Covid-19 lessons for the fight against Antimicrobial Resistance

Infezioni 25 febbraio

Covid-19 pandemic has proved to be a severe moment of truth for health systems around the world. In some places, it has exposed weaknesses and gaps—shortages of critical supplies, underinvestment in public health infrastructure, and a lack of coordination and agility among policymakers, political authorities, and health care leaders—which have led to overwhelmed health systems, rapid growth in cases, and high mortality. We believe that all health systems should learn a lot from this pandemic about the way that national health systems should fight any disease and manage the overall population health of their citizens. Since globalization has contributed to the quick spread of the Covid-19 around the world, countries have been tempted to retreat into narrow national strategies for fighting it. However, it would be an enormous mistake. What Covid-19 has taught is the need for an equivalent globalization of scientific, medical, and public health efforts informed by a shared purpose and goals, as well as wider cooperation to counter this and future pandemics. The world needs to create a shared global heath system to identify and spread innovative approaches for combatting pandemics. Particularly, the health systems should facilitate the widespread sharing of information and evidence about the specific interventions used. Different health systems will inevitably take slightly different approaches to fighting the diseases, but if health systems around the world join together, it will be easier to quickly identify and disseminate the best approaches for prevention, containment, mitigation, and treatment. In many cases, the practices that have been proved most effective in the fight against Covid-19 are the same ones that should be used to treat any major health condition. This may be particularly true for antimicrobial resistance (AMR). Like Covid-19, AMR is also a global threat — potentially  a still greater one. Based on broad estimates, deaths from antimicrobial resistant infections are projected to increase from current toll of 700,000 to 10 million every year by 2050. Like Covid-19, AMR can affect us all. It does not care who we are, or where we are: everyone is at risk. AMR has emerged as one of the principal public health problems of the 21st century that threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi no longer susceptible to the common antimicrobial agents used to treat them. The problem of AMR is especially urgent regarding antibiotic resistance in bacteria. Antibiotics played an unprecedented role in social and medical development, and at present, antibiotics are obligatory in all health care systems. The success of modernized medicine, namely organ transplantation, cancer therapy, management of preterm babies, or a surplus of advanced major surgeries, might not have been possible without effective antibiotic treatment to control for bacterial infections. AMR develops across the animal, human, and environment triangle or niche and there is interlinked sharing of these pathogens in this triad. The plausible causes of AMR include overuse and misuse use of antibiotics in animals (food, pets, aquatic) and humans, antibiotics sold over-the-counter, increased international travel, poor sanitation/hygiene, and release of nonmetabolized antibiotics or their residues into the environment through manure/feces. These factors contribute to a selection pressure for the emergence of AMR in the community. AMR shows no signs of decline, though it may perhaps shift direction. The etiology of AMR is multifaceted, and its consequences pose an impact across the globe. The World Health Organization (WHO) is now leading a global effort to address antimicrobial resistance. At the 68th World Health Assembly in May 2015, the World Health Assembly endorsed a global action plan to tackle antimicrobial resistance. It sets out five strategic objectives:

  • to improve awareness and understanding of antimicrobial resistance;
  • to strengthen knowledge through surveillance and research;
  • to reduce the incidence of infection;
  • to optimize the use of antimicrobial agents; and
  • to develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.

Actions against resistance should focus firstly on local needs and plans because each country is different. However resistance is everyone’s problem and all countries have a role in solving the problem. The countries that have crafted inclusive national plans have been successful in controlling AMR. These approaches include cautious use of antibiotics, surveillance of antibiotics by employing the “One Health Approach,” advancement of health care setup, restricted drug promotion, consistent disease control strategies, and stewardship plans. On the other hand, these strategies demand patience and time to be organized. Furthermore, these require a comprehensive endorsement from the government authorities with ample funds. However, AMR poses a global challenge. No single country, however effective it is at containing resistance within its boundaries, can protect itself from the importation of AMR through travel and trade. Working alone is not sufficient and international partnerships to seek global solutions to tackle AMR are mandatory. By collaborating there are opportunities for disseminating the best approaches for prevention and management. The global nature of AMR calls for a global response, both in the geographic sense and across the whole range of sectors involved. Nobody is exempt from the problem, nor from playing a role in the solution. This means wider engagement the wider, healthcare workers, vets, farmers around the world. AMR is universal, affecting anyone and everyone, at any age and in any country and misuse is worsening the situation globally. Urgent action is needed. Public health education and changes in behaviour are critical as we begin to enter a post-antibiotic era where the simplest of infections will kill, as we only know too well with Covid-19. The current pandemic shows that despite all of our medical advances, we remain incredibly vulnerable to infections for which we have no therapies. However, it shows that if sufficiently motivated, we can make huge changes in short timeframes.

We hope that Covid-19 is a learning experience. We hope that the global response to the Covid-19 pandemic provides the perfect opportunity to strengthen health systems in a way that can both tackle the current pandemic and limit the spread of AMR over the long term.