Resistance to antimicrobial agents is a serious health concern that could put the world at risk of running out of antibiotic options.
Antimicrobial resistance (AMR) occurs when bacteria, parasites, and viruses no longer respond to antimicrobial medicines. It is a natural process that happens over time through genetic changes in pathogens, causing antimicrobial treatments to fail because microorganisms have become resistant to them.
A report by WHO estimated that about 700,000 people die each year due to drug-resistant diseases and that if unmitigated, the report further projected it could cause 10 million deaths by 2050.
Yearly campaign to raise awareness of AMR globally
A 2022 analysis by Lancet found that in 2019, about 1.27 million deaths were directly a result of antimicrobial-resistant infections, while another 4.95 million deaths were associated with drug-resistant infections generally. Out of these deaths, twenty percent occurred among children aged below five years.
In Kenya, 8,500 deaths were directly attributable to AMR, and 37,300 deaths were somehow associated with it in 2019, making Kenya the seventh highest in the ranking of 15 countries of Eastern Africa in age-standardized mortality.
Promote best practices among stakeholders
As part of the efforts to combat AMR, the World AMR Awareness Week (WAAW) is marked yearly from November 18 to November 24 to raise awareness of AMR globally and promote best practices among stakeholders to curb the spread of drug-resistant infections. This year’s theme was Preventing Antimicrobial Resistance Together.
“Along with the climate crisis, AMR is one of the biggest health and environmental threats we face. The climate crisis and AMR are closely related. Changes in the natural environment due to climate crisis are increasing the spread of infectious disease, including drug-resistant infections,” said Mia Amor Mottley, Prime Minister of Barbados, during the opening of World AMR Awareness Week.
“There’s growing evidence that the environment plays a key role in AMR development, transmission, and spread. The same drivers that cause environmental degradation contribute to AMR, threatening our health and food systems.”
According to the President of the United Nations General Assembly, Dennis Francis, “AMR is truly a global concern, a silent yet bigger killer than HIV and AIDS and malaria, causing five million deaths globally each year. By 2050, it will be on par with the death toll from cancer. The spread of AMR renders medicines that we rely on to keep us healthy virtually ineffective. This is even more concerning against the backdrop of climate change and environmental degradation, which are altering our ecosystems.”
While resistance can develop naturally, the overuse of antimicrobials in humans, animals, and plants has accelerated the process.
Supportive care and restricted access
Worldwide, it is estimated that over 50 percent of antibiotics are purchased privately from pharmacies or in the informal sector from street vendors, often without prescriptions. In Africa alone, 31.7 percent of those who receive antibiotics do not consult a doctor for a prescription, while 26.4 percent obtain the antibiotics over the counter.
Although antimicrobials have been regular supplements in animal feed for years and are used to improve livestock productivity, their overuse in feeding forage has led to a rise in AMR. Statistics show that 73 percent of all antimicrobials sold globally are used in animals raised for food. China is currently the world’s largest producer and consumer of antimicrobials, followed by the US and the European Union.
Just like the impacts of the climate change crisis, the effects of AMR are felt disproportionately.
According to Mia Mottley, the burden of AMR falls on poor communities where medicines are already scarce, health and hygiene infrastructure are not sustained, and clean water is not freely available for drinking or hand washing.
The high volume of antibiotics used in the agri-food system
Due to limited resources for supportive care and restricted access to stronger medication (3rd or 4th line antimicrobials when standard treatment fails), developing countries, most of which are found in the Global South, are the most affected by AMR.
A dire shortage of health workers and overcrowding in hospital wards worsen the situation in most of these countries, which enables such infections to spread faster.
Being a global crisis and seeing how potentially fatal it can grow, there needs to be collaborating efforts by different stakeholders and groups, including the youth, to address the spread of AMR.
“We need to work cross-sectorally to preserve our ability to prevent and treat human, animal, and plant diseases and to minimize risks and spillovers. We need to reduce food safety and security risks considering the high volume of antibiotics used in the agri-food system,” Dennis Francis said.
Mia Mottley said: “The chain starts with you and each of us. The youth must choose to act. Young people are important in spreading the word and mobilizing action on this awful, silent pandemic. It makes me glad to see your actions inspire more actions because the youth are the future generations. They have the creative ideas and the energies to shape our present for a better future.”
Audrey Wong, the chair of external relations of the International Pharmaceutical Students Federation, who has, in her years of practice as a young clinical pharmacist, witnessed a lot of over-prescriptions of antibiotics, says it’s unfortunate that we still see AMR cases even in younger patients.
“My role, in this case, is to recommend narrowing or de-prescribing antibiotics. I have also been able to educate nurses and medical doctors on different drug resistance patterns. As a young AMR advocate, I also work with other young leaders to raise awareness of AMR, such as during our annual Global AMR Youth Summit, where we highlight the impact of AMR on our patients and find ways to collaborate in eradicating AMR,” she said.
‘The youth have a wealth of information’
According to Karina, a final year veterinary student at the University of West Indies and trust member of the International Veterinary Students Association (IVSA), “when it comes to AMR, there are so many things happening that we need to keep on top of. Being in the veterinary field, I have seen how AMR affects us daily, especially in the food animal industry.”
She said that her organization has been working yearly to create awareness and understanding of the effects of AMR and how young professionals like her can make a difference. This is a joint effort; we can’t do this alone. She believes education around AMR shouldn’t just be about what it is and what each of us can do. Even in the veterinary field, overuse of antimicrobials happens, especially in pet stores prescribing antibiotics to clients. It stems from such little things.
Audrey said we cannot wait until we are ready to confront AMR. It’s growing every day, and many patients are on antibiotics. Now is the time to act, and young people want to see more action from their leaders, but they also need to raise more awareness to bring together people and rally them around addressing AMR.
“The youth have a wealth of information and opportunities to work together to fight against AMR,” said Mottley. “I am asking the young people to use their voices to talk about AMR, to raise awareness among your peers, colleagues, parents, and grandparents. This is the first step in advocating for action. Start with the community around you. Make sure they use antibiotics as they were intended. Contact your political leaders and call for action; that is the only way we can hope to defeat this silent pandemic.”
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Gloriah Amondi is a Kenya-based multilingual human rights lawyer, Mandarin teacher, and writer contributing to The Nation’s weekend editions. Her works have been published in journals such as Kalahari Review, Ibua Literary Journal, Lolwe Literary Magazine, and Dooney’s Café.