The age of antimicrobial discovery has been overshadowed by the emerging threat of resistance, For too long clinicians like myself have witnessed the impact of antimicrobial resistance – more commonly referred to as AMR. As a result of this growing health threat, a wide range of infections – such as pneumonia, tuberculosis, bloodstream infections and gonorrhoea – have become harder, and sometimes impossible, to treat as more and more antibiotics fail to cure patients.
Despite this danger, a lack of comprehensive data on the real burden of AMR was a barrier to ensuring that AMR entered the spotlight and received the attention it deserved. Without these much-needed figures, it has been unclear what pathogens are most prevalent in sub-Saharan Africa, and we've been unable to convince policymakers that AMR is a threat worth prioritising.
The good news is that we now have the data that we so urgently need. Estimates published today in The Lancet have shown that at least 1.27 million deaths per year are directly attributable to AMR. This incredible toll now means that AMR is a leading cause of death globally, higher than some diseases like HIV/Aids or Malaria.
When looking at sub-Saharan Africa, the paper shows that the region faces the highest burden of AMR, with 255,000 deaths attributable to drug-resistance in 2019, and a particularly high number from vaccine preventable pneumococcal bacterial disease. Shockingly, around half of total deaths were in children under the age of five.
Across the region, there are several drivers of AMR – with misuse and overuse of antibiotics for both patients, animals and food production playing a central role. In many communities across Africa, first-line antibiotics can easily be purchased without a prescription from both legal and illegal outlets. Furthermore, heath systems lack the right tools to improve diagnostics as well as access to effective and quality-assured second-line antibiotics, meaning that doctors and nurses are left powerless to treat common infections.
As a result, we can no longer be certain that antibiotics will simply save lives – making essential medical practices such as surgery, cancer treatment or even childbirth more dangerous, and potentially life threatening.
Quite simply, we are not working fast enough to address AMR on the African continent or around the world. Our current action plans are not ambitious enough, we have chronic stock-outs of current antibiotics, we are not innovating fast enough to develop new treatments, and we are failing to deliver on commitments around clean water and sanitation to prevent infections.
But not all hope is lost. I am thrilled that we now have the evidence we need to fuel political intervention, and we already know the immediate steps that countries can take to protect their healthcare systems from the threat of AMR.
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Firstly, the continent needs better stewardship to encourage more thoughtful use of antimicrobial treatments – expanding access to lifesaving antibiotics where needed and minimising use where they are not necessary. We also must take greater action to monitor and control infection nationally and within individual hospitals, as well as continue to invest in strengthening our healthcare infrastructure so that we can stop and treat infections before they threaten patients lives.
To achieve our goals, we must engage every single layer of society – from policymakers, communities, and doctors – we all have a role to play in raising awareness and sharing solutions towards AMR.
With the true scale of this threat now clearly evidenced, it's time to take decisive action on AMR. The COVID-19 pandemic has clearly shown us how much is at stake when we do not have the right tools available, and the same can be said for antibiotics. Across the world, we have all benefitted from the invention and availability of antibiotics, and so its time to come together to protect modern medicine and prevent millions more deaths.
