AMR: Brewing silent pandemic

• NCDC, researchers, doctors raise alarm over growing cases of antimicrobial resistance

From Fred Ezeh, Abuja

The Nigeria Centre for Disease Control (NCDC), Guild of Medical Laboratory Directors (GMLD), medical doctors, researchers from Veterinary Research Institute, Vom, Jos, Plateau State, and others have raised the alarm over the growing cases of antimicrobial resistance (AMR) in the health care delivery space. Sadly, poor or insufficient attention is being given to the issue.

They said the experience is increasingly becoming worrisome and threat to quality healthcare service delivery. Considering its dynamics and rising cases, stakeholders described AMR as the growing silent “pandemic” that requires urgent and global attention to avoid catastrophic public health emergencies.

Reference was, however, made to available information indicating that, while many people are unaware or have less information about the ARM challenges, the voice of those who are championing the cause are not loud enough to drive the message to various locations particularly the rural communities.

Also, there seems to be little efforts or commitment from the Federal Government and its agencies in terms of policy implementation, financial support, logistic, and otherwise, regarding the fight against the AMR, hence the campaign by some health experts on the growing challenges, and the need for urgent action against the challenges.

To amplify the campaign, the UKAid through the Fleming Fund Country Grant AMR Phase II Project being implemented by the Management Science Health (MSH), organised a capacity building workshop for media professionals and some community-based organisations in Lagos.

At the meeting, several experts on AMR made submissions highlighting the need for a strong and result-oriented campaign and collaboration with relevant individuals and groups to champion the campaign against rising cases of AMR.

It was highlighted that there are 4.95 million annual deaths associated with global AMR cases, and the death is expected to double to 10 million a year by 2050. It was also noted that Nigeria ranked 19th highest with AMR-related mortality out of 204 countries surveyed with 263,400 deaths associated with AMR and 64,500 deaths directly attributed to AMR.

It was also projected that the global economy currently loses about $100 trillion to AMR, and it might lead to 3.8 per cent reduction in global GDP and 3.8 per cent reduction in livestock numbers by 2050.

AMR situation in Nigeria

The situation of AMR in Nigeria is scary, requires urgent action from the government, and works with the private sector to tackle the growing challenges of AMR to the health sector. Sadly, the current AMR policy being implemented is silent on private sector participation in AMR response in Nigeria.

Meanwhile, a case of AMR occur when bacteria, viruses, fungi, and parasites develop the ability to resist the drugs such as antibiotics, antivirals, and antifungals designed to kill them This means that infections caused by these resistant microbes become harder and sometimes impossible to treat.

In this case, bacteria develop strong mechanisms to evade the effects of antibiotics; viruses develop mutations that make them less susceptible to antiviral medications; and also fungi develop mechanisms to resist antifungal medications.

This is increasingly becoming a threat to healthcare service delivery in Nigeria and even beyond. Research indicated that AMR has gone beyond human, and it’s being experienced in animals, hence the development of One Health Approach to respond to the AMR cases in humans, animals, and even the environment.

Causes of AMR have also been reviewed, and top on the findings are the increasing cases of overuse and misuse of antimicrobial medications, poor infection control practices, lack of new antimicrobial medication development, genetic mutation and adaptation of microorganisms, among several others.

NCDC said that AMR has grown in prominence to compromise treatments for almost all human and animal diseases caused by bacteria, parasites, viruses, and fungi, adding that the most vulnerable patients bear the brunt of the impact, as AMR increases treatment costs and can also prolong illness, worsen disability and increase mortality. However, the precise magnitude of AMR and its true impact on health care delivery and its costs are still largely unknown.

Dangers ahead

Information obtained from the Federal Ministry of Health indicated that the situation is becoming more scary and worrisome and requires urgent attention from all relevant organisations.

It noted that for the past few years, the threat from AMR has continued to grow and compromise effective treatment of infections to an ever increasing range of bacteria, parasites, viruses, and fungi.

AMR has resulted in reduced efficacy of medicines, making the treatment of infections expensive, difficult, or even impossible. This impact is particularly felt by vulnerable patients, who may be unable to bear the associated higher costs or worsened illness, ultimately resulting in greater disability and increased mortality.

Globally, the magnitude of the problem, its effect on animal and human health, and its impact on economies seems to be poorly documented. However, estimates record an untenably high burden that might largely be borne by low-income countries like Nigeria.

World Health Organisation (WHO) has challenged member states to effectively participate in an integrated global programme for the control of AMR. This, they could do by developing Action Plan to ensure continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way, and accessible to all.

