"In the century since Alexander Fleming stumbled across penicillin in a laboratory in London, antibiotics have become a mainstay of medicine, transforming once-deadly infections into treatable and curable conditions. However, Antimicrobial Resistance threatens to unwind that progress making it, without question, one of the most pressing health challenges of our time." -- Dr Tedros Adhanom Ghebreyesus, WHO Director-General speaking at the High-Level Meeting of Antimicrobial Resistance at the 79th United Nations General Assembly (UNGA)
Antimicrobial resistance (AMR) has become one of the leading threats to global public health and development. In 2019 4.95 million deaths were from drug-resistant infections and 1.27 million of these deaths were directly attributed to AMR. According to the recent Lancet publication titled 'Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis', recent projections suggest that AMR could lead to an estimated 10 million total deaths annually by 2050.
Antibiotic Resistance occurs when microorganisms such as bacteria, viruses, fungi and parasites no longer respond to the drugs formulated to kill or control them. This makes infections harder to treat. Although AMR is a natural phenomenon that can develop over time due to genetic changes micro-organisms, the challenges currently faced are largely driven by human activity.
The contributors to AMR include the overuse or misuse of antimicrobial medicines (such as antibiotics, antivirals, antifungals, and antiparasitics) in humans, animals and plants -especially those used for food production -- and the environment. This is misuse is exacerbated by inadequate poor infection prevention and control (IPC) practices in health facilities.
As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability and death.
Every year, from 18th to 24th November, the global health community observes World Antimicrobial Awareness Week (WAAW) to raise awareness and understanding about AMR, and to promote best practices among stakeholders across the One Health spectrum to reduce the emergence and spread of drug-resistant infections. This year's theme titled 'Educate, Advocate and Act Now' calls on all stakeholders to implement action plans to continue educating all stakeholders, policymakers, healthcare workers and the public to implement strategies that address antimicrobial misuse and overuse.
While AMR threatens global public health, it disproportionately affects low and middle-income countries with recent estimates showing that countries in the sub-Saharan African region have the highest AMR burden accounting for 27.3 deaths per 100,000 overall deaths. The impact of this is far-reaching, affecting already weak health systems globally, disrupting economies, and further threatens the achievement of the 2030 Sustainable Development Goals (SDGs).
Nigeria's approach to tackling AMR
Nigeria ranks 20th globally in the age-standardized mortality rate associated with antimicrobial resistance (AMR), among 204 countries analyzed. In 2019 alone, the country accounted for an estimated 263,400 AMR-associated deaths. Comparative data highlights the severity of the AMR crisis in Nigeria. AMR-related fatalities surpass those caused by enteric infections, respiratory infections, tuberculosis, neglected tropical diseases, malaria, and even cardiovascular diseases. This underscores the urgent need for targeted interventions to combat AMR and its devastating impact on public health.
In May 2015, the 68th World Health Assembly (WHA) recognised AMR as a significant threat to global health, urging Member States to participate in an integrated global programme for surveillance of AMR through the Global Antimicrobial Resistance Surveillance System (GLASS). Additionally, it called for the development of a multisectoral national action plan that adopts a One Health approach to combat AMR, aligning with the Global Action Plan on AMR (GAP).
In May 2015, the 68th World Health Assembly (WHA) identified antimicrobial resistance (AMR) as a critical threat to global health. The Assembly urged Member States to actively engage in the Global Antimicrobial Resistance Surveillance System (GLASS), an integrated global program for monitoring AMR trends and patterns. Furthermore, Member States were called upon to develop multisectoral national action plans incorporating a One Health approach. These plans aim to address AMR comprehensively across human, animal, and environmental health sectors, aligning with the objectives of the Global Action Plan on AMR (GAP).
In response to this call, Nigeria launched and implemented its first 2017-2022 National Action Plan for Antimicrobial Resistance (NAP). This strategic plan aimed to reduce, prevent and slow the evolution of resistant organisms and minimise their impact on healthcare. It also sought to ensure the optimal use and improved access to effective, safe and quality-assured antimicrobials for continued successful management of infections.
Building on the successes and lessons learned from the implementation of the first National Action Plan (NAP) on antimicrobial resistance (AMR) and informed by the One Health Situational Analysis of AMR in Nigeria, the AMR National Action Plan 2.0 (2024-2028) was launched in October 2024. This significant milestone follows the high-level meeting on AMR at the 79th United Nations General Assembly (UNGA) in September 2024, where global leaders made ambitious commitments to address the global AMR challenge.
The launch of the AMR NAP 2.0 underscores Nigeria's determination to transition from political declarations and commitments to tangible, actionable steps. However, the success of this plan requires enhanced coordination and collaboration among One Health stakeholders spanning human, agricultural (animal and plant), and environmental health sectors. Only through such a unified approach can we effectively implement the strategic plan and reverse the current trajectory of AMR in the country.
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The call for enhanced coordination and collaboration among the One Health stakeholders comes as Nigeria accepted the global hosting rights for the 5th High-Level Ministerial Conference on Antimicrobial Resistance, scheduled to take place in 2026.
The Coordinating Minister of Health and Social Welfare, Prof Muhammad Ali Pate , highlighted Nigeria's leadership in the fight against AMR. He emphasised that the National Action Plan on AMR, which integrates One Health principles, has mobilised human, animal, and environmental health sectors to work in synergy. This integrated approach has earned Nigeria global recognition as a leader in Africa for addressing AMR.
Of note is Nigeria's health sector prioritisation of resilience where the country is actively working on health security and climate resilience to protect the health of citizens. The body of work on AMR is embedded in this pillar of our health sector reform agenda.
What Next?
As the 2024 WAAW calls on all stakeholders to Educate, Advocate and Act Now, the global community must continue to advocating for bold commitments as demonstrated by the political declaration at the 79th UN General Assembly.
However, it is not enough to just make commitments, it's important to act now by taking decisive steps towards combatting AMR. The strategic plan should not become just another policy document not fully integrated, down to the state level. Instead, it must serve as a tool that drives collective and decisive action.
