A Growing Menace..Slow response to drug resistance plagues public healthcare

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Antimicrobial resistance (AMR) was declared a public health emergency by the World Health Organisation (WHO) in 2015, but the severity of the problem is still not widely appreciated, particularly in Africa.

AMR or drug resistance in human, animal and plant life occurs due to various factors including natural genetic mutation, inappropriate use of drugs and use of substandard and counterfeit antibiotics.

On the other hand, transmission of AMR is accelerated by inadequate infection prevention and control, contamination of food supplies with AMR bacteria, impaired access to potable water, and by limitations in public health prevention programmes, including immunisation, sanitation, and sexual health.

More than 700,000 people die every year from infectious diseases that antibiotics can no longer cure, and experts warn that this figure is likely to jump to 10 million a year by 2050. 

The World Health Organiaation is justifiably worried.

“Lack of programmes and actions to deal with this problem is worrisome. Public awareness is also very low in all regions (globally),” Dr Stanley Midzi from the WHO office in Zimbabwe told journalists during a recent virtual media training workshop on AMR.

The 2015 declaration by WHO culminated in the adoption of a Global Action Plan (GAP) on AMR by the 68th World Health Assembly in the same year, obligating member states to put in place national action plans to fight antimicrobial resistance. 

But global reaction towards the emerging health crisis has generally been slow, for various reasons, especially in Africa.

A 2018 report by the Inter-Agency Co-ordination Group on AMR which was set-up by the UN in 2016, showed that implementation was a challenge, especially in resource-constrained low- and middle-income countries.

Other major challenges in implementation also identified included -lack of awareness and political will, finance, coordination, monitoring and data and technical capacity.

Zimbabwe, for example, took two years to come up with a national action plan and finally launched one in 2017.

The plan, among other objectives, seeks to improve awareness and understanding of AMR through effective communication, education and training, strengthening the knowledge and evidence base through surveillance and research and reducing the incidence of infection through effective sanitation, hygiene and infection prevention measures.

But, implementation of the action plan has largely been lethargic due to a lack of resources.

“The government of Zimbabwe has set up a national anti-microbial resistance programme that is working to combat the AMR problem. At least now with improved funding as compared to when we started in 2015, we can really look forward to much more improvements in terms of addressing the problem of AMR,” director of epidemiology and disease control in the Ministry of Health and Child Care, Dr Portia Manangazira , said at the media workshop on AMR.

Zimbabwe is only now scaling up efforts to counter the threat of AMR with the assistance of the Multi-Partner Trust Fund (MPTF), an initiative launched by FAO, the World Organisation for Animal Health (OEI)and WHO in June 2019. 

Zambia also took two years to craft a national action setting out priority actions and strategies to address factors influencing the development and spread of AMR in that country.

Zambia’s five-year roadmap, launched in 2017, seeks to phase-out antibiotic misuse and improve awareness and understanding of AMR through effective communication, education and training, among other objectives. 

As with Zimbabwe, Zambia's action plan experienced teething problems due to funding constraints before FAOs Fleming Fund intervened to support part of the response. 

At regional level, the Southern African Development Community (SADC) only initiated the development of a regional AMR response in 2018 and is still to conclude the envisaged strategy which will be collectively implemented by member states. 

The SADC AMR strategy was validated by a technical committee in December last year and awaits approval by the SADC member states.

As AMR increasingly becomes a serious threat to global public health, urgent prioritised action is required.

In Zimbabwe, for example, AMR related deaths are thought to have increased during the last cholera and malaria outbreaks.

By April this year, Zimbabwe had recorded over 170,000 malaria cases including 152 deaths, a 44 percent increase compared to the same period last year.

On the other hand, during the last cholera outbreak which occurred between September 2018 and March 2019, a total of 10,421 people were infected resulting in 69 deaths.

“As a country we do have quite a lot of challenges of AMR. In the past we have seen it during cholera and typhoid outbreaks and during the Covid-19 outbreak we have also realised that some of the issues of AMR still come to haunt us in terms of complicating cases,” Dr Manangazira said.

“As a country we have experienced quite a number of cholera outbreaks but of note is the last outbreak where the resistance was really quite high. We saw complications among cholera cases that would normally just improve on adequate rehydration. The resistance was characterised in terms of ciprofloxacin among other common antibiotics and this actually assisted us to argue in favour of a vaccine.

“We saw a lot of severe cases because of the resistance to the commonly used antibiotics but it also meant that we had to deploy much more resources to treat those patients as they would stay longer in the cholera treatment facilities, the course of antibiotics also rises exponentially once you go past the first line and we also saw that during the last cholera outbreak, in some instances, third line antibiotics had to be used.”

The sale of fake drugs has also exacerbated the AMR challenge, says Food and Agriculture Organisation (FAO) AMR sub-regional office of Southern Africa coordinator Dr Mark Obonyo.

“The problem is big, I would not say the magnitude at the moment because we are planning within the Multi-Partner Trust Fund to try to quantify how big a problem this could be by mapping out the supply chain straight from the importation. We will also attempt to map out the illegal routes through which these counterfeit drugs gain entrance into the market,” he said.

“What we are fighting for is to preserve the few antibiotics that are still working so if already we have the problem of AMR, now you are compounding it with another problem of bringing counterfeit drugs into the market.”

In Africa, AMR has been documented to be a problem for HIV and the pathogens that cause malaria, tuberculosis, typhoid, cholera, meningitis, gonorrhoea, and dysentery.

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