Why is AMR considered a global health crisis?
MH: AMR is present in all parts of the world with the potential to affect anyone of any age. Due to AMR, an increasing number of bacterial infections, such as pneumonia and tuberculosis, are becoming harder to treat as the pathogens causing these infections become resistant to regular antibiotic treatment. This leads to longer hospital stays, higher medical costs, and more deaths. Unless we take urgent action, AMR could cause an estimated 10 million deaths every year by 2050, making it one of today’s major threats to global health as well as to food security and development.
Why is there so little data on the regional and global prevalence of AMR?
SS: Today, due to substantial investments in surveillance capacity-building by the Fleming Fund and others, large quantities of data are being generated on AMR across low- and middle-income countries. However, to meaningfully translate any of this AMR (or antimicrobial use and consumption) data into reliable estimates of: the prevalence of AMR, the mortality and morbidity attributable to AMR, the speed or rate of emergence and spread of AMR, and the effectiveness of policies and actions, all the data must be quality-assured, and this is what is in short supply.
Why is AMR a particular challenge in low- and middle-income countries?
MH: LMICs have a higher burden of infectious diseases, largely due to limitations in health and sanitation infrastructure, as well as a higher dependence on antibiotic use in agriculture and food production. With higher disease prevalence comes higher antibiotic use or misuse, which can lead to resistant bacteria—or, “superbugs.” At the same time, limited financial resources and technical capacity make it difficult to conduct AMR surveillance in these countries. So, in addition to tackling the spread of AMR, working on developing sustainable solutions to track and understand its impact is crucial.
What does AMR stewardship look like?
SS: Conserving the efficacy of the current set of available antimicrobials, till new drugs are developed, is a key policy option for responding to AMR. In the context of human health, antimicrobial stewardship (AMS) is a potentially powerful strategy, and generally best implemented in hospital settings. Hospital clinicians work in close consultation and collaboration with the microbiology lab team and a designated antimicrobial steward (usually a senior and experienced clinician). The overall goals of any AMS initiative are to:
- work with health care practitioners to help each patient receive the most appropriate antimicrobial with the correct dose and duration
- prevent antimicrobial overuse, misuse, and abuse
- minimize the development of resistance
How do vaccines help contain the spread of AMR?
MH: Vaccines reduce the use, and subsequently, mis-use, of antibiotics by preventing infection in the first place. As we have seen with the uptake of Haemophilus influenza B and Streptococcus pneumoniae vaccines, vaccination has been associated with decreased incidence of resistant bacterial strains. Preventing infection is always preferable to treating it, making vaccines a critical first line of defense to staying healthy and reducing the spread of AMR.