Open Bioeconomy Lab member Minette Shalo attended the Global Youth Antimicrobial Resistance (AMR) Summit in Nov 2020 – here she describes why engaging youth with tackling AMR is important and what we can all do to unite and preserve the effectiveness of antimicrobials. Minette is a Researcher on the CRISPRTyphoidDx project which is using CRISPR-based technology to identify AMR mutations in Salmonella Typhi.
World Antimicrobial Awareness Week (WAAW) is celebrated every year in November to increase awareness of global antimicrobial resistance (AMR) and to encourage best practices among the general public, health workers and policymakers to avoid the further emergence and spread of drug-resistant infections. This year, it was celebrated from the 18th to 24th November under the theme:
‘United to preserve antimicrobials’ to promote the imminent need for interdisciplinary approaches and mutual engagement of all sectors and actors to prevent AMR and preserve antimicrobials” (WHO, 2020).
Global Youth Antimicrobial Resistance (AMR) Summit
The global youth AMR summit is a yearly event that seeks to empower, support, and include youths from all over the globe in the decision-making process with respect to the fight against antimicrobial resistance, as well as the gathering of experiences, insights, and recommendations from experts in the field. The AMR Youth Summit aims to engage all healthcare and non-healthcare professionals, in rising against the challenge of combating AMR within their specialities; joining hands and building on their experience as young professionals. It took place from the 20th to the 22nd of November 2020 and it was the first-ever virtual summit registering 4000 participants from 127 countries worldwide, across 20 disciplines with the goal to:
– Educate and empower young people about different AMR related issues
– Discuss youth concerns related to AMR and Create a space for networking between young AMR leaders and activists
– Provide opportunities for networking between youth and AMR experts, leaders and professionals
– Promote the interprofessional and One Health approach within the youth and relay recommendations and solutions for stakeholders and decision-makers
WHAT IS AMR AND WHY IS IT IMPORTANT?
Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi, and parasites resist the effects of medications, making common infections harder to treat and increasing the risk of disease spread, severe illness and death. Antimicrobials are critical tools for fighting diseases in humans, animals and plants and include antibiotic, antiviral, antifungal and antiprotozoal medicines.
Antimicrobial Resistance is one of the world’s major public health problems. According to the World Bank (2017), If no action is taken by 2050 10 million lives per year will be lost due to AMR. AMR also affects multiple SDGs including pushing extra 24 million people into extreme poverty by 2030 (SDG 1), worsening world hunger by decreasing livestock productivity by 7% by 2030 (SDG 2), increasing inequalities (SDG 10), and affecting global GDP with economic losses $3.4 trillion by 2030(SDG 8).
The median overall increased cost to treat a resistant bacterial infection is estimated to be about 700 USD, equal to over one year’s wages of a rural worker in India. Novel treatments for multidrug-resistant infections can cost up to tens of thousands of dollars, making them unaffordable for many (ReAct, 2020).
DRIVERS OF AMR
Although AMR occurs naturally over time due to certain mutations in microorganisms, certain factors can accelerate this process. A combination of overuse in many parts of the world, misuse due to lack of access to appropriate treatment and underuse due to lack of financial support to complete treatment courses is one of the main drivers of AMR. Others 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 vaccines and diagnostics; lack of awareness and knowledge; lack of enforcement of legislation; pharmaceutical waste and agricultural misuse.
Antimicrobial stewardship is a coherent set of actions or strategies put in place to improve the appropriate use of antimicrobials through the promotion of optimal agent selection, dosing, duration and route of administration (Dyar et al., 2017). It has also been defined as a coordinated program that promotes the appropriate use of antimicrobials to improve patient outcomes, reduce microbial resistance, and decrease the spread of infections caused by multidrug-resistant organisms. Simply put, these are actions put in place to ensure responsible use of antibiotics.
These actions include:
- Creation of a global action plan to tackle the growing problem of resistance to antibiotics and other antimicrobial medicines.
- Of top priority is improved awareness and understanding of antimicrobial resistance through effective communication, education and training. This is especially important for healthcare professionals who are at the forefront of prescribing, administering or distributing these antimicrobials.
- Antibiotic stewardship programs, to help clinicians improve clinical outcomes and minimize harms by improving antibiotic prescribing.
- Implementation of systems to monitor antibiotic prescription such as preauthorization, to improve antibiotic use.
- Regularly distribution of information on antibiotic use and resistance to prescribers, pharmacists, nurses, and hospital leadership.
