Antimicrobial Resistance (AMR) Dr Ali Ahmed Yahaya, WHO-Regional Office for Africa-AFRO Brazzaville-Congo

What is AMR? AMR is a natural phenomenon accelerated by use of antimicrobial medicines. Medicines for treating infections lose effect because the microbes change Mutate Acquire genetic information from other microbes to develop resistance Types of AMR 1. Antibacterial resistance (e.g. to antibiotics) 2. Antiviral resistance (e.g. to anti-HIV medicines) 3. Antiparasitic resistance (e.g. to anti-malaria medicines) 4. Antifungal resistance (e.g. to medicines for Candidiasis) AMR in the African region

Benefits of antimicrobial medicines have been enormous Penicillin increased survival from 10% to 90% among patients with pneumonia & bacteria in their blood AMR in the African region

Resistance was foreseen early “The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily under dose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant” Alexander Fleming, Nobel Lecture, December 1945 AMR in the African region

Survey of 114 countries in all regions 2014 WHO report “Antimicrobial resistance: global report on surveillance” Survey of 114 countries in all regions 23 countries in AFR Data limitations Surveillance gaps in many countries No standard methodology But best available global & regional pictures In all regions, very high AMR levels in common bacteria to major antibiotics E coli, K pneumoniae, S aureus, S pneumoniae, N gonorrhea 3rd generation cephalosporins, fluoroquinolones, methicillin

Available National Data Available National Data* on Resistance for Nine Selected Bacteria/Antibacterial Drug Combinations, 2013 Data is Patchy High reported proportions of resistance means that treatment for severe infections, for which E. coli & k. pneumoniae are a likely cause, may need to be initiated with expensive therapy AMR in the African region

Resistance was foreseen early Extensively drug-resistant TB (XDR-TB) had been reported by 92 countries by the end of 2012 AMR in the African region

AMR – Why is it increasing? Circulation of substandard counterfeit antimicrobials Weak IPC : spread of MDR health care associated infections in health care facilities Spread and contamination of the environment (hospital wastewaters, un-completely treated urban wastewaters, untreated effluents from livestock farms or aquaculture) Antibiotics fed to animals to promote growth in some countries Antibiotic resistance is a complex problem with many drivers combating it requires a multifaceted approach AMR in the African region

Consequences Implications Projections AMR in the African region

AMR Global Action Plan (GAP) Adopted by World Health Assembly in May 2015 Technical blueprint on what to do Consolidates global scientific consensus & draws upon countries, FAO, OIE, civil society & others Reflects stepwise approach recognizing countries have different starting points, priorities AMR in the African region

Five strategic objectives Improve awareness and understanding Strengthen knowledge through surveillance & research Reduce incidence of infection (IPC\Sanitation) Optimize use of antimicrobial medicines Ensure sustainable investment 1 2 3 4 5 Next step to translate into National Action Plans AMR in the African region

Implementation GAP: Guiding Principles Realistic & achievable objectives Take into account different capacities of Member States Involve FAO and OIE, where appropriate All-inclusive approach (HIV, TB and malaria) Joint ownership between HQ and Regions Communication! AMR in the African region

Implementation GAP: 10 work streams (HQ & AFRO) Global communications campaign Support National Action Plans of MS Global Antimicrobial Resistance Surv System Support measures to improve IPC Monitor use & enhance stewardship of antibiotic use Encourage R and D and explore new business models Improve Point of Care diagnostics Address the Environmental Drivers Vaccines to prevent AMR One Health Liaison AFRO inter-clusters/programms Workforce. AMR in the African region

AFRO major achievements 9 countries trained on the development of AMR-National Action Plan using “One Health Approach”. Epidemiologists and laboratory scientists from national institutions representing food, animal and human health sectors from the 13 countries participated in the Global Antimicrobial Resistance Surveillance System (GLASS) training. 12 countries participated in the training workshop on methodology for monitoring antimicrobial consumption. AMR in the African region

Major issues and challenges Lack of a national comprehensive policy and plan (NAP) to address AMR Lack of inter-sectorial approach to fight AMR Weak medicines regulatory capacity and circulation of substandard/counterfeit antimicrobials Medicines supply and distribution systems in most countries of the Region are fragmented and weak Weak Infection Prevention and Control (IPC) AMR in the African region

Conclusion AMR now an urgent, global, Large problems, societal threat– e.g., climate change — require whole-of-society engagement & strategies & solution commensurate with scope Adopting & acting upon a broader concept of AMR is essential to achieving such an approach & sustainably reversing AMR Opportunities for existing and new initiatives: IDSR, IHR JEE, One Health approach, etc. Key developments are underway but world is in a race against time Each major aspect is solvable Did we start on time? No Are we responding too late? Not if action is taken THANK YOU AMR in the African region