One Health Action to Prevent Antimicrobial Resistance

By Dr Poonam Khetrapal Singh

There is urgent need for sustained multispectral action to prevent and contain antimicrobial resistance (AMR), which occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines, making infections harder to treat and increasing the risk of disease spread, severe illness and death.

New global estimates show that in 2019, nearly 5 million human deaths worldwide were associated with bacterial AMR, of which 1.3 million human deaths were directly attributable to bacterial AMR. In a high-impact scenario, AMR will reduce global annual GDP by 3.8% by 2050. If left unchecked, in the next decade, it could result in a GDP shortfall of US$ 3.4 trillion annually, pushing 24 million more people into extreme poverty.

Since 2014, preventing and combating AMR has been one of eight Flagship Priorities of the WHO South-East Asia Region, which is at high risk for the emergence and spread of AMR. All Member States continue to implement national action plans to address AMR, and in each Member State, a multisectoral working group or coordination committee on AMR has been established, in alignment with the Global Action Plan on AMR, adopted in 2015. Most Member States continue to implement national monitoring systems for resistance pathogens and antimicrobial consumption as well as foster stewardship in human health. All Member States are enrolled in the Global Antimicrobial Resistance Surveillance System (GLASS) AMR and the South-East Asia Region is the only WHO Region in which all countries carry out the annual Tracking AMR Country Self-Assessment Surveys, which this year was expanded to include the environment sector for the first time.

Despite this progress, countries of the Region continue to face an array of multisectoral challenges, as highlighted in a review of progress launched at the Seventy-fifth Session of the WHO Regional Committee for South-East Asia in September 2022. Such challenges include unsafe disposal of medicine and pharmaceutical waste, inadequate regulation of antimicrobial use in food production, insufficient infection prevention and control in health facilities, and inadequate access to safe water, sanitation and hygiene in homes and health facilities. The climate crisis is creating additional breeding grounds for antimicrobial-resistant bacteria.

In recognition of these and other challenges, for this year’s WAAW, the One Health Quadripartite – which includes WHO, the Food and Agriculture Organization of the United Nations (FAO), the World Organization for Animal Health (WOAH), and the United Nations Environment Programme (UNEP) – is highlighting the urgent need to increase One Health action to address AMR, with the theme ‘preventing antimicrobial resistance together.

The Region has several priorities…..
First, accelerating implementation of national multispectral action plans, for which adequate, sustained and reliable financing must be allocated – domestic, international and global.

Second, improving surveillance of antimicrobial-resistant infections and strengthening laboratory capacity. This is critical to know the true extent of the problem, and to effectively target energy and resources.

Third, developing and enforcing regulations on the appropriate use of antimicrobial medicines in all relevant sectors – human, animal, plant, food safety and environment – while ensuring such regulations promote and facilitate access for appropriate antimicrobial use.

Fourth, stepping-up investments in adequate water, sanitation and hygiene, a critical health intervention in and of itself, but which will also have significant impact on the tsunami of environmental pollution and contamination-driven antimicrobial resistance.

Time is of the essence. The development of a new antimicrobial can take 10-15 years and cost more than US$ 1 billion. Few are in the pipeline.

For the foreseeable future, we must accelerate One Health action while continuing to increase national, regional, international and global awareness and support – precisely as Indonesia achieved during its presidency of the G20 group of nations, which resulted in a Call to Action to increase One Health efforts to address AMR. Today, throughout WAAW and beyond, WHO reaffirms its commitment to support all countries of the Region to prevent and contain AMR together, across sectors, partners, stakeholders and the public.

(The author is Regional Director for South-East Asia, WHO)

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