorship programmes to enable youth-led actions against AMR at national, regional and global levels.
- Encouraging countries and key stakeholders, such as civil society organisations and institutions, to address the AMR priorities and to include youth in co-creating their strategic plans on AMR.
- Ensuring One Health approach remains the bedrock for advancing progress to combating AM

Social media and AMR

Social media campaigns have been very impactful in getting more attention to AMR. AMR, which is often looked as a very medicalised issue, fails to connect with non-medical people. The response to stopping misuse and overuse of medicines has to be rooted in the communities - and communications of which has to take diversity of the communities in account.

"AMR is like a very medical term and it can be really hard to understand and to relate to for a lot of people," said Dr Audrey Wong. "That is why we use diverse approaches to reach out to people- for videos we used TikTok, we used story books, among other tools. We also tried to put spotlight via our story book that links malaria with AMR."

AMR survivors breathe life to "AMR is invisible. I am not"

A powerful and potentially game-changing campaign: AMR is invisible. I am not" has helped humanise the AMR epidemic - which continues to take lives as well as increase human suffering.

Audrey believes that even individuals can take their own small steps to help mitigate the threat of AMR. Along with it, we must push for stronger national action plans to reduce and prevent the AMR threat. "It is always about what we all can do (to prevent AMR)."

Promises made by world leaders at UNGA HLM on AMR 2024

World leaders at the 79th United Nations General Assembly High-Level Meeting on AMR adopted a political declaration which has concrete targets. Some of these promises include:

* Reducing the global deaths associated with bacterial antimicrobial resistance by 10% by 2030 against the 2019 baseline of 4.95 million deaths

* 100% countries having basic water, sanitation, hygiene and waste services in all healthcare facilities and 90% of countries meeting all WHO minimum requirements for infection prevention and control programmes at the national level by 2030

* At least 80% of countries can test resistance in all bacterial and fungal pathogens included in the Global Antimicrobial Resistance and Use Surveillance System (GLASS) by 2030

* Ensure, by 2030, that all countries have developed or updated and are implementing multisectoral national action plans on antimicrobial resistance with national targets informed by analysis of existing capacities and priorities

* Strive to meaningfully reduce, by 2030, the quantity of antimicrobials used globally in the agrifood system from the current level.