RATIONAL USE OF ANTIMICROBIALS IN HUMANS AND ANIMALS
Irrational use of antimicrobials by humans is one of the leading causes of AMR and needs to be monitored and controlled. This includes the use of Antimicrobial Growth Promoters(AGP) in animal Husbandry. Indiscriminate use of antimicrobials leads to drug resistance which threatens the health of both animals and humans. Human antibiotic consumption is reported to have increased by 36% globally between 2000 and 2010 (Leung et al., 2011). Non-prescription use is very common in LMIC despite the threats of AMR.
Animal health and welfare depend on the availability, effectiveness and appropriate use of quality veterinary medicines, including antimicrobials. Preserving the efficacy of these life-saving medications, as well as their availability for both human and veterinary use, is, therefore, essential to preserve our future. This is why it is essential that obligatory prescriptions are required for all antimicrobials used for disease control in food animals and national systems are created to monitor antimicrobial use in animals.
Antimicrobial Resistance and the Environment
The environment serves both as a reservoir for AMR microbes and a genetic source for new resistance genes. Antimicrobial residues and antimicrobial-resistant (AMR) bacteria are found in surface waters, soils, animal and human waste streams, and foods of plant origin. This is as a result of widely used antimicrobials for people, livestock, poultry, aquaculture, apiculture, pets, and plants, not only for the treatment of infections, but also for disease control, prophylaxis, and to promote growth in food-producing animals. The environment is thus key to antibiotic resistance.
Interprofessional and One Health approach to tackling AMR
The ‘One Health’ approach as defined by WHO is an approach to designing and implementing programmes, policies, legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes. AMR is a multisectoral global health issue. It touches upon multiple fields and is related to several target groups. So interprofessional collaboration and adoption of a One Health approach is considered the optimal way to tackle AMR in a holistic way.
To effectively detect, respond to, and prevent the transmission of AMR infections we must take into account antimicrobial use in humans, animals and the environment. Drug-resistant microbes can be transmitted between animals and humans through direct contact between animals and humans or through contaminated food, so to effectively contain it, a well-coordinated approach in humans and in animals is required. This requires a collaborative effort from professionals with a range of expertise who are active in different sectors, such as public health, animal health, plant health and the environment.
ANTIMICROBIAL RESISTANCE MITIGATION
What has been done and what more can be done?
- Global acceptance of the threat posed by AMR
Antimicrobial resistance is now more globally accepted as a huge problem by major stakeholders. In 2011, the World Health Organisation selected antimicrobial resistance as the theme for World Health Day in an attempt to bring international attention to the growing public health threat of AMR (Leung et al., 2011). It is also crucial that AMR is understood at the level of the community given that misuse of antimicrobials is a major propagator of AMR. There is thus a need for proper advocacy and campaigning on AMR and the appropriate use of antimicrobials. The WHO Global Strategy recommends education of patients and the general community on measures to prevent infection, reduce transmission of infection, and on the appropriate use of antimicrobials. Education of patients on suitable alternatives to antimicrobials for relief of symptoms and discouraging patient self-initiation of treatment is also recommended (WHO, 2001).
- International Measures
Given that AMR is a global issue, it requires a global response. International collaborations will ease sharing of data, control of counterfeit antimicrobials, implementation of international policies and improve research and development of new drugs and vaccines. Increased collaboration between governments, non-governmental organizations, professional groups and international agencies is also vital in the global fight against AMR. The global action plan on antimicrobial resistance endorsed by WHO, the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (OIE) identifies roles for national governments, the Tripartite organizations (FAO, OIE and WHO) and other national and international partners aimed at ensuring the world’s continued ability to treat and prevent infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way and accessible to all who need them (WHO, 2020).
- AMR and Policymaking
Antimicrobial use is influenced by an interplay of the knowledge, expectations and interactions of prescribers and patients, economic incentives, characteristics of the health system(s) and the regulatory environment (WHO, 2001). National commitment to understand and address this issue via the implementation of targeted policies is thus essential. This requires the formation of a national committee to monitor the effect of AMR and provide intersectoral coordination. According to the World Health Organisation, effective action requires the introduction and enforcement of appropriate regulations, allocation of appropriate resources for education and surveillance, and constructive interactions with the pharmaceutical industry to ensure appropriate licensure, promotion and marketing of existing antimicrobials and for encouraging the development of new drugs and vaccines (WHO, 2001). Main areas for policy change include accountability programs and global governance, waste and water management, investment in a sustainable response, and acceleration of progress as regards AMR mitigation.
