Antimicrobial Resistance: World Risks Reversal of Progress Made in Public Health, Says WHO

Onyebuchi Ezigbo in Abuja

World Health Organisation (WHO) has warned that increasing incidence of drug resistance to medicines used in treatment of fungal infections, neglected tropical diseases, such as tuberculosis, HIV and malaria parasites may reverse decades of progress made in key areas of public health globally.
WHO said that this drug resistance also known as Antimicrobial Resistance (AMR) poses a major threat to human health.

It said that as a result of drug resistance, antibiotics and other antimicrobial agents become ineffective and infections become difficult or impossible to treat, thereby increasing the risk of disease spread, severe illness and death.
The apex health organisation said that an estimated five million deaths were associated with bacterial AMR in 2019, including 1.27 million deaths being directly caused by it.

A report by WHO, said that AMR related deaths is significantly more than the number of deaths caused by tuberculosis, HIV and malaria, thereby making it a leading cause of death around the world.
It said that low- and middle-income countries bear a greater burden of infectious disease and with limited resources will be most adversely affected by AMR.
“The burden of AMR is highest in low-resource settings, particularly sub-Saharan Africa and South Asia, which already carries much of the world’s burden of communicable diseases.

This makes AMR not only a global public health problem, but an issue of health equity and socioeconomic development.
“Lower respiratory tract infections, like pneumonia, accounted for more than 1.5 million deaths associated with AMR, making it the most burdensome infectious syndrome in 2019.

“Although antibiotics are a key focus, drug resistance to medicines used in treatment of fungal infections, neglected tropical diseases, tuberculosis, HIV and malaria parasites is compromising the ability to treat these infectious diseases, and we risk reversing the decades of progress that have been made in these important areas of public health”.

While making a presentation at the weekend during a conference organised by Association of Nigeria Health Journalists (ANHEJ) with support from WHO in Akwanga, Nasarawa State, the organisation’s Cluster Lead AMR Expert, Dr. Chavan Laxmikant  said that a person with a drug-resistant infection is more likely to be sick and in hospital, and absent from work and family commitments, for longer, and require more expensive medicines and medical care compared with someone with an antimicrobial-susceptible infection.
According to him, this has major implications on health-care costs and productivity, both for patients and their caregivers, as well as more broadly on the health system and national economy.

Laxmikant explained that drug-resistant infections often require the use of second- or third-line treatments, which are usually more expensive, not widely available and can cause serious side effects, like organ failure.
“Sometimes these infections no longer have effective treatment options. Modern medicine is dependent on the ability to prevent and treat infections using antibiotics, including during joint replacement surgery, organ transplantation, cancer chemotherapy and the treatment of chronic diseases like asthma and diabetes.

“If antibiotics and other antimicrobials lose their effectiveness, we lose the ability not only to treat infections, but also to manage other public health conditions,” he said.
The WHO Lead Expert gave the key drivers of AMR as when bacteria, viruses, fungi and parasites no longer respond to antimicrobial agents.
He added that as a result of drug resistance, antibiotics and other antimicrobial agents become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness and death.

“In principle, AMR can occur naturally in almost all living organism, in response to antimicrobial exposure. Microorganisms, such as bacteria utilize different mechanisms, to become resistant to antimicrobials.  

Although AMR occurs naturally over time, its emergence and spread is accelerated by the misuse and overuse of antimicrobials to treat or prevent infections in humans, animals, and plants.

“The resistant infections are further transmitted by humans and animals in the community directly (to other humans and animals) or indirectly (into the environment or in food products)”      

He listed other factors that facilitate the spread of AMR to include: lack of access to clean water, sanitation and hygiene (WASH) for both humans and animals; poor infection and disease prevention and control in health-care facilities and farms; poor access to quality, affordable medicines, vaccines and diagnostics; lack of awareness and knowledge and lack of enforcement of legislation.

The WHO scribe said that although antibiotics are used to kill some bacteria that cause infections, but “they also kill the ‘good’ or ‘helpful’ microbes that protect our body from infection”.

He said the antibiotic-resistant bacteria sometimes survive and multiply, and their resistance traits can be spread to other bacteria.

“Antibiotics are lifesaving, but they should only be taken when they have been prescribed by a health worker for bacterial infections.

“Unnecessary exposure to antibiotics, such as when they are prescribed and used for conditions that aren’t caused by bacteria, like colds and flus, pressures bacterial populations to adapt, leaving the antibiotic-resistant strains to flourish. They can also lead to side effects,” he said.