Health in Africa

Antibiotic resistance: How to tackle AMR in Africa

Pan-Africa experts meet to find solutions to the antimicrobial resistance mess 

By Vibha Varshney
Published: Tuesday 21 January 2020

Experts from 10 African countries are set to meet in Lusaka, Zambia (January 22-24, 2020) to figure out ways to tackle antimicrobial resistance (AMR) — one of the biggest threats to human health.

The Pan-Africa Workshop on Effective Implementation of National Action Plan (NAP) on Antimicrobial Resistance is being organised by Zambia National Public Health Institute, under the country’s health ministry, and Centre for Science and Environment (CSE), a non-profit based in New Delhi, India.

Experts are slated to assess efforts in Africa to contain antibiotic resistance, discuss the implementation of NAPs, the antimicrobial resistance surveillance framework and surveillance of antimicrobial use in countries. 

The experts will meet even as 80 years of antibiotic use, overuse and abuse have made microbes resistant to them. Despite signs of danger, antibiotic use increase every year.

More than 70,000 people die every year from infectious diseases that antibiotics can’t cure anymore. This is likely to jump to 10 million a year by 2050. The number of defined doses of antibiotics is estimated to triple by 2030 over 2015.

The World Health Organization is justifiably worried. It has identified AMR as one of the 12 global health challenges in 2020.

At risk is the overall development agenda, including the United Nations-mandated Sustainable Development Goals to be met by 2030.

A 200 per cent increase in antibiotics usage between 2000 and 2015 was driven by low- and middle-income countries. In high-income countries (HICs), overall consumption increased modestly.

Action against AMR

A drug resistance index (DRI) — developed by researchers from the Center for Disease Dynamics, Economics & Policy (CDDEP), Washington and Rollins School of Public Health, Emory University, Georgia — was used to track global trends in effectiveness of antibiotic therapy in 41 countries in 2018.

The result showed that high-income countries had the lowest DRIs and low-income and middle income countries had high DRIs.

To ensure adequate action on the grave issue of antibiotics, the UN set up the Interagency Coordination Group (IAGC) on Antimicrobial Resistance in 2016. The group formulated a blueprint to fight against antimicrobial resistance in which it recommended a ‘One Health’ response.

The One Health approach considers humans, animals, the food chain, the environment, and the inter-connectedness between them as one entity. Under this, while the countries will need to ensure that those who need antimicrobials, vaccines and diagnostics should not be deprived, but at the same time, their use for growth promotion in animals and agriculture has to be phased out.

The group also recommended that funds should be made available to increase innovation in new antimicrobials, diagnostics, vaccines and waste management tools in the final report which they presented in April 2019. 

As many as 117 countries finalised their NAPs by January 2019; another 62 were in the process of developing theirs. Yet there are likely to be hurdles in the fight against this resistance, a 2018 analysis by IACG indicated.

It showed that more than formulating action plans, implementation was a challenge, especially in resource-constrained low- and middle-income countries. The group identified the major challenges in implementation— lack of awareness and political will, finance, coordination, monitoring and data and technical capacity.

To ensure implementation, IACG suggested that intervention must be mainstreamed into broader health, agricultural and environmental projects. The availability of funds was also crucial for the success of NAPs. Increased regional cooperation was essential.

What efforts

World bodies are trying to meet these requirements. In June 2019, Food and Agriculture Organization, World Organisation for Animal Health and World Health Organization launched the AMR Multi-Partner Trust Fund to scale up efforts to support countries to counter the threat of AMR.

The fund has a five-year scope (through 2024) and has received an initial contribution of $5 million from the Government of the Netherlands. The immediate funding requirement is $70 million, which will provide technical support to countries in designing NAP and scale up local action.

Countries can modify their NAPs based on learnings from within and outside the country. CSE is working with the Zambian government to improve implementation of their NAP. It has helped the country to reprioritise its NAP based on current ground-level scenario, implementation progress and available resources.

It also provides an understanding of how each sector — human health, animal and environment — perceive each activity and what timeline each would prefer to implement them. The two stakeholders have also worked on AMR surveillance.

A five-year roadmap to phase-out anti-biotic misuse in food-animal sector, particularly non-therapeutic antibiotic use and use of critically important antibiotics in therapeutic applications has been developed as well. 

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