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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Consequences Implications Projections
AMR in the African region

10. 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

11. 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

12. 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

13. 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

14. 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 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

15. 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

16. 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