A qualitative global analysis of changing patterns in antimicrobial resistance and the insidious nature of the emerging sinister threats of resistance in HIV, Malaria, and Typhoid

Abstract

The first antibiotic was used 80 years ago. Research on antibiotics is an ongoing process with continuous learning of their effectiveness and efficiency in human and animal healthcare systems. A silent and insidious phenomenon that has escaped popular consciousness and discussions on which are limited to academia and the rarefied realms of professional bodies is Antimicrobial Resistance (AMR). This development has significant catastrophic potential and is not being given the political attention that it deserves, despite already having reached epidemic proportions. To the lay person, it is largely invisible. There have been 2 significant initiatives from global leaders to address the issue. The World Health Organization (WHO), Food and Agriculture Organization, and Organization for Animal Health tabled a Global Action Plan which outlined the grave situation. The call from the United Nations general assembly in 2016 gave further clarity to the urgency of the matter. There was a recognition of the need for proactiveness and ownership from all governments. Some governments have drawn up action plans for AMR with fiscal allocations. These efforts are outnumbered by governments that have not done enough for in the initiative against AMR. The principal difficulty to be surmounted in AMR is the multisectorial nature of the phenomenon. AMR exists at the intersection of human health, animal health and environmental health. The One Health approach has not seen adequate uptake, rendering it limited to the category of a concept and not a practice with significant impact in managing epidemiological risk. The requirement for antibiotics in both humans and animals can be curtailed through the effective implementation of a three pronged approach that includes clean potable water and sanitation, reduction in incidence and prevalence of infections and enhanced vaccination coverage. Of critical importance will be to challenge and change the twin narratives of antibiotics being a cheap tool to combat illness and there being no unpleasant impact on populations. This will require strong ownership from government and regulatory bodies. Without laws to tackle this growing problem, AMR control will remain a pipe dream.