In September 2024, the future of global action against antimicrobial resistance (AMR) was discussed during a high-level meeting at the United Nations General Assembly (UNGA) and a political declaration was adopted at this meeting. The declaration lays adequate importance on prevention aspects, which are the best bet to tackle AMR, particularly in low- and middle-income countries (LMIC).
As part of the World AMR Awareness Week, celebrated from November 18-24, Delhi-based think tank Centre for Science and Environment (CSE) conducts a global campaign to spread awareness about practices, key issues and solutions and brings together key global experts and stakeholders.
This year, the theme of CSE’s campaign was Prevent AMR. On November 20, 2024, CSE hosted a webinar titled Prevention is our best bet for controlling Antimicrobial Resistance.
The discussion explored how LMICs could take forward and leverage the prevention aspects highlighted in the declaration. The webinar featured AMR focal points from Africa and Asia, spanning both human and animal sectors.
The panel experts included Saviour Yevutsey, head of AMR secretariat, Ghana; Emmanuel Tanui, national AMR focal point, ministry of health, Kenya; Md Abu Sufian, director, department of livestock services, Bangladesh; Mwapu Ndahi, assistant chief veterinary officer and deputy director, federal ministry of agriculture and rural development, Nigeria and Amit Khurana, director, sustainable food systems programme, CSE.
Experts shared their reflections, perspectives and experiences on initiatives and challenges related to implementing the declaration’s prevention aspects in their respective countries.
The key takeaways from the webinar are discussed below.
The global narrative towards addressing AMR is changing towards prevention. Political declaration ensures a very good emphasis on the preventative aspects of AMR, not just in human health but also in animal and environment sectors. It is affordable, logical and gives high returns on investment. Prevention is manageable and cross cutting. The declaration has given a new direction to LMICs in the fight against AMR.
Prevention aspects in the declaration need to be aligned to the existing policies of the countries. This will help achieve the common goal as placed by the declaration. For example, the revision of the National Action Plans on AMR can be aligned to the political declaration, which is being done in Ghana, for example.
There is a need to leverage enforcement of issues linked to prevention. AMR is a behavioural issue and needs proper regulation to check practices. If the UNGA declaration and its issues are to be digested well by policymakers, then some of the issues can be added in the checklist that agencies use. These could be health facility licences that are renewed based on the availability of water, sanitation, and hygiene, as well as infection prevention control (IPC) practices in those facilities.
Governance and multisectoral coordination is important to consolidate and maximise national and sub-national efforts for AMR prevention. For example, Nigeria has designed a multisectoral one health governance structure that is guided by a manual which highlights the terms of reference and the structure.
Awareness of the public and farmers, as well as training of stakeholders, professional health-workers, both in the human and animal sectors, is very important to prevent AMR. Awareness enables stakeholders to change their behaviour and practices. There is a need to work on the education of farmers and consumers, and develop appropriate messages for the community to improve behaviour (for example, washing vegetables before consuming).
Farmers, especially small-scale farmers, need to be aware of the dangers of AMR and the way out which is prevention. For example, in Kenya, there exists a training module for IPC that is hosted in a virtual academy and the participants then get a certificate as well.
There was strong emphasis and consensus on the integral role of biosecurity when it comes to preventing diseases and reducing the treatment cost in the first place.
For example, Nigeria and Kenya have developed biosecurity guidelines and standard operating protocols for major food value chains in respective countries and are using these to train and sensitize their farmers. Bangladesh has implemented a small pilot to implement its biosecurity principles in farms and found that strictly adhering to these can reduce medical cost significantly.
Other relevant policy measures talked about from point of view of ensuring prudent antibiotic use in animal sector include standard treatment guidelines, antimicrobial stewardship strategies, essential medicines list, prescription policy, and prohibition of antimicrobial use in feed.
Vaccination of animals can also prevent AMR, but it needs to be cost-effective. The cost of importing from other countries or producing vaccines is quite high. Another challenge is linked to the cold chain management. Vaccination is therefore used by large-scale commercial players who can afford it. For small-scale farmers, vaccination needs to be made cost-effective.
Ensuring good quality antimicrobials and vaccines in supply chain for both human and animal sector is very important. Infiltration of sub-standard products through porous borders is a big challenge.
It is important to promote and provide incentives for farmers to make them move away from antibiotic use. For example, in the event of a disaster, the farmers that adhere to biosecurity measures can get some additional help from the government.
Additionally, alternatives to antibiotics have been shown to reduce antibiotic use, but they must be cost effective in order to be scaled up. In India, the use of ethnoveterinary medicine in farms promoted by the National Dairy Development Board could be upscaled because it was cost-effective and farmers got incentives.
Access to high-quality clean water and safe drinking water, particularly in LMICs, can help prevent disease and AMR. There is therefore a need to prioritise investment in providing funding for basic health infrastructure and deliberate capacity building and empowerment of regulators. Not just in the human sector, but also in the animal sector. In order to truly prevent AMR in the animal sector, animals must have access to the same safe drinking water as humans.
The involvement of the environment sector is crucial to control and prevent AMR. Inappropriate activities that are carried out in the animal and human sectors all end up in the environment. An example of the challenge in the environment sector is the lack of appropriate technology to treat liquid waste from pharmaceutical manufacturing
There is a need for appropriate financing to commit for AMR prevention strategies. Most AMR activities or interventions in LMICs, being donor-driven, need investments from the government to ensure that the interventions are sustainable beyond the donor commitments.
Other challenges identified in preventing AMR included poor IPC practices in hospitals, a lack of access to high-quality health products and technologies, a lack of enforcement and compliance with existing regulations, health-care system inadequacies, and a lack of evidence and data on alternative practices to reduce antibiotic use.
While knowledge, guidelines and initiatives do exist in LMICs that can aid in prevention of AMR, their implementation is a big challenge.
The webinar concluded with an emphasis on the prevention agenda, which is cross-cutting and encompasses the following priorities. Firstly, the conservation of existing antibiotics by reducing misuse and overuse is critical, particularly as the development of new antibiotics has largely stalled.
Secondly, recognising the need for LMICs to develop and grow, it is vital to establish a short-term agenda to reduce the use of chemicals, alongside a long-term strategy to create a roadmap that decreases reliance on industrially intensive food systems.
Lastly, there is a pressing need to minimise the introduction of pollutants into the environment from the outset.