Antimicrobial Resistance (AMR) : In top 10 global health threats

Shobha Shukla / Bobby Ramakant *

Antimicrobial Resistance (AMR) is already among the top 10 global health threats. "If AMR is going to impact our present and future, then we, the young people, should be most concerned. We have to combat AMR, prevent AMR, and engage youth," said Mayowa Sodiq Akinpelu, Chair of African Youth Antimicrobial Resistance Alliance Task Force.

Mayowa was speaking at the launch of a Youth Manifesto for the United Nations General Assembly High-level Meeting on Antimi- crobial Resistance (UNH-LM on AMR) on 26th September 2023.

This youth manifesto has been prepared by a consultation process facilitated by the Quadripartite Working Group on Youth Engagement for AMR, shared Dr Philip Mathew of the World Health Organization (WHO) AMR Awareness, Campaign and Advocacy team (on LinkedIn), who was present at the launch of the youth manifesto.

"If we do not stop AMR, we the youth, will be suffering its catastrophic im- pact when we are adults of the day. We have to avert this challenge," said Naha-shon Gicheru, a member of Quadripartite Working Group on Youth Engagement for AMR.

Protect the medicines we have

"Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and become resistant to (or no longer respond to) medicines, making infections harder to treat and increasing the risk of disease spread, severe illness and death. AMR is a problem driven by misuse and overuse of antimicrobial medicines, including antibiotics and antivirals, and results in critical medicines losing effectiveness to treat infections," said Thomas Joseph, Head, AMR Awareness, Advocacy and Campaigns, World Health Organization (WHO) HQ.

AMR is not a 'silent pandemic'

When AMR is preventable, then even one death is a death too many. AMR is associated with an estimated 4.95 million deaths annually, mainly in low-and middle-income countries.

AMR is a health concern that affects all ages. It also transcends borders, both territorial and scientific, affecting human, animal and plant health as well as the environment, weaving a complex net of global repercussions.

AMR can signi- ficantly affect achievement of several Sustainable Development Goals of the 2030 Agenda. Financially, AMR would cost the world US$ 412 billion a year in additional health-care costs and US$ 443 billion per year in lost workforce productivity. "If we look at these statistics, then cost of AMR is astronomical. Economic cost is itself catastrophic. It impacts our future," said Nahashon Gicheru.

AMR-a threatening candidate for the next global health emergency

In addition to 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 decreased animal health and welfare, exacerbating animal suffering and loss.

Preventing and mitigating AMR require a multisectoral response based on a One Health approach, involving the human health, food production, animal, plant and environmental health sectors, for collaborative design and implementation of evidence-based solutions.

Alarming rates of resistance are being found among prevalent infectious pathogens, including bacteria, viruses, parasites and fungi, and their resistance to existing antimicrobials is provoking a surge in the use of last-resort drugs. Now, even their effectiveness is being threatened. A two-fold increase in resistance to last- resort antibiotics is projected by 2035, making AMR a threatening candidate for the next global health emergency.

Youth uprising against AMR

AMR is a rising concern that looms over the 1.8 billion young people around the world, even as it progressively decreases the number of effective antimi-crobials. Youth around the world have been fighting AMR through various initiatives at grassroots and global levels, such as campaigns, youth summits, innovative hackathons and outreach activities.

Youth, as key stakeholders in combating AMR, are not only raising the awareness of the public about AMR but also promoting structural and behavioural change in prescription and consumption of antimicrobials. They also have a role in sensitising national and global actors and decision-makers to invest more in tackling AMR, including in actions led by youth.

The United Nations General Assembly High Level Meeting on AMR in 2024 is an opportunity to drive global change, as its resolutions might be crucial in shaping the future of health and AMR. It is in the interest of all that the voices of youth networks and organisations be included and amplified, as they can play a critical role in setting the global AMR agenda.

"When I was implementing infection control in an isolation facility in Kenya during the peak of COVID-19 pandemic, it took me 2 years in service without fully knowing AMR. How it impacts human health, animal health, and the environment is important to understand," added Nahashon Gicheru. "National Action Plans on AMR and implementing them, including addressing risk factors of AMR like handwashing, is so key. Working with youth at local level is vital."

Rhema Hooper, a student representative of College of Health, Lehigh University, said that "We are being an example of how to educate and engage young people especially students in AMR awareness campaign and advocacy." One positive outcome is that now young students use phones to alert patients on when to take their medicines to combat AMR.

Rhema Hooper added that "We can equip university students to connect with local communities on issues like AMR. Schools can play an important role on AMR and food security, for example."

Dr Salman Khan who is being trained at government-run Grant Medical College and JJ Hospital Mumbai in India, said that "Knowing grassroots reality (regarding danger of AMR), I had a constant urge to make a difference. This drove me to engage youth in AMR. I was involved and able to witness multiple activities done by medical students, including AMR stewardship, infection control, and a lot more."

"Imagine if every region, sub-region, every country, every sub-national level, has a youth group engaged on AMR," what a difference it can make!" added Dr Khan.

Listen to the people we serve

"We have to keep AMR-affected communities in the centre," when it comes to responding to AMR, said Dr Salman Khan.

As per the Youth Manifesto, 'An effective, sustainable response to AMR requires a “whole-of-society” approach, in which young people can play a crucial role now and in the future. Youth can help to increase awareness and change behaviour in society and to advocate for action on AMR in political and policy fora. Young people should have a seat at the table in shaping responses to global threats such as AMR.

The ideas, perspectives and skills of youth must be harnessed to advance global, regional, national and subnational AMR plans and interventions. Meaningful engagement of youth should be a priority for the United Nations General Assembly High-level Meeting on AMR in 2024 and beyond'.

Preamble to the Youth Manifesto

* Ensure meaningful youth engagement in policy, advocacy and programme implementation to achieve integration of the priorities stated below into local and national action plans.

* Foster multi-stakeholder collaboration to establish capacity-building initiatives and mentorship programmes to enable youth-led actions against AMR at national, regional and global levels.

* Encourage countries and key stakeholders, such as civil society organizations and institutions, to address the priorities stated below and to include youth in co-creating their strategic plans on AMR.

* Enable youth networks to use the AMR-related information provided by the Quadripartite Joint Secretariat on AMR and the Quadripartite organizations, which are the Food and Agriculture Organization of the United Nations (FAO), the United Nations Environment Programme (UNEP), the World Health Organization (WHO) and the World Organisation for Animal Health (WOAH), for producing educational materials and capacity-building for young people.

Top priorities identified by youth include
(i) Advocacy and engagement at various levels;
(ii) Education and capacity-building and inclusion of AMR awareness and appropriate use of antimicrobials in the health curricula of primary, secondary and higher education institutions, among others;
(iii) Equitable patient care, so that people across the world have access to effective, high-quality diagnosis and treatment for infectious diseases and the benefits of research and development reach everyone; and
(iv) Addressing AMR with a One-Health approach.