Misuse of Medicines Making Infections Difficult to Treat
By Joyce Ojanji
“In 2004, I was 25 years old. I had a severe car accident in Johannesburg, South Africa, and ended up in a hospital with a lot of massive injuries. I had been resuscitated on the side of the road, I was put on life support, I had multiple fractures in my face- a broken jaw and a broken nose- and also lost one eye,’’ said Vanessa, an antimicrobial-resistance (AMR) survivor, Chairperson of the World Health Organization (WHO) Taskforce of AMR Survivors.
“I also had a head injury, major abdominal injury, fractured pelvis, neck, and back injury. But the most complicated injuries were to my face, and it took me 10 years to recover from them, during which time I have had 4 different facial prosthetic implants,” said Vanessa.
Six years into the accident and after her fourth implant, one day, while getting into her car, Vanessa saw moisture seeping all over her face. It was pus oozing out from her fourth implanted prosthetic.
She underwent emergency surgery, and the doctors did “debridement” and reconstructive surgery to fix up the damaged tissue. Two weeks later, the infection returned. She got more tissue reconstruction done. But the infection kept on returning and it worsened over time. This went on for the next 11 months during which she was kept under the care of several specialist surgeons.
She was eventually diagnosed with a highly antibiotic-resistant form of Methicillin-resistant Staphylococcus aureus (MRSA) infection. She could not undergo any more surgeries for one year, as the doctors had to wait for the tissue to recover.
“AMR is a problem driven by misuse and overuse of antimicrobial medicines, including antibiotics and antivirals, and results in critical medicines losing effectiveness to treat infections,” said Thomas Joseph, Head, AMR Awareness, Advocacy and Campaigns, WHO, at a recent pre-conference meet of 22nd International Conference on AIDS and STIs in Africa (ICASA).
He added that AMR is associated with five million deaths a year. Besides this, there is a huge burden of morbidity and healthcare expenditure that can affect household welfare severely. The World Bank estimates that Global GDP could fall by $1 to $3.4 trillion annually after 2030 due to AMR and an additional 24 million people would be forced into extreme poverty by 2030 if no action is taken on AMR today.
Drawing attention to World AMR Awareness Week (WAAW) which is celebrated between 18-24 November every year with this year’s theme being Preventing AMR Together, Joseph called on all stakeholders to realize that “if we do not act now, we could go back to a pre-antibiotic era, when even simple infections become untreatable.”
According to him, research and development of new treatment options, including new antibiotics, are not prioritized due to a sector-wide market failure. As a result, the world is running out of treatment options and new drugs are not coming into the market. Even when new medicines finally reach the market, low- and middle-income countries are not able to access them due to intellectual property and pricing constraints.
He observed that antimicrobials should be regarded as global public goods and urged governments to strengthen their health systems and push for universal health coverage so that everybody has access to the needed antimicrobials prescribed by registered healthcare providers.
When it comes to addressing AMR, mere information is not enough and therefore to bridge that knowledge-action gap, quadripartite agencies of the Food and Agriculture Organization of the United Nations (FAO) United Nations Environment Programme (UNEP), World Health Organization (WHO) and World Organisation for Animal Health (WOAH) have united to advance progress on One Health approach in addressing challenges such as AMR.
As per WHO, One Health is an integrated unifying approach to sustainably balance and optimize the health of people, animals and our environment. By linking humans, animals and the environment, One Health can help to address the full spectrum of disease control and contribute to global health security.
“The health of humans, animals, (domestic and wild), plants and our environment are closely interlinked and interdependent. This means that whatever happens to one of them, the others will be inevitably affected and impacted for better or for worse and we cannot ignore one at the cost of another,’’ said Javier Yugueros-Marcos, Head of the Department of Antimicrobial Resistance & Veterinary Products at World Organization for Animal Health (WOAH).
To further accelerate the response to AMR, Beatrice Atim Odwong Anywar, Uganda’s Minister of State for Environment, and Member of the Global Leaders Group on AMR said that world leaders at next year’s UN General Assembly will be convening a United Nations High-Level Meeting on AMR.
“Out of the five million AMR-related human deaths that occur every year, most of them are happening in low- and middle-income countries. These are the countries where the burden of diseases is also higher. That is why Uganda is spearheading action against AMR across sectors such as human health, animal health, food and agriculture, and the environment,” added Minister Anywar.