The AMR hazard
LAST month, the antimicrobial resistance agenda received a significant policy and research boost. At a high-level UN General Assembly meeting on AMR, member states pledged to double down on AMR containment efforts with guarantees and increased funding. The meeting, eight years after the first one in 2016, provided a political push to a coordinated global response to the agenda.
AMR, a multifaceted global threat, is affecting humans, animals, the environment, agriculture and food. Its wider effects are discernible in higher mortality rates, additional expenditure for health systems, compromised health gains from surgical procedures due to infections, economic losses, low productivity and rising poverty caused by the exorbitant healthcare costs associated with AMR. A credible estimate predicts that 28 million could become poor due to the high rates of AMR; of those affected, 26m are likely to live in low-income countries.
These figures, along with a study published in The Lancet in mid-September, present a grim picture: the study estimated 1.91m deaths, which can be attributed to AMR, and 8.22m deaths associated with AMR by 2050. The report shows South Asia, Latin America and the Caribbean as the worst-hit regions. The research also shows an over 50 per cent decrease in AMR-related deaths among under five-year-olds.
At the other end, mortalities rose by over 80pc in the over 70-year-old age bracket. The study forecasts 39m deaths from AMR between 2025 to 2050. The latest estimates are far higher than the original estimate of 10m deaths by 2050, which was predicted in the Review on Antimicrobial Resistance in 2014. The new statistics should force us to take notice of the magnitude of the AMR threat — the report identifies South Asia as the hotspot.
The authorities must strategise to tackle antimicrobial resistance.
An earlier study conducted by the US- based Institute for Health Metrics and Evaluation showed that in Pakistan there were 59,200 deaths directly attributable to AMR with 221,300 deaths linked with AMR in 2019. In South Asia, new AMR mortality-related figures for Pakistan are likely to be higher than in other regional countries.
The two aspects of AMR devastation must prompt the authorities to strategise and implement measures on a war footing to reduce the scale of the rapidly growing AMR crisis.
The aforementioned meeting did indicate that there is an existing global alignment around AMR as evidenced in the adoption of the political declaration. The declaration, which was the most significant outcome of the high-level gathering, lays tremendous emphasis on framing and implementing national action plans on AMR.
Most countries have formed their plans in line with the World Health Organisation’s global action plans and many are in the NAP revision process, including Pakistan. Yet implementation challenges have so far been exacerbated by funding shortfalls and the lack of sustained political will. However, with the adoption of the political declaration, political will and funding pledges seem to have aligned well. The declaration also sets a target of 60pc of the national action plans being funded and evaluated by 2030, along with the intention to update the global action plan by 2026.
Moreover, the head of the Global Leaders Group on Antimicrobial Resistance, Barbados Prime Minister Mia Amor Mottley launched a funding appeal of $100m for the national action plans. The political declaration also sets the target of a 10pc reduction in AMR-related deaths by 2030. More importantly, given the intertwined nature of the AMR threat, a multisectoral and collaborative approach under the umbrella of One Health, steered by the Quadripartite arrangement, has been re-inforced. The co-mbined One Hea-lth work will be further accelerated and coordinated through a collaborative ap-proach and incre-ased funding ap-propriation.
As Pakistan is likely to be one of the worst affected countries in the South Asian region, the AMR threat is a real and present danger, which has been growing imperceptibly over many decades. Against this bleak backdrop, there is an urgent need for sharper focus on AMR control and containment programmes through accelerated and consistent political commitment and enhanced funding. This assumes special significance in light of the new research, which presents an escalated level of the AMR threat, as well as the political declaration, which puts political weight behind containment and control measures.
Therefore, the need for urgent action cannot be underestimated. The revised national action plan forms the foundation for incentivised, speedy planning on AMR with political resolve and dedicated resources.
The writer, a public health and policy consultant, is the author of Patient Pakistan: Reforming and Fixing Healthcare for All in the 21st Century.
X: @arifazad5
Published in Dawn, October 8th, 2024