We need to act fast to stop the spread of superbugs
Critical gaps in action to address the rise and spread of drug-resistant superbugs are putting recent progress in peril. Health representatives from national governments and agencies, civil society, the private sector and global philanthropies will meet in Ghana next week, to focus on ambitious action, but also warn that despite pockets of country-level innovation, international progress is stalling.
Government ministers, scientists, industry and civil society leaders are meeting in Accra, Ghana, for the second international Call to Action on antimicrobial resistance (AMR), focussed on global, coordinated action to halt the spread of superbugs. According to the World Bank, by 2030, a further 24 million people in low- and middle-income countries (LMICs) will be pushed into poverty if effective action is not taken.
Faced with the heaviest burden of disease, LMICs are leading the way using pioneering activities to tackle superbugs. Tackling AMR requires a multisector approach – referred to as One Health – due to the interconnected nature of human, animal and environmental health. Reflecting this cross-cutting nature, groups from across governments, communities and sectors have come together to develop innovative solutions aimed at reducing illness and death caused by superbugs.
Dr Jeremy Farrar, Director of Wellcome, said: "People are dying today, all around the world, because of drug-resistant infections. These infections threaten the whole of modern medicine. Surgery, safe child birth and treatment for cancer all become impossible if we cannot prevent and treat infections. We are at a pivotal moment for AMR. In some areas, we have made some progress which should be celebrated, but in many areas progress has stalled. It takes governments, industry, doctors and whole communities to help make the world safe from superbugs, and we must ensure the political momentum is there to push us further and faster towards this goal."
Interventions that have already been shown to be cost-effective at the local level will be presented at the event to inspire leaders and connect the groups to other countries where the programmes could also work. These ideas include:
An initiative in Tanzania to reduce inappropriate use of antibiotics through a network of accredited outlets called Accredited Drug Dispensing Outlets (ADDOs). Trained drug dispensers now work across Tanzania to sell appropriate antibiotics, educate people and reduce the incidence of drug-resistant infections across the country.
In India, the ‘Superheroes Against Superbugs’ initiative is spreading awareness of antibiotic resistance to young children through comics, storytelling and role play. Through workshops, the team are helping to start a better conversation about the proper use of antibiotics and encouraging children to spread these messages to their parents and the wider community.
In Ghana, the Christian Health Association (CHAG) is improving pharmaceutical service and healthcare through improved access and appropriate use of quality-assured medicines in church health systems. They are also tracking hand hygiene practices and hospital-acquired infections, and general attitudes, knowledge and practices towards AMR.
A recent report from the World Health Organization (WHO) does, however, point to progress. 93% of countries surveyed are developing or have developed a national action plan, a tool established to ensure countries are making a robust plan to address AMR, up from 85% the previous year. However, only 38% of countries have implemented this plan, and 15% of countries have no plan at all, highlighting that there is still a significant way to go if we are to turn the tide on AMR.
Kwaku Agyeman-Manu (MP), Minster for Health, Ghana, said: "Antimicrobial resistance is a developmental issue that seeks to threaten and wipe out all the majority of the gains of the Sustainable Development Goals (SDGs). Everyone must take action; big country or small country, rich or poor, because we are all at risk. Ghana is pursuing this health security threat and making sure this is followed under the One Health Agenda because it is the right thing to do, especially so when His Excellency the President of the Republic Nana Addo Dankwa Akufo-Addo is a co-advocate for the SDGs. Pursuing the Agenda 2030 by leaving no one behind becomes meaningless if we do not pay attention not just on the development of action plans, but through effective implementation of the plans and strategies for accountable governance and also keeping the momentum on antimicrobial resistance. This second Call to Action is a call for commitment and also to ensure that all the ‘voices’ are heard and their inputs also shape recommendations for monitoring strategies and activities."
The Call to Action event in Accra on November 19 and 20 is co-hosted by the government of Ghana, Thailand and the UK, along with the Wellcome Trust, World Bank and the UN Foundation in partnership with the Inter-Agency Coordination Group (IACG) on Antimicrobial Resistance It is the second time the event has been held, following the event in Berlin in 2017. Since then, much great work has been done, but progress is fragile and not where it needs to be to effectively tackle the problem of superbugs.
By May 2019, the Inter-Agency Coordination Group (IACG) on Antimicrobial Resistance will submit their report to the UN Secretary General. This includes making recommendations on how to better coordinate action across sectors and countries, as well as serving as a vehicle for building political momentum and future governance, and mobilising a broad base of stakeholders. The UN Secretary General will then report back to the UN General Assembly in 2019. When AMR was tabled at the UN General Assembly in 2016, it was only the fourth time in the history of the UN that a health topic had been discussed at the UN General Assembly, representing the severity of the issue for every country around the world.
Professor Dame Sally Davies, Chief Medical Officer for England said: "The world is fast approaching a crossroads on antimicrobial resistance (AMR). If we don’t all take sufficient action now, as nations, organisations, and individuals, we risk losing one of the greatest achievements of modern medicine — one that we all take for granted. Innovation is key to tackling AMR and there are fantastic examples of this happening in communities all around the world, some of which will be showcased at the Call to Action event. We must find a way to unite, to learn from one another and scale up these ideas to address the global threat of AMR. I call upon leaders at the second Call to Action to build upon the momentum generated and continue working towards a unified, global response."
Tim Evans, Senior Director of Health, World Bank, said: "Antimicrobial resistance (AMR) is a major threat to human and sustainable development. Gone unchecked, AMR could cost the world up to 3.8% of global GDP by 2050, eroding hard-earned gains in health, agriculture and the environment. Innovative investments now, using a One Health framework are urgently needed to turn the tide on AMR."
Kathy Calvin, United Nations Foundation, said: "We need urgent action now if we are going to help curb the devastating effects of antimicrobial resistance on the health and wellbeing of people and communities around the world. Under the framework on the Sustainable Development Goals, we have the unique opportunity to work across sectors to create systemic change to improve the health and wellbeing of the world. We look forward to seeing the regional actions and commitments from the second Call to Action conference and carrying that momentum forward through our work with the United Nations and other partners to help prevent drug-resistant infections."
Dr. Tares Krassanairawiwong, Secretary General, Food and Drug Administration, Ministry of Public Health, Thailand, said: "Translating the Plan on AMR into actions is definitely challenging, but doable – when we have passion, commitment and enduring actions."
Dr. Sorravis Thaneto, Director General, Department of Livestock Development, Ministry of Agriculture and Cooperatives, Thailand, said: "As a complex problem, AMR requires a comprehensive and unified collaboration. We will ensure that the goals of all the implementation will be accomplished."
James Duah, Deputy Executive Director, Christian Health Association of Ghana (CHAG), said: "As the situation of AMR comes to the top of issues to be addressed, we must increasingly be aware of the fundamental elements that contribute to AMR. Addressing hand hygiene and ensuring compliance to protocols could contribute immensely to reducing AMR."