WHO prioritizes AMR: A key issue tackled through multi-sectoral partnership

Manjari Peiris, Sri Lanka
[First published in Asian Tribune]
Antimicrobial resistance (AMR) is a multi-sectoral problem affecting human and animal health, agriculture, as well as the global environment and trade. Clean water, sustainable food production and poverty alleviation are but a few of the challenges it poses. It is learnt that AMR threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.

The cost of healthcare for patients with resistant infections is higher than care for patients with non-resistant infections due to longer duration of illness, additional tests and use of more expensive drugs. In a webinar organised by Citizens News Service (CNS) a whole range of issues related to AMR were discussed at length by experts.

 Dr Haileyesus Getahun, Coordinator, UN Inter Agency Coordination Group on AMR explained that Antimicrobial resistance is the ability of a microorganism (like bacteria, viruses, and some parasites) to stop an antimicrobial (such as antibiotics, antivirals and antimalarials) from working against it. As a result, standard treatments become ineffective, infections persist and may spread to others. As per the O’Neil report published in 2015, kills an estimated 700,000 people annually. The WHO Global TB Report states that in 2017, there were 558,00 people with drug resistant TB of which 230,000 people died due to it. Another study published in The Lancet in 2016 attributed 214,000 deaths of neonates from septicaemia (bloodstream infection). Another study by WHO estimated 34,000 deaths from HIV drug resistance in Sub Saharan Africa. The problem, undoubtedly is huge.

The environment is the key to antibiotic resistance. Bacteria in soil, rivers and sea water can develop resistance through contact with resistant bacteria, antibiotics and disinfectant agents released by human activity. People and livestock can then be exposed to more resistant bacteria through food, water and air. Up to 75% of antibiotics used in aquaculture may be lost into the surrounding environment. 70% of antibiotics are used by animals. Manure fertilizers cause antibiotic contamination in surface runoff, groundwater and drainage networks. Human antibiotic use jumped by 36% in the 2000s.

Antimicrobial use for livestock will jump 67% by 2030. Antibiotics are increasingly used to boost animal growth in intensive farming, especially in developing countries. Antibiotics also can be absorbed by plants and crops. Major waste flows including wastewater, manures and agricultural run-off contain antibiotic residues.

WHO has grouped the antibiotics in 3 categories:
  • ACCESS Antibiotics that should be available at all times
  • WATCH Antibiotics recommended as first-or second-line treatment for a small number of infections
  • RESERVE Antibiotics that are last-resort options

No one can completely avoid the risk of resistant infections, but some people are at greater risk than others (for example, people with chronic illnesses). If antibiotics lose their effectiveness, then we lose the ability to treat infections and control public health threats.

Many medical advances are dependent on the ability to fight infections using antibiotics, including joint replacements, organ transplants, cancer therapy, and treatment of chronic diseases like diabetes, asthma, and rheumatoid arthritis.

Antimicrobial resistance is occurring everywhere in the world, compromising our ability to treat infectious diseases, as well as undermining many other advances in health and medicine. The goal of the global action plan of the WHO is to ensure, for as long as possible, continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality assured, used in a responsible way and accessible to all who need them. To achieve this goal, the plan sets out five strategic objectives:
  • to improve awareness and understanding of antimicrobial resistance
  • to strengthen knowledge through surveillance and research
  • to reduce the incidence of infection
  • to optimize the use of antimicrobial agents
  • to develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.
Development of this plan was guided by the advice of countries and key stakeholders, based on several multi-stakeholder consultations at different global and regional forums.

Antimicrobial Resistance is a result of failed health systems and WHO as custodian of global health has prioritized AMR as a key issue that should be tackled through multi-sectoral partnership and in One Health context says Dr Ranieri Guerra, Assistant Director General, of the World Health Organization.

Manjari Peiris, Citizen News Service - CNS
October 27, 2018

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