As the world battles the Covid-19 pandemic, effort and focus have turned to the steadily emerging global public health problem of antimicrobial resistance.
Antimicrobial resistance is the ability of micro-organisms such as bacteria or fungi to persist in any part of the body despite administration of drugs designed to kill them. This advent of multidrug-resistant bacteria are rendering antibiotics ineffective in the treatment of many infectious diseases.
As antimicrobial resistance knocks more antibiotics off the shelves, people and animals will have to suffer from untreatable infections putting more lives and livelihoods in peril. This phenomenon will abet pathogen survival, increase medical costs, lead to pervasive infections and consequently cause death. This is why antimicrobial resistance is now is a key element of the Global Health Security Agenda.
In 2016, a momentous political declaration of the high-level meeting of the United Nations General Assembly on Antimicrobial Resistance was made to catalyse the world’s commitment to arresting antimicrobial resistance. The member states in the forum lobbied for the establishment of the Inter-Agency Coordination Group (IACG) to spearhead practical guidance for approaches needed to ensure sustained, effective global action to redress antimicrobial resistance.
Kenya took this declaration earnestly, with the then Cabinet Secretary for Health, Dr Cleopa Mailu, declaring that the country was not immune to the threat as it had increasingly recorded cases of antimicrobial resistance.
Mailu stressed that with increasing levels of international travel and trade, antibiotic resistance would remain one of the biggest threats to global health, food security, and development.
However, countries like Denmark, Germany and Sweden have sharply restricted the use of antibiotics in food animals. The Netherlands has even gone a notch higher to reduce animal antibiotic abuse by half — without harming animal welfare or meat industry profits.
A report released in April 2019 by IACG on antimicrobial resistance is an indicator of the derailed effort in combating the problem and thus should horrify any sovereign state that is responsible to its citizens. It is estimated that resistant infections are already causing at least 700,000 deaths globally every year, including 230,000 deaths from multidrug-resistant tuberculosis (MDRTB).
This report has been augmented and cemented by a worst-case scenario developed by the World Bank which has projected that the figure could rise to 10 million deaths every year by 2050 if no action is taken. Economically, the same report estimates that by 2030, an additional 24 million people will be forced into extreme poverty, with low-income countries hit hardest, jeopardising the achievement of the Sustainable Development Goals.
And by 2050, the world will lose nearly four per cent of its GDP (a loss of more than $6.1 trillion per year) if containment measures are not implemented.
These reports depict containment challenges in our dysfunctional public health system which is marred by over-prescription and irrational use of antibiotics both in human, livestock and environment leading to a miniature portion of bacteria surviving these antibiotics later evolving and reproducing, hence developing resistance.
The World Health Organisation (WHO) has been at the vanguard in galvanising establishment of robust and seamless AMR surveillance systems across all continents amid Covid-19. In July 2020, it called for more meticulous use of antibiotics among coronavirus patients to help curb the threat of antibiotic resistance.
Despite this communique, review in May found that among about 2,000 hospitalised Covid-19 patients globally, 72 per cent received antibiotics even though only eight per cent had presented with bacterial or fungal infections. With this incorrigible and gullible antibiotic consumption style, the superbug is simmering along and getting grim under Covid-19.
The only pivotal path out of this looming crisis is to strengthen laboratories both at national and county level to keep vigil and combat AMR through One Health Concept. Laboratory systems and laboratory professionals are a fulcrum and will play a vital role in surveillance, identification, mapping, quantification and communication of any resistance.
Although other stakeholders like patients, prescribers and dispensers contribute to AMR under the umbrella of antimicrobial stewardship, the definitive evidence that resistance is a problem, as well as the fine description of the problem comes from laboratories.
Most critically, attempts to treat infections or presumed infections without laboratory input drive resistance by increasing unwarranted antimicrobial use. Therefore, correct diagnosis and tests should be sagaciously requested within the context of an effective laboratory system to foster targeted and rational use of antimicrobials.
In the same vein, funds should be allocated and channelled to researchers to initiate the development of phages to kill targeted superbugs naturally. Otherwise, the problem will snowball and become stubborner than Covid-19.
As a consumer, you have the responsibility to stand up against the irrational routine use and feeding of antibiotics to humans and livestock.
-Mr Maragia is Turkana County’s Medical Laboratory Coordinator