What Nigeria can do about Antimicrobial Resistance

Antimicrobial resistance (AMR) is a growing global public health concern. The rapid emergence of drug resistant microorganisms worldwide is undermining the efficacy of available antibiotics. According to some estimates, super bugs now kill more than 100,000 people globally, every year. On our current trajectory, this number is projected to rise to 10,000,000 per year by 2050. It will cost world economies around $100 trillion over the next 35 years and the World Bank reckons that it will push 28.3 million extra people into extreme poverty by 2050. Many experts however, believe these estimates are highly conservative. This is a serious problem as many otherwise simple infections now have great potential to be fatal. Neisseria gonorrhoea the causative agent of the sexually transmitted infection gonorrhoea, has developed resistance to all antibiotic classes that have been used for its treatment, and strains resistant to multiple antibiotic classes have emerged. Other infections such as malaria, tuberculosis, pneumonia etcetera, now pose a bigger public health threat than previously known. Overall, modern medicine is threatened by AMR- cancer treatment, organ donations/transplants, diabetes management, routine surgeries and so on.

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Antimicrobial resistance is due largely to evolutionary genetic mutations in bugs (microbes), but is accelerated by humans in a variety of ways. There is a fundamental discovery void as no new classes of antibiotics have been introduced into clinical practice since the late 1980s, largely because investing in antibiotics research and production does not make financial sense for pharmaceutical companies. Other factors such as over prescribing, abuse of antimicrobial agents, patient attitude to drug use, and excessive use of antibiotics in animal husbandry- livestock and fish farming, have contributed to AMR. Microorganisms, when exposed to the life or death challenge posed by antimicrobials develop resistant genes which give them a survival advantage. Many physicians over time have prescribed antibiotics unnecessarily, due to lack of rapid diagnostic tools. Blind prescription of antibiotics by informed guess work, prior to availability of culture results is common practice. Also, due to sometimes subtle or active pressure from patients, doctors, many of whom justifiably have neither the time nor the energy to argue with these patients, give in to the pressure.

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Also, greater demand for food especially cheap animal protein products have led to the intensification of agriculture sustained by huge and often indiscriminate use of antibiotics to prevent/treat diseases, as well as to accelerate growth and reach market size sooner. This plays a significant role in transferring antibiotic resistant genes to humans. Resistant strains that emerged in farms have been detected in human populations.

Governments, health agencies and international organizations such as the United Nations have highlighted the magnitude of the problem, and have proposed measures such as the development of new drugs, improvement of diagnostics, antibiotic stewardship programs etcetera. Admittedly, Nigeria cannot be a part of the production of new drugs as this is very expensive. However, there are very important approaches that have so far, not been explored.

Physicians, farmers, regulators and the public need to be aware, massive campaigns are therefore, necessary. I expect that many physicians are now aware of this problem and are making efforts to prescribe antibiotics more prudently. However, more strategic and deliberate efforts to encourage clinical staff to be careful in this regard is highly desirable. In the clinical settings still, we need better infection control practices, improvement in hygiene/sanitation, stellar infection transmission prevention strategies, etc. In Nigeria, there is a colossal regulatory crisis.

In Nigeria, there are too many unqualified health care providers. We need policies and mechanisms that will regulate their activities, as well as mechanisms to ensure that drugs are of good quality, only used when professionally prescribed, backed up by laboratory diagnosis and taken responsibly. To achieve any meaningful results, we need to revamp our health institutions, which are very weak and have been in a pathetic state of disrepair for a very long time. Improved healthcare delivery (infrastructural and personnel) is extremely important. We must henceforth; generously care for our health professionals particularly doctors so as to retain our talent. The absurd, irresponsible brain drain has to stop. No serious country trains medical doctors and allows them to leave. These doctors are needed in Nigeria especially in the rural areas. There should be relevant investment and incentives in this regard, as a matter of urgency.  Antibiotic use in animal husbandry should be strictly regulated, with greater focus on improving nutrition and sanitation. Undoubtedly, this will have economic and basic human nutritional implications. Loss in meat production can be expected, which may escalate Nigeria’s malnutrition crisis.

However, there is a potential upside to this, as this could create access to developed markets. Namibia is one of Africa’s largest exporters of beef to Europe and became the first African country to be permitted to export beef to Hong Kong and the US due to quality assurance schemes, strict animal welfare regulations, stringent sanitation requirements, as well as banning antibiotic growth promoters in livestock rearing.

Other potentially effective strategies include improved sanitation, access to safe water, infection control, vaccination, exploring and developing non-animal protein sources, improved nutrition (to boost immune system of citizens), and so on. The world is at a cross roads with infectious diseases, and Nigeria should not act unconcerned. This is not a futuristic problem; we are already confronted with AMR related complications in Nigeria. However, due to an unfortunate lack of medical statistics, we erroneously assume AMR is not yet a real problem in Nigeria. This is a very dangerous assumption.

Oluwadara Alegbeleye

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