It also suggested that the action plan should also target efforts to reduce, prevent, and slow the evolution of resistant organisms and their impact on health care, while ensuring optimal use and improved access to effective, safe, and quality-assured antimicrobials for continued successful management of infections.

Experts’ suggestions

The experts stated that many Nigerians are complaining that they have been treating common diseases like malaria or typhoid more often in recent times, and they might not know that they have become resistant to antibiotics because of previous abuse.

They said that many Nigerians have formed the habit of walking into a pharmacy to purchase drugs that ought to be purchased under a doctor’s prescription because of the weak system in Nigeria.

“Doing this over time is an invitation to AMR, and we are seeing that now more among the people. Many of them insist they are doing the right thing, perhaps, because the previous attempt worked, but they are unaware of the long-term damage being done on their health.”

Head, Department of Medical Microbiology and Parasitology, University of Port Harcourt Teaching Hospital (UPTH), Dr. Mary Alex-Wele, in her submission noted that AMR require massive advocacy that will be loud for a very long time, to enable the information penetrate deeper into the society, particularly the rural communities.

She added: “Understanding and addressing AMR starts with personal responsibility. This means staying informed, questioning misconceptions, and recognizing the one’s role in shaping public discourse.”

She advocated that media platforms, social and conventional, should be used to amplify the voices of experts and experiences of those affected. “Most importantly, we should discourage easy access to some kinds of drugs, particularly the antibiotics, as well as self-medication.

“We are experiencing some of these issues because the monitoring systems are weak. Ideally, no one should access antibiotics at any pharmacy or patent medicine stores without doctor’s prescription, but that’s not the case in many locations because people have prioritized financial gains to human health.

“Ignorance is another great challenge in responding to the challenges of AMR. Many people are unknowingly inviting long-term health challenges by the misuse or misapplication of drugs, particularly the antibiotics. Gradually, they develop AMR because of the wrong application or usage of drugs,” she said.

She thus suggested regular training and monitoring of drug dispensing agents by relevant government individuals and departments to constantly educate them on new developments as regards AMR and other things.

Director of Research, National Veterinary Research Institute, Jos, Dr. Sati Ngulukun, said the unchecked usage of antimicrobial medications in animals is increasingly having serious effects on humans and the environments who often consume or interact with the animals, respectively.

“It shouldn’t be easy for people to walk into the pharmacy or drug store and buy antibiotics. Ideally, antibiotics is not an over the counter drug, whether it’s for animals or for humans. Antibiotics should only be used when they are prescribed by a doctor, whether a human doctor or an animal doctor. So, once the regulations are enforced, it will reduce the indiscriminate use of antimicrobials.”

GMLD President, Dr. Samuel Fele suggested a strong and deeper involvement of private hospitals and specialist clinics in combating AMR, which could be done through antimicrobial stewardship programmes, infection control measures, education, collaboration, and policy advocacy.

He said that private medical laboratories, pharmacists, local patent medicine stores, if properly educated and enlightened, could play vital role in combating AMR through accurate diagnostics, antimicrobial susceptibility testing, surveillance, data sharing, and collaboration with public health systems, insisting that their contributions are essential in ensuring appropriate antibiotic use and reducing the spread of resistant infections.

He also suggested that being a vital part of AMR response, the private sector should be more involved in research on AMR trends and mitigation strategies. “There should be sustained advocacy across the levels so that more people can be aware of the challenges.

“The media professionals are also key to any success that would be achieved. To this end, there should be constant engagement with the media for the purposes of providing updates, information, and other expertise they might require to educate their audience/readers.”

What the government is doing

In response to the growing cases of AMR, the Federal Ministry of Health created the National AMR Technical Working Group (AMR-TWG) comprising stakeholders from human health, animal health, food animal production and environment sectors tasked with conducting a situation analysis of AMR in Nigeria and designing a National Action Plan for AMR containment in the country.

The first National Action Plan (NAP 1.0: 2017 to 2022) was developed, and recently, it was reviewed, resulting in the development of NAP 2.0 (2024 to 2028) currently being used to respond to AMR.

Nigeria’s National Action Plan on AMR (NAP 2.0 2024) outlines strategies to strengthen leadership, collaboration and governance structure; strengthen awareness and education; strengthen AMR surveillance systems; regulate antibiotic use in hospitals, farms, and pharmacies; and improve infection prevention and control, and biosecurity measures, as well as strengthen research and development

This Action Plan details objectives derived from analyzing the strengths, weaknesses, threats, and opportunities of the National AMR situation and making recommendations based on the objectives of the Global Action Plan on AMR.

The goal of wss to reduce, prevent and slow the evolution of resistant organisms and their impact on health care while ensuring optimal use and improved access to effective, safe and quality-assured antimicrobials for continued successful management of infections.