- Healthcare Industry
Hospitals are particularly important in the mitigation of AMR due to the intensity at which antimicrobials are used. Integrated approaches to improving the use of antimicrobials, reducing the incidence and spread of hospital-acquired (nosocomial) infections, and linking therapeutic and drug supply decision-making are thus essential (WHO, 2001). Effective surveillance, infection control and therapeutic support are also required. You can find several recommendations by the World Health Organisation for strategies for hospital management, diagnostic laboratories and Interactions with the pharmaceutical industry here
- Research and Funding
Investment in sustainable innovative solutions such as the development of new antimicrobial medicines, vaccines and diagnostic tools especially those targeting critical gram-negative bacteria such as carbapenem-resistant Enterobacteriaceae. The launch of the Antimicrobial Resistance Multi-Partner Trust Fund (AMR MPTF), the Global Antibiotic Research & Development Partnership (GARDP), AMR Action Fund and other funds and initiatives could fill a major funding gap (WHO, 2020).
- Surveillance Systems
Reliable estimates of the global burden of AMR are crucial to managing AMR. More reliable, detailed and dynamic information is essential to successfully address an apparent rise in resistant infections, enabling policymakers and healthcare providers to implement national AMR action plans, and efficiently allocate resources (Schnall et al., 2019). Robust surveillance systems are needed especially in LMICs to ensure the inconsistency in the availability of data is resolved. The Global Antimicrobial Resistance Surveillance System (GLASS) launched in 2015 was developed by the World Health Organisation to support the global action plan on antimicrobial resistance. The aim is to support global surveillance and research in order to strengthen the evidence base on antimicrobial resistance (AMR), help informed decision-making and drive national, regional, and global actions (WHO, 2017).
WHAT ROLE CAN YOUTHS PLAY IN THE FIGHT AGAINST AMR?
- By 2030, we will be one of the generations most impacted by AMR; so we need to accept the role we play in the emergence and spread of AMR. If we understand the impact of our actions, then we can hold ourselves accountable and work towards the mitigation of AMR.
- Be part of the change. Get involved in projects promoting safe antimicrobial use; attend webinars, workshops and share what you have learned.
- Be part of a group or association advocating for the safe use of antimicrobials or policies to mitigate antimicrobial resistance. Support antimicrobial stewardship programmes.
- Take action! Start with yourself and your family. Practice safe antimicrobial use of antimicrobials where necessary, avoid self-prescription, complete your medication and avoid disposing of antibiotics carelessly.
- Advocate for antimicrobial stewardships using the resources at your disposal. You can use social media or whatever means is available to you. Keep yourself updated on progress in AMR mitigation.
- Promote discussions on antimicrobial use in agriculture and its consequences. Advocate for policies and laws to enable long-term prevention and control.
- Get vaccinated; it can protect you against some diseases that are treated with antibiotics. They include tetanus and whooping cough.
- Maintain proper hygiene and sanitary conditions to avoid getting infected and potentially transmitting resistant infections.
- World Health Organisation, 2020. World Antimicrobial Awareness Week 2020. Available at; https://www.who.int/news-room/events/detail/2020/11/18/default-calendar/world-antimicrobial-awareness-week-2020. (Accessed: 21 January 2021).
- World Bank, 2017. Drug-resistant infections: a threat to our economic future. World Bank.
- ReAct, 2020. The global threat of antibiotic resistance. Available at; https://www.reactgroup.org/antibiotic-resistance/the-threat/. (Accessed: 21 January 2021).
- Dyar, O.J., Huttner, B., Schouten, J. and Pulcini, C., 2017. What is antimicrobial stewardship?. Clinical Microbiology and Infection, 23(11), pp.793-798.
- Leung, E., Weil, D.E., Raviglione, M. and Nakatani, H., 2011. World Health Organization World Health Day Antimicrobial Resistance Technical Working G. The WHO policy package to combat antimicrobial resistance. Bull World Health Organ, 89(5), pp.390-2.
- World Health Organization, 2001. WHO global strategy for containment of antimicrobial resistance (No. WHO/CDS/CSR/DRS/2001.2). World Health Organization.
- World Health Organisation, 2020. Antimicrobial Resistance. Available at: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance#:~:text=The%20main%20drivers%20of%20antimicrobial,access%20to%20quality%2C%20affordable%20medicines%2C. (Accessed: 21 January 2021).
- Schnall, J., Rajkhowa, A., Ikuta, K., Rao, P. and Moore, C.E., 2019. Surveillance and monitoring of antimicrobial resistance: limitations and lessons from the GRAM project. BMC medicine, 17(1), p.176.
- World Health Organization, 2017. Global Antimicrobial Resistance Surveillance System (GLASS) report: early implementation 2016-2017. Global Antimicrobial Resistance Surveillance System (GLASS) report: early implementation 2016-2017.