KATHMANDU, NOVEMBER 19

In the wake of World AMR Awareness Week (WAAW: 18-24 November), top political figures, including the Prime Minister and health minister, expressed their deep concerns over exacerbating issues due to misuse, overuse of antibiotics and AMR.

This year, the theme for World Antimicrobial Awareness Week (WAAW) 2024 is 'Educate. Advocate. Act now.

PM KP Sharma Oli requested that everyone follow possible initiatives to reduce antibiotic use, as well as make a commitment to train themselves, family, and community about AMR. He also urged the relevant agencies to work together, as this challenge can only be met through collaborative efforts.

Similarly, three government ministers-Minister for Health and Population Pradeep Paudel, Minister for Forests and Environment Ain Bahadur Shahi Thakuri, and Minister for Agriculture and Livestock Development Ramnath Adhikari-have called for the proper use of antibiotics.

They also stressed the importance of raising antimicrobial resistance awareness and advocating for it.

There is an opportunity for Nepal to demonstrate accountability and fulfil its commitments made regarding antimicrobial resistance during the two high-level sessions this year: the 79th United Nations General Assembly (UNGA) and the 77th World Health Assembly, and the week is especially significant for Nepal, according to the message issued by them.

They went on to say that in developing countries like Nepal, where antibiotics play an important role in the treatment of contagious and communicable diseases among humans, livestock, and plants, the global rise in antimicrobial resistance has reduced antibiotic efficacy, posing new challenges in the treatment of contagious diseases.

Amidst their collective message about the AMR issue, it is critical to understand what AMR is, how it threatens global health, and how we can protect ourselves from it.

What is AMR?

Antimicrobial resistance (AMR) is currently one of the greatest global threats. It results in millions of deaths, long-lasting disabilities and increased health care costs. It also has severe impacts on livelihoods, threatens food security and results in the loss of animal lives.

According to Thomas Joseph, Head, AMR Awareness, Campaigns and Advocacy, World Health Organisation (WHO) HQ and Chairperson of the AMR Awareness Working Group for the Quadripartite Joint Secretariat on AMR, AMR occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines.

'As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability and death. AMR threatens our ability to treat common infections and to perform life-saving procedures, including cancer chemotherapy and caesarean sections, hip replacements, organ transplantation and other surgeries,' he said.

'Data shows that there were 1.27 million attributable deaths directly caused by bacterial AMR in 2019, but the number of total associated deaths to AMR in a year is around 5 million. AMR deaths may increase by 50% in the next 25 years,' said Thomas.

Likewise, WHO data also depicts that antibiotic resistance currently results in around 1.2 million deaths annually worldwide and is estimated to surge to 5 million by 2050. By 2030, the economic burden due to this could reach up to 34 billion US dollars. This is likely to hinder progress towards achieving the Sustainable Development Goals by 2030.

Factors fueling AMR

The primary driver of AMR is the misuse and overuse of antimicrobials (antibiotics, antivirals, antifungals, and antiparasitics) in human, animal and plant health. It is further complicated by the increased incidence of infections due to the poor quality of drinking water, low access to sanitation, and insufficient infection control in healthcare facilities. Inappropriate disposal of waste, especially those with antimicrobials, contributes to the spread of AMR.

According to Alexandra Cameron, Unit Head, Impact Initiatives and Research Coordination, AMR at WHO, Antimicrobial Resistance impacts are compounded by the problem of substandard and falsified medicines, which are widely prevalent, especially in low- and middle-income countries.

'AMR really risks reversing some of the gains that we have made in modern medicine. In addition, AMR also places a heavy burden on health systems and jeopardises our response to dealing with health emergencies such as pandemics. Using the wrong treatment can result in a lack of cure and negative patient outcomes,' she said.

'This is further compounded by the problem of substandard and falsified medicines, which are widely prevalent, especially in low- and middle-income countries. Substandard and falsified medicine is a form of misuse that is often invisible to the provider.'

She further said, 'Overuse of antimicrobials can also lead to medicine stockouts, making effective treatments unavailable to other patients who desperately need them, and when stockouts of antimicrobials occur, we have provider surveys that show us that providers are often forced to use either suboptimal treatments, so looking at alternative suboptimal treatments, or treatments that are much more expensive than what would be the first line of therapy.'

According to Alexandra, we also have the paradox that misuse and overuse of antimicrobial medicines coexist alongside a lack of access to effective antimicrobials. In low and middle-income countries, lack of access is causing more deaths than AMR itself.

Preventative measures

Experts believe that a people-centred public health approach is one of the most important components for preventing AMR. Primary healthcare must be central to our strategy for achieving universal health coverage. A timely and accurate diagnosis is essential so that the person can receive quality-assured care.

Dr. Yvan JF Hutin, Director, Department of Control, Surveillance and Prevention of Antimicrobial Resistance, World Health Organisation (WHO), said, 'World leaders need to fully finance the AMR response. Effective governance, investing in AMR prevention while we accelerate research and development, and addressing issues of inequitable access to diagnostics and antimicrobial medicines must be prioritised.'

He also said that what the world needs now are bold, transformational, and firm commitments from the heads of states, which will ensure that the implementation of action plans on AMR is accelerated and effective.

'There is no time to waste; we must act together to preserve the effectiveness of these global public goods to ensure a safe planet for our children,' he added.