Out of the 5 million AMR-related human deaths that occur every year, most of them are happening in low- and middle-income countries
World leaders at next year’s UN General Assembly will be convening a United Nations High-Level Meeting on AMR. “We are at a critical point in time to act against AMR. The attention to AMR is growing and it is rightly so. The UN High Level Meeting on AMR next year is a critical opportunity to further accelerate the response to AMR,” said Beatrice Atim Odwong Anywar, Uganda’s Minister of State for Environment, and Member of the Global Leaders Group on Antimicrobial Resistance (AMR).
“Out of the 5 million AMR related human deaths that occur every year, most of them are happening in low- and middle-income countries. These are the countries where the burden of diseases is also higher. That is why Uganda is spearheading action against AMR across sectors such as human health, animal health, food and agriculture, and the environment,” added Minister Beatrice.
One Health Approach
The health of humans, animals, (domestic and wild), plants and our environment are closely interlinked and interdependent. “This means that whatever happens to one of them, the others will be inevitably affected and impacted for better or for worse”, says Javier Yugueros-Marcos, Head of the Department of Antimicrobial Resistance & Veterinary Products at the World Organisation for Animal Health (WOAH). We cannot ignore one at the cost of another.
Agrees Emmanuel Kabali, AMR Project Coordination Consultant at Food and Agriculture Organization (FAO), that “AMR is a complex issue that impacts human, animal, plant and environmental health. Antimicrobials are used extensively in humans, and in animal and plant production”.
“The drivers of AMR are in several sectors. Misuse or overuse of antimicrobials happen in human health, animal health, food and agriculture, and several other sectors”, adds Dr Philip Mathew, Technical Officer, World Health Organisation (WHO).
As per WHO, One Health is an integrated unifying approach to sustainably balance and optimize the health of people, animals and our environment. By linking humans, animals and the environment, One Health can help to address the full spectrum of disease control and contribute to global health security.
Antimicrobials is public goods
There are several issues of access and equity affecting AMR. “Research and development of new treatment options, including new antibiotics, is not prioritized due to a sector-wide market failure. As a result, we are running out of treatment options and new drugs are not coming into the market. Even when new medicines finally reach the market, low- and middle-income countries are not able to access these due to intellectual property and pricing constraints. Antimicrobials should be regarded as global public goods. Governments should strengthen their health systems and push for universal health coverage, so that all have access to the needed antimicrobials prescribed by registered healthcare providers,” said Thomas.
Information, knowledge, action gap
“When it comes to addressing AMR, mere information is not enough. Information has to be translated into knowledge and action. We need to bridge that knowledge-action gap. In context of sustainability, we often say - think global, act local. What we do at the local level or what we do in our house, community, school, or organisation, also makes a huge difference. Key message is grounded in promoting appropriate use of antimicrobials, and to stop misappropriate or inappropriate use of antimicrobials in human health, animal health and livestock, food and agriculture, and environment. That is why quadripartite agencies of Food and Agriculture Organization of the United Nations (FAO) United Nations Environment Programme (UNEP), World Health Organization (WHO) and World Organisation for Animal Health (WOAH) have united to advance progress on One Health approach in addressing challenges such as AMR,” said Wondwosen Asnake Kibret, Policy and Partnerships Coordinator, UNEP. “Calling AMR a ‘silent pandemic’ might convey a wrong message that ‘it is a very distant issue which may affect us sometime in the future’. AMR is not a distant issue as it is killing millions right now – even one death is a death too many when it comes to preventable threats like AMR. AMR can happen to anybody at any time”, cautions Philip.
That is why all sectors across the One Health spectrum spanning human, animal, plant, and the environment must work together to ensure the responsible use of antimicrobials while taking preventive measures to decrease the incidence of infections. The medicines that we have today to combat diseases have to be handled with care and used responsibly.
This is the second part of a series on AMR.
(Shobha Shukla and Bobby Ramakant lead the editorial team of Citizen News Service and are on the Board of Global AMR Media Alliance (GAMA) and Asia Pacific Media Alliance for Health and Development APCAT Media; views are personal.)