The Urgent Fight Against Antimicrobial Resistance (AMR) in Africa: A Call for Collective Action
Author:
George Njenga Kiai
Article Type:Article Number: 4
This article explores the urgent need to address Antimicrobial Resistance (AMR) in Africa, highlighting insights from the CiSPHA Regional Webinar titled "The Last Mile towards the HLM on AMR: CSOs Consultation on the Challenges and Advocacy Opportunities." It discusses the severe impact of AMR on public health in Africa, emphasizing the importance of a One Health approach, strengthening surveillance and laboratory capacities, ensuring access to quality medicines, and empowering civil society in advocacy efforts. The article also connects these discussions to the UN High-Level Meeting on AMR at the 79th session of the United Nations General Assembly (UNGA 79) in September 2024, calling for coordinated actions across all sectors to combat this growing threat.
Introduction
Antimicrobial resistance (AMR) is one of the most pressing public health threats globally, with particularly severe implications for Africa as outlined in our previous issue’s article Antimicrobial Resistance: Focus on Africa. As pathogens evolve and become resistant to existing treatments, infections become harder to manage, leading to increased disease spread, severe illness, and mortality. The World Health Organization (WHO) estimates that AMR is responsible for 1.27 million deaths annually, with low- and middle-income countries (LMICs) bearing the highest burden. Sub-Saharan Africa (SSA), in particular, has experienced the greatest mortality rate from AMR and continues to struggle with challenges such as poor AMR surveillance, irrational antibiotic use, and weak regulatory systems.
This article is based on insights from the CiSPHA Regional Webinar titled, “The Last Mile towards the HLM on AMR: CSOs Consultation on the Challenges and Advocacy Opportunities.” The event aimed to inform and engage Civil Society Organizations (CSOs) on the current developments in AMR, present key recommendations for action, and share insights on the High-Level Meeting (HLM) on AMR at the 79th session of the United Nations General Assembly (UNGA 79) in September 2024.
The Growing Threat of AMR in Africa
AMR in Africa is a multi-dimensional crisis affecting every layer of society. As emphasized by the speakers during the CiSPHA Regional Webinar, AMR could significantly reduce life expectancy on the continent by 2035 and overwhelm already fragile healthcare systems. Sub-Saharan Africa has been particularly hard-hit, with the highest mortality rates globally due to AMR, driven by factors such as inadequate healthcare infrastructure, the widespread misuse of antibiotics, and the prevalence of substandard medicines.
The One Health Approach: Integrating Human, Animal, and Environmental Health
One of the central strategies discussed in the webinar was the implementation of a One Health approach, which integrates human, animal, and environmental health sectors. The interconnected nature of these domains means that antimicrobial resistance in one area can quickly spread to others. For instance, antibiotic use in livestock can lead to resistant bacteria that may be transmitted to humans through the food chain or direct contact.
The One Health approach is critical in addressing AMR at its roots, particularly in Africa, where agriculture plays a significant role in the economy and uses a large volume of antibiotics. The webinar highlighted the need for stronger cross-sector collaboration to reduce the misuse of antibiotics in human medicine and agriculture, including promoting better infection prevention and control (IPC) practices.
Strengthening Surveillance and Laboratory Capacity
Accurate and timely data are crucial for combating AMR, yet many African countries face significant challenges in this area due to limited laboratory infrastructure and trained personnel. Without robust surveillance systems, it is difficult to monitor the spread of resistant infections, understand local epidemiology, and develop effective treatment guidelines.
During the webinar, participants underscored the importance of investing in laboratory capacities across the continent. This includes not only building new laboratories but also upgrading existing ones, training healthcare workers in microbiology and bacteriology, and integrating AMR surveillance into national health systems. Improved laboratory capacity will enable countries to detect resistance patterns more effectively and prescribe appropriate treatments, thereby slowing the spread of resistant infections.
The Role of Civil Society in AMR Advocacy and Action
Civil society organizations (CSOs) are essential in the fight against AMR. They serve as a bridge between communities and policymakers, advocating for the implementation of national action plans (NAPs) and ensuring that the voices of the most vulnerable populations are heard. However, CSOs in Africa often face significant challenges, including limited funding, fragmented efforts, and a lack of coordination among different groups.
