Antimicrobial resistance (AMR) is a global health and development threat. It is everywhere. It can affect anyone, of any age, in any country. It risks people, pets, wildlife, plants, and the environment.
Antimicrobials – including antibiotics, antivirals, antifungals, and antiparasitics – are medicines used to prevent and treat infections in humans, animals, and plants. Microorganisms that develop antimicrobial resistance are also referred to as “superbugs”. Antimicrobial resistance occurs when bacteria, viruses, fungi, and parasites change over time and no longer respond to existing medicines. Medicines become ineffective leading to treatment failure and increasing the risk of disease spread, severe illness, and death.
Nearly 5 million human fatalities worldwide in 2019 were attributed to bacterial AMR, of which 1.3 million were directly linked to bacterial AMR, demonstrating the severity of the issue.
Though the emergence of resistance in microorganisms occurs naturally over time, its amplification and spread are the results of human behavior. Antimicrobial-resistant organisms are found in people, animals, food, plants, and the environment (in water, soil, and air). They can spread from person to person, between people and animals, and from food of animal origin. The main drivers of antimicrobial resistance include the misuse and overuse of antimicrobials; 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.
One of the top 10 worldwide public health hazards to humanity, according to WHO, is AMR. Antimicrobial resistance’s spread threatens to undo many of the medical advances of the last century. Previously curable infectious diseases may become untreatable and spread throughout the world. This has already started to happen. A growing number of infections – such as pneumonia, tuberculosis, gonorrhea, and food-borne diseases such as salmonellosis – are becoming harder to treat as the antibiotics used to treat them become less effective. Older and cheaper antibiotics like penicillin, tetracycline, and ciprofloxacin have been effective in the past, but now all of the 82 million cases of gonorrhea detected each year are resistant to one or all of these. The last effective drug, ceftriaxone, already indicates increasing gonococcal resistance.
Antibiotic-resistant Mycobacterium tuberculosis strains are threatening progress in containing the global tuberculosis epidemic. Antimalarial drug resistance is another serious cause for concern. Parasite resistance to artemisinin – the core compound of the best available medicines to treat malaria has been reported. HIV drug resistance (HIVDR) poses the risk of compromising the effectiveness of antiretroviral therapy (ART) in reducing HIV incidence and HIV-associated morbidity and mortality.
In Nepal, national surveillance shows that around 80 percent of typhoidal salmonellae (the bacteria causing typhoid fever) is now resistant to ciprofloxacin which used to be the treatment choice for typhoid fever. Approximately half of hospital-acquired infections are multi-drug resistant.
The economic burden of AMR is substantial. In addition to death and disability, prolonged illness leads to higher medical costs due to longer hospital stays and the need for more expensive medicines. Left unchecked, in the next decade, AMR could result in a global GDP shortfall of US$ 3.4 trillion annually and push 24 million more people into extreme poverty.
The most dangerous region of the globe is probably the WHO South-East Asia Region, of which Nepal is a member. As recent history demonstrates ––given the ease and frequency with which people now travel, AMR is a global problem, requiring efforts from all nations and many sectors.
Combating the complexities of AMR requires a multisectoral One Health approach. Multiple sectors and stakeholders engaged in human, terrestrial and aquatic animal and plant health, food, and feed production, and the environment need to communicate and work together in the design and implementation of programs, policies, legislation, and research to attain better public health outcomes. Together they need to focus on:
1) Improving awareness and understanding of antimicrobial resistance through effective communication, education, and training in the appropriate use and prescription of antimicrobials in human health, animal health, and agricultural practice. It includes making antimicrobial resistance a core component of professional education, in the health, veterinary and agricultural sectors.
2) Strengthening surveillance and research across human, animal, plant, food, and environment sectors in efforts to tackle antimicrobial resistance (AMR).
3) Strengthening policies and implementation of infection prevention and control measures through effective sanitation, hygiene, and infection prevention measures. Infections can be prevented by washing hands regularly, preparing food hygienically, avoiding close contact with sick people, practicing safe sex, and keeping vaccinations up to date. Good husbandry practices, biosecurity, sanitation, hygiene, vaccination, and other infection prevention measures are essential to reduce the need for antimicrobials in animals and antimicrobial pesticides in plants.
4) Optimize the use of antimicrobial medicines in human and animal health through effective and enforceable regulation and governance for licensing, distribution, use, and quality assurance of antimicrobial medicines in human and animal health and appropriate use of antimicrobial agents in agriculture.
5) Ensure sustainable investment in countering antimicrobial resistance and increase investment in new medicines, diagnostic tools, vaccines, and other interventions.
As a WHO member state, Nepal endorsed the global action plan to tackle AMR during the 68th World Health Assembly. The same year during the WHO South East Asia Regional Committee Meeting in Timor Leste, member states passed a key resolution for steadfast political commitment and multisectoral coordination for AMR control.
The Ministry of Health and Population in Nepal has drafted a National Action Plan (NAP) to contain AMR. This plan provides the necessary framework for action.
WHO remains committed to supporting the Government of Nepal in its implementation.
Rajesh is the WHO Representative to Nepal.