The African Union crafts a continental position on AMR ahead of UNGA

The African continent has galvanized to outline its priority list for tackling antimicrobial resistance, or AMR, ahead of this month's high-level meeting on the issue at the United Nations General Assembly. AMR happens when antimicrobials, such as antibiotics, are no longer effective against bacteria, viruses, fungi, and parasites. This growing problem jeopardizes advances in modern medicine, such as treating infectious diseases and performing complex surgeries. “If AMR spreads unchecked, many infectious diseases will become untreatable, reversing a century of progress in medical practices,” according to a new report which was authored by the Africa Centers for Disease Control and Prevention and the African Union’s InterAfrican Bureau for Animal Resources. The authors have dubbed it a “landmark” report, and published it in the lead-up to the U.N. meeting this month where experts are urging world leaders to commit to reducing AMR mortality by 10%, inappropriate human antibiotic use by 20%, and inappropriate animal antibiotic use by 30% — by 2030. The report aims to encapsulate “Africa’s aspirations, achievements, challenges, and solutions in combating antimicrobial resistance.” An estimated $2 billion to $6 billion is needed each year to address this issue in Africa, yet the estimated annual budget for AMR national action plans for countries across the continent is around $100 million. But this larger investment will pay off, according to the authors. For example, investing in water, sanitation, hygiene, and infection prevention efforts could avert up to 20% of AMR-linked deaths in Africa each year. “If left unaddressed, AMR will drive much of Africa into extreme poverty and cause significant annual losses in Gross Domestic Product,” the report said. Deaths from antimicrobial resistance are already surpassing those from malaria, HIV, and tuberculosis in Africa, according to the report. And by 2050, as the African population is expected to double, AMR-associated deaths could rise to 4.1 million annually. While the root causes on the continent are multilayered, AMR is largely caused by overuse and misuse of antibiotics for humans and in food systems, such as raising poultry, low vaccination rates which allow unnecessary infections to spread, waste from hospital and pharmaceutical operations that infiltrate the surrounding environment with antimicrobials, and migration, which allows for resistant strains of pathogens to spread across the continent. Inadequate levels of local manufacturing also play a role. Many African countries rely on imports for over 90% of their pharmaceutical needs, resulting in shortages and stockouts. “The pervasive lack of access to common antibiotics, has led to an over-reliance on a few available drugs, even when they are not the primary choice for treatment,” according to the report. For example, the scarcity of amoxicillin, which is crucial for pediatric patients, often results in children receiving drugs for infections that aren’t effective, or no treatment at all, and this can lead to severe situations like sepsis. And regulatory hurdles also play a role. The registration process for some antibiotics can take up to two years in many countries, which can then discourage companies from entering the market. Unsanitary conditions and inadequate infection prevention measures also fuel its spread. One in 3 hospitals in Africa lack clean running water, according to the report. There is also inadequate data around the issue. The report cited a survey that looked at 371 laboratories in 14 African countries and only 1.3% performed analysis of bacteria that are deemed high priority due to drug resistance. Most African countries have a national plan for tackling AMR, but progress has been mixed around implementation — some have initiated activities and others are yet to start implementation. “The adoption and implementation of AMR interventions in Africa have been limited due to misalignment of priorities, lack of resources, and inadequate coordination,” according to the report. The AU has a Framework for Antimicrobial Resistance Control that runs between 2020 and the end of next year. There is also an AU task force on the issue, and a collaborative initiative involving the AU, the Food and Agriculture Organization, the United Nations Environmental Programme, the World Health Organization, and the World Organisation for Animal Health. In crafting this report, Africa CDC and AU-IBAR consulted with a series of experts in public health, microbiology, and veterinary medicine to form an African perspective on the issue. This is aimed at equipping African health ministers to properly represent the continent’s priorities on the issue in the coming weeks at UNGA. “These discussions were aimed at developing a cohesive narrative that reflected Africa’s unique challenges and proposed solutions, ensuring that the continent’s voice is unified and impactful on the global stage,” the report said. Priorities include strengthening governance, addressing root causes, building an evidence base, improving reporting mechanisms, mobilizing and coordinating resources, strengthening community engagement, and enhancing research and innovation.