To address these challenges, the webinar called for greater collaboration among CSOs across the continent. By working together, CSOs can amplify their advocacy efforts, share resources, and develop unified strategies for engaging with governments and international partners. This is particularly important in pushing for the prioritization of AMR in national health agendas and securing the necessary political and financial commitments for effective action.
Ensuring Access to Quality and Affordable Medicines
One of the most significant contributors to AMR in Africa is the widespread availability of substandard and falsified medicines. These poor-quality drugs not only fail to treat infections effectively but also contribute to the development of resistance. The problem is particularly acute in regions with weak regulatory frameworks, where counterfeit medicines can easily enter the market.
The webinar participants stressed the need for stronger regulatory oversight to ensure that only quality-assured medicines are available to the public. This includes strengthening national regulatory authorities, improving post-marketing surveillance, and cracking down on the illegal trade in counterfeit drugs. In addition, there is a need to support local pharmaceutical manufacturing to reduce reliance on imported medicines, which are often more expensive and more difficult to regulate.
Addressing the Economic Impact of AMR
The economic impact of AMR is profound, particularly in low- and middle-income countries where healthcare systems are already under strain. The loss of productivity due to illness and death, combined with the increased cost of treating resistant infections, can have a devastating effect on national economies. The webinar highlighted the need for countries to recognize AMR not just as a health issue but as an economic one that requires urgent attention.
Investing in AMR prevention and control can yield significant economic benefits by reducing healthcare costs and improving productivity. For example, improving infection prevention and control measures in healthcare settings can reduce the incidence of hospital-acquired infections, which are often more difficult and expensive to treat. Similarly, promoting the rational use of antibiotics can reduce the development of resistance, thereby preserving the effectiveness of existing drugs and avoiding the need for more expensive treatments.
International Cooperation and Resource Mobilization
Addressing AMR requires a global response, with strong international cooperation and resource mobilization. The upcoming UN High-Level Meeting on AMR at the 79th session of the United Nations General Assembly (UNGA) presents a critical opportunity for African nations to secure the political and financial commitments needed to tackle this issue effectively. Aligning national efforts with global initiatives, such as those discussed on the AMR Multi-Stakeholder Partnership Platform, can enhance the impact of interventions and ensure that Africa’s specific needs are addressed.
The webinar participants emphasized the importance of engaging with international partners to share best practices, mobilize resources, and ensure that African voices are heard in global discussions on AMR. This includes advocating for increased funding from high-income countries, as well as exploring innovative financing mechanisms to support AMR initiatives in Africa.
The Path Forward: Recommendations for Action
The discussions during the webinar led to several key recommendations for tackling AMR in Africa:
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- Implement a One Health Approach: Strengthen multisectoral collaboration across human, animal, and environmental health sectors to address the drivers of AMR comprehensively.
- Enhance Surveillance and Laboratory Capacity: Invest in laboratory infrastructure and training to improve the detection of resistant infections and inform treatment guidelines.
- Promote Rational Use of Antimicrobials: Develop and implement guidelines for the rational use of antibiotics in human medicine, agriculture, and veterinary practice, and strengthen antimicrobial stewardship programs.
- Improve Access to Quality Medicines and Vaccines: Strengthen regulatory frameworks to ensure the availability of quality-assured medicines and expand vaccine coverage, particularly in underserved areas.
- Support Civil Society Advocacy: Empower CSOs to play a leading role in raising awareness, advocating for policy change, and holding governments accountable for their commitments to combat AMR.
- Increase Investment in AMR Research and Development: Support the development of new antibiotics, vaccines, and diagnostics through public-private partnerships and other innovative financing mechanisms.
- Strengthen International and Regional Cooperation: Engage with global and regional partners to share best practices, mobilize resources, and coordinate efforts to address the cross-border nature of AMR.
Conclusion: A Call for Collective Action
The fight against AMR in Africa is a collective responsibility that requires coordinated efforts from all sectors of society. From implementing the One Health approach to strengthening surveillance, ensuring access to quality medicines, and advocating for international support, there is much to be done. As highlighted in the CiSPHA Regional Webinar, civil society, governments, and international partners must come together to combat this growing threat before it undermines the health and prosperity of future generations. It is essential that African nations, civil society organizations, and international partners seize the opportunity at the UN High-Level Meeting on AMR, to make meaningful progress in tackling this silent pandemic.
