AU intensifies efforts to combat antimicrobial resistance in Africa

Dr Wande Alimi from Africa CDC addresses participants during the AMR week in Zimbabwe. [Courtesy] Africa bears the highest burden of Antimicrobial Resistance (AMR) due to overuse and misuse of antibiotics. AMR is a public health threat causing more deaths in Sub-Saharan Africa than HIV and malaria combined. It is estimated that by 2050 it will have caused over 50 million deaths globally, if not checked as superbugs resistant to all known antibiotics are increasing with few antibiotics in the pipeline to treat extensively-drug resistant bacteria. Infections once easily treatable now pose a significant challenge due to resistant bacteria and fungi. Kenyans have been experiencing AMR which medical researchers and pharmaceutical companies have blamed on recurrent use of over-the-counter drugs. In response to this, the Ministry of Health in Kenya has issued new treatment guidelines after previous drugs became ineffective in treating gonorrhea and syphilis. Other infections becoming harder to treat in Kenya as antibiotics become less effective are pneumonia, tuberculosis and food-borne diseases. The Government of Kenya with the support of development partners has taken several measures across various sectors to intensify action against AMR. In response to the AMR threat, the Ministry of Health in partnership with the Ministry of Agriculture, Livestock, Fisheries & Cooperatives have consolidated national efforts to implement sustainable measures to mitigate any further emergence and spread of AMR. In 2017, the Government of Kenya published the National Action Plan on prevention and containment of antimicrobial resistance (NAP on AMR) covering the period 2017-2022. The NAP is aligned with WHO's Global action plan on antimicrobial resistance (GAP on AMR), outlines multi-sectoral and One Health policies and interventions, and assigns key roles and responsibilities to various stakeholders. The country's AMR governance encompasses national and county levels; the National Antimicrobial Stewardship Interagency Committee (NASIC) is functional and meets regularly; and eight of 47 counties have formed County Antimicrobial Stewardship Interagency Committees (CASICs). As of 2021, 12 health facilities served as AMR surveillance sites and are connected to the national AMR surveillance system and database; however, only six facilities actively submit AMR data. The Ministry of Health aimed to have around 30 facilities connected to the national AMR surveillance system and database by the end of 2022. AMR surveillance in the animal health sector began in May 2021, with six laboratories reporting data to a separate national database. Pilot projects to implement routine AMR surveillance systems began in 2017. By 2019, those efforts had expanded to cover four hospitals in Kiambu, Trans Nzoia, Kilifi and Machakos counties. During the Regional Meeting to Review Antimicrobial Stewardship Guidelines and Implementation of AMR Surveillance, in Nairobi, August 2023, Kenya's Health Cabinet Secretary Susan Nakumicha emphasized the urgency of collective efforts to address AMR. The CS advocated for a comprehensive One-Health Approach, integrating efforts across human health, animal health, and the environment, to prevent the emergence and spread of AMR while promoting responsible use of antibiotics. World Health Organisation in a recent report, warned that the progress in modern medicine is facing risks due to drug resistance experienced around the world. "An era in which common infections and minor injuries can be major killers is no longer an apocalyptic fantasy but a very real possibility for the 21st Century," said the report titled Antimicrobial Resistance. "It is clear that resistance to common pathogens has reached alarming levels in many parts of the world indicating that many of the available treatment options for common infections, in some settings, are becoming ineffective," WHO says. Participants during the AMR week in Zimbabwe. [Courtesy] AMR worsens through misuse of antibiotics, non-compliance to prescriptions, poor prescribing habits and use of fake or counterfeit medicines- which have lower doses of the active ingredient. This has been blamed on weak regulation, lack of awareness, and poor unsafe water, sanitation and hygiene (WASH) and poor Infection, Prevention and Control (IPC). African Union said to address AMR there is need for accountable governance and implementation of National Action Plans, advocacy for One Health approach integrating human, animal, and environmental health sectors, and robust surveillance and reporting systems. The Africa CDC and African Union Inter-Africa Bureau for Animal Resources (AU-IBAR) teams have been actively developing a landmark report of African priorities and outcomes for AMR, ahead of the AMR High-Level Meeting at the UN General Assembly in September 2024. In a statement the AU said it is engaging in a series of consultation meetings with multi-sectoral experts, in line with a One Health approach. Recently the AU convened AMR expert dialogue workshop to provide input on the planned outcomes for the AMR High-Level meeting at the United Nations General Assembly (UNGA 2024) to establish a common understanding of top AMR challenges and solutions to the same. To address AMR drivers in the African context the meeting called for preventative measures to address transmission through capacity building of health workers, creating awareness to drive action through WASH and IPC practices, vaccination campaigns, and animal husbandry/ biosecurity practices). The Coordinator of the Economics, Trade, and Marketing Unit/Food Safety Officer, AU-IBAR, John Oppong-Otoo, highlighted the challenges posed by the increasing antimicrobial resistance. "The rise of antimicrobial resistance complicates the treatment of infections, leading to longer hospital stays, increased mortality rates, and higher healthcare costs. In countries with limited resources and healthcare infrastructure, the burden of AMR can be especially challenging to manage," Oppong-Otoo said. "Furthermore, the environmental dimension of AMR cannot be overlooked. The discharge of antimicrobial residues from agricultural runoff, pharmaceutical manufacturing, and improper disposal of unused medications can contribute to the spread of resistance genes in soil, water, and air, impacting ecosystems and potentially exacerbating the problem," he added. Africa CDC and AU-IBAR said AMR targets, baselines, and surveillance measures need to be set in accordance with the realities of local populations. They called for improved data tracking and surveillance systems, particularly in the animal, agriculture, and environment sector, where data is less standardised than the human health sector. The AU said creation of data and information sharing platforms for example regular impact studies, peer learning groups for cross-country sharing of best practices could better support the implementation of AMR National Action Plans. To mobilize and coordinate resources, the experts said there is a need for predictable, equitable, and sustainable funding across all African countries, including access to grants for the implementation of AMR initiatives. "AMR should be incorporated into broader health frameworks to enable an effective, multi-sectoral One Health response. Resources need to be mobilized to meet country-specific contexts and be aligned with measurable milestones laid out in AMR National Action Plans," read the statement. Dr Yewande Alimi from, Africa CDC called for equitable access, preventing overuse and misuse of antibiotics while ensuring vulnerable populations have access to essential antibiotics, vaccines, and diagnostics. Andy Bulabula from Africa CDC Emphasized the need to address issues at micro and macro levels for effective health interventions. "Efforts to implement health initiatives have begun, but a significant challenge is the lack of governance. There is a need for stronger leadership and structured guidance for countries to effectively implement health programs," he said. Bulabula noted that currently health programmes heavily rely on international partners and moving forward, there is need to align with the Abuja Declaration, which mandates allocating 15 per cent of government expenditure to health programs. He said at the population and community level, there is a gap in translating scientific evidence into actionable steps which requires context-sensitive measures and practices within communities. Patrick Chanda Kabwe of Africa CDC said health facilities lack the funding and human resources to implement basic measures to address AMR. Kabwe regretted that Africa is often on the tail end of receiving newer vaccines and therapeutics, and communities that are most vulnerable lack access. Dr Evelyn Wesangula of National AMR Focal Point, Ministry of Health, Kenya, emphasized the importance of presenting data that shows economic loss and the cost-effectiveness of interventions. Dr Wesangula further highlighted the need to align data with government priorities. Dr Tochi Okwar of Nigeria Centre for Disease Control and Prevention underscored the importance of developing homegrown solutions that are informed by global best practices and regular collaboration among African experts to advance understanding and action on AMR.

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