Dr Haileyesus Getahun
Director of Global Coordination and Partnership on Antimicrobial Resistance, World Health Organization
Antimicrobial resistance (AMR) is one of the greatest threats we face as a global community that has not yet got the attention it deserves.
Antimicrobials are agents that fight diseases in humans, animals and plants and are critical tools for our significant progress in human medicine and veterinary health in the last century. However, the misuse and overuse of antimicrobials are accelerating the development of drug resistance and they are becoming ineffective.
Alarming levels of drug resistant infections have been reported in countries of all income brackets resulting in common diseases becoming untreatable, and lifesaving medical procedures riskier to perform. It poses a formidable challenge of reversing a century of progress in tackling diseases, achieving universal health coverage and sustainable development goals.
What is the One Health initiative, and how can that be applied when tackling the AMR issue?
The drivers of AMR cut across several sectors including human and animal health, plants and crops, food production as well as the environment. The ‘One Health’ approach refers to designing and implementing programmes, policies, legislation and research in a way that enables these sectors and stakeholders to communicate and work together to achieve better public health outcomes.
It is important to build effective national responses across the One Health spectrum through increased political commitment, coordinated multisectoral action and availability of domestic resources.
Implementing national One Health action plans should be the primary responsibility of national governments aligned with leveraging gains across their efforts for sustainable development goals. Research and development for antimicrobials, diagnostics, vaccines, waste management tools, and safe and effective alternatives to antimicrobials, as well as access to quality and affordable antimicrobials for both humans and animals should be an integral part of these efforts.
What are the main barriers to tackling AMR?
The challenges of AMR are complex and multifaceted. Lack of basic access to clean water and sanitation, as well as poor infection and disease prevention and control in health care facilities, farms and communities all fuel transmission of drug resistant infections.
Additionally, poor access to high-quality and affordable medicines, vaccines and diagnostics further fuel the crisis. Ineffective surveillance systems and incomplete understanding of the magnitude of the problem globally are also key barriers that blight the development and implementation of effective and tailored strategies. Lack of grass root movements and civil society engagement, and the absence of organised activism and advocacy further dwarf our efforts to tackle antimicrobial resistance.
Who is most vulnerable to the effects of AMR?
AMR affects everyone. Alarming levels of drug resistant infections have been reported in all countries. Without effective antibiotics, those individuals undergoing routine surgery like hip replacements or caesarian section, or affected by common illnesses may end up having life-threatening infections.
People are already dying from drug-resistant infections and diseases. For example, half a million TB patients developed drug resistant diseases globally in 2018, and only a little more than half of them were treated successfully.
As drug resistant infections spread, sustainable food production and global trade will be at risk. Healthcare expenditures would increase dramatically. As a result, the World Bank estimated that, by 2030, up to 24 million people – mostly in low-income countries – would be forced into extreme poverty.
Can we help to combat AMR on an individual level?
Supportive individual behaviour of the public and professionals such as physicians, dentists, pharmacists and veterinarians will help to address the misuse and overuse of antimicrobials.
Additionally, the utilisation of infection prevention and control – including vaccination, clean water, sanitation and hygiene – will help to prevent and mitigate the development and transmission of infections, thereby reducing the future need for antimicrobials.
Getting advice from a professional before using antibiotics either for oneself or for any family member is the most important intervention that one can do.