Antimicrobial resistance in Africa: challenges and proposed strategies

Antimicrobial resistance (AMR) is a growing public health concern globally and currently accounts for over 700,000 deaths per year worldwide. It is estimated that by 2050, AMR would cause 10 million deaths yearly and a global economic loss of about $100 trillion.

Although antimicrobial resistance is a concern in every country regardless of growth and development, the lack of quality data on it due to poor AMR surveillance systems in Africa has further complicated the problem, making it difficult to understand issues related to AMR and the true extent of the problem on the continent. This gap in public health capacity is problematic, often resulting in treatment guidelines that are not suitable for the local situation.

The major challenges limiting the ability to combat AMR on the continent are weak medicines regulatory capacity and circulation of substandard/counterfeit antimicrobials; poor laboratory capacity on AMR testing and reporting; …

However, despite the limited laboratory capacity to monitor AMR, available data in Africa reveal that the continent shares the global trend of increasing drug resistance. Significant resistance has been reported for diseases such as cholera, dysentery, typhoid, meningitis, gonorrhoea, TB, malaria and AIDS.

What is Antimicrobial Resistance (AMR)?

Antimicrobial drugs refer to medicines that are active against a range of infections, such as those caused by bacteria (antibiotics), viruses (antivirals), fungi (antifungals) and parasites (including antimalarials).

AMR occurs when microorganisms, which lead to infections, are not killed by exposure to medicines that would normally have stopped their growth or killed them. Hence, the strains that survive the exposure continue to grow and spread. The result of this has been the development of highly resistant strains, often referred to as ‘superbugs’. Examples are Methicillin-resistant Staphylococcus aureus (MRSA) and extremely drug-resistant tuberculosis, bacteria which can hardly be treated with existing medicines.

Since antimicrobials were first discovered, AMR has been a naturally occurring process. However, in recent times, AMR has become a major global crisis because of the inappropriate use of antimicrobials, which has significantly increased the rate of development and spread of drug-resistant microorganisms. Unfortunately, the rate of development of resistance has not been matched by the discovery of new antimicrobials.

The growing challenge of AMR in Africa

Although Africa has recorded some progress with the gathering and use of AMR data for TB, Malaria, and HIV/AIDS, significant challenges still exist. The major challenges limiting the ability to combat AMR on the continent are weak medicines regulatory capacity and circulation of substandard/counterfeit antimicrobials; poor laboratory capacity on AMR testing and reporting; lack of a comprehensive policy and plan to address AMR; inadequate AMR surveillance strategies and limited quality assurance and control protocols.

Africa lacks a formal, region-wide framework for collaboration among surveillance programmes initiated by various countries on the continent. The consequences of a lack of a regional framework for collaborative surveillance of AMR include difficulty in tracking emerging resistance challenges; identifying, characterising and containing new antibiotic threats; and in systematically comparing and evaluating the success of national resistance containment activities.

It is good to acknowledge the effort of African Centre for Disease Control and African Society for Laboratory Medicines funded by Fleming Funds, but a lot more need to be done and with more urgency to tackle AMR on the continent.

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Proposed strategies to combat AMR in Africa

In view of the above challenges, there is an urgent need for a collaborative effort from policymakers, partners, and stakeholders in the public health sector to develop targeted capacity-building interventions in areas such as AMR surveillance, laboratory services, quality control of test reagents and protocols, effective medicines regulation and rational use of medicines.

Bloom Public Health proposes the following strategies to combat AMR in Africa:

The development of comprehensive national policies and plans to prevent and combat AMR: Taking into account national health and medicines policies, Government authorities need to develop and implement comprehensive AMR policies and strategies that limit the emergence and spread of resistant germs.

Strengthening clinical laboratory capacity: Strategies to ensure the quality of laboratory test results are crucial to the success of surveillance initiatives. Laboratories need to have procedures for ongoing assessment of the quality of test reagents and test performance. Participation in national and/or external quality assurance (EQA) programmes are essential.
This can be achieved through public and private partnerships. For example, Bloom Public Health has been at the forefront of strengthening and building laboratory capacity across Africa and over the last few months channelled its expertise in providing technical assistance to laboratories and institutions.

Strengthening national medicines regulatory capacities: This is essential to limit the health and safety risks of the populace to substandard, falsified labelled, and counterfeit medical products. The quality of medicines circulating within the national pharmaceutical markets should be monitored in order to prevent smuggling and use of substandard/counterfeit antimicrobials that may contribute to increasing AMR.

Combating the crisis of AMR in Africa will require the collaborative effort of public health practitioners, law enforcement, professional associations, NGOs, private sector, and other relevant authorities. Urgent and coordinated action at all levels is crucial to curb the uncontrolled rise of resistant germs that threaten lives and waste limited resources, ensuring the preservation of antimicrobials for future generations.