Awareness On Antimicrobial Resistance

Antimicrobial resistance (AMR) is increasingly considered a global crisis that must be managed. It is one of the greatest threats to public health and food security.  AMR occurs when bacteria, viruses, fungi, and parasites no longer respond to antimicrobial medicines. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective, and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability, and death.

The World AMR Awareness Week (WAAW) is celebrated from 18 to 24 November every year. With the theme ‘Educate, Advocate, Act Now’, this global campaign aims to raise awareness and understanding of AMR among key stakeholders, including youths, and consequently reduce the emergence and spread of drug-resistant infections.

Unfortunately, the mortality data of AMR is alarming. According to WHO, it is estimated that bacterial AMR was directly responsible for 1.27 million global deaths in 2019 and contributed to 4.95 million deaths. While AMR affects countries across the regions, its drivers and consequences are exacerbated by poverty and inequality.

Undoubtedly, low- and middle-income countries are most affected. Again, misuse and overuse of antimicrobials in humans, animals, and plants are the main drivers in the development of drug-resistant pathogens. Among many others, tuberculosis (TB) is a major contributor to antimicrobial resistance. Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to isoniazid and rifampicin, the two most effective first-line TB drugs.

The evidence suggests that AMR has adverse impacts on health systems and national economies. Understandably, this demands more expensive and intensive care, extended hospital stays, prolonged loss of income, constant medication, pressure on caretakers, family loss, and grief.

Apart from this, people in low-income countries have limited access to clean water, sanitation, and hygiene (WASH) for both humans and animals and lack infection and disease prevention and control interventions. Similarly, poor access to quality and affordable vaccines, diagnostics, and medicines is critical. 

In addition, there is still a lack of awareness about AMR and its serious implications for human health. Again, there is slow progress regarding enforcement of relevant legislation and policy frameworks so far.

Antibiotics are one of the most commonly used groups of medicines globally. Tackling the growing challenges of AMR demands coordinated actions in the human health, food production, animal, and environmental sectors. In this context, One Health refers to an integrated, unifying approach that aims to achieve optimal and sustainable health outcomes for people, animals, and ecosystems. The approach brings together stakeholders from relevant sectors to prevent, control, and mitigate the adverse impacts of AMR for better health and socio-economic outcomes. 

Despite significant efforts in responding to AMR, progress is minimal. First and foremost, there is inadequate monitoring and reporting at all levels. 

Like many other countries, Nepal has developed a national action plan on AMR (2024-2028) in close consultations with key stakeholders that primarily seeks to improve community awareness and understanding of AMR through effective communication, education, and training.

 Moving on, implementation of the NAP-AMR is a high-priority agenda item for governments, technical partners, health care providers, the private sector, and civil society. 

“This ambitious plan offers opportunities for us to invest more in strengthening laboratory capacity for AMR surveillance, analysis, and reporting of data at all levels. But we need more trained human resources and good health infrastructure to ensure AMR sites have robust surveillance and monitoring systems.” says Usha Tandukar, Senior Drug Administrator at the Ministry of Health and Population. 

 Again, the priority now is to scale up and sustain the progress in strengthening AMR surveillance systems. “We need more resources to enhance the capacity of the laboratories, strengthen awareness and advocacy, facilitate robust monitoring and reporting systems, and widen the dissemination of data across stakeholders for concerted actions,” says Dr. Ranjan Raj Bhatta, Director at the National Public Health Laboratory. 

Other strategic priorities include strengthening the knowledge and evidence related to AMR through surveillance and research and reducing the incidence of infection through effective infection prevention and control. In addition, the plan also seeks to optimise the use of antimicrobial agents in the human, animal, and food sectors and ensure sustainable resources for the containment of AMR.

 “At the AMR multi-sector steering committee, the sharing of AMR surveillance data across human, animal, food, and environment sectors is a high priority agenda for increased understanding of issues to initiate joint actions. However, there is an emerging need to strengthen the institutional capacity of laboratories for surveillance and reporting systems at the province level,” says Dr. Barun Kumar Sharma, Chief at Central Veterinary Laboratory. 

In Nepal, technical partners such as WHO, Fleming Fund/FHI 360, FAO, and a few others are supporting governments to enhance their capacity in the area of health system strengthening for AMR surveillance data, interdisciplinary research, and use of evidence to inform policies and strategic actions. “With the support from Fleming Fund/FHI 360, the laboratory capacity has now significantly improved. Moreover, strengthening AMR surveillance systems, reporting, and use of the data have been useful to inform policy and practice,” says Jyoti Acharya, Chief, Medical Laboratory at Bir Hospital. 

On the other hand, social and anthropological perspectives are vital for a holistic understanding of AMR and identifying sustained local responses. Moreover, looking at the ways in which antimicrobials are embedded in societies provides new insights around people’s perceptions, beliefs, and experiences using antimicrobials. The priority is to identify pragmatic ways to increase access to and rational use of medicines to maintain health.

Thus, social and interdisciplinary research is crucial for innovative and insightful solutions to realistically address the growing impacts of AMR. The anthropological focus is largely related to interpreting the role antibiotics have in health and healthcare, looking at the range of places and spaces in which these medicines enable particular forms of life and social worlds. In addition, it broadly seeks to explore the use of medicines and the meanings of medicines for patients, prescribers, and providers.

Moreover, interdisciplinary research, including ethnographic fieldwork, not only provides knowledge and enriched evidence of local realities but also a deeper analysis of the differential effects of AMR on people and communities within and across societies. 

The political economy of AMR is instrumental in exploring the social, cultural, economic, and political dimensions of AMR in a larger context. Hopefully these evidences and holistic perspectives are optimally used to inform policies and practices for harnessing health ecosystems at large.

(Bhandari is a health policy analyst and has an interest in anthropology.)