By: Lunga Memela (Communication Engagement Lead)
Imagine falling ill with an infection, your health practitioner prescribes the best medication to cure you, you take it diligently – for added benefit you also adjust your diet and lifestyle but, over time, it becomes apparent that the bacteria in your body has become resistant to the antibiotic. What then?
This has been the sad reality for many individuals diagnosed with Tuberculosis (TB), for example, and subsequently multidrug-resistant TB (MDR TB) which at times results in extensively drug resistant TB (XDR TB). The challenge is heightened in countries like South Africa, for instance, where the past few decades has seen a dreadful number of cases of TB and HIV co-infection, with many-a-citizen having limited access to the relevant treatment.
A soaring number of people are contracting drug-resistant infections globally, and this why there is an urgent mandate for the pharmaceutical industry, private and public health sectors to join forces in eradicating the problem and to speak in unison beyond 18–24 November, which is World Antimicrobial Awareness Week (WAAW). This annual event aims to increase awareness of global antimicrobial resistance (AMR) by encouraging best practices among the general public, health workers and policy makers to avoid the further emergence and spread of drug-resistant infections.
In the spirit of promoting expert opinions and finding innovative ways to raise health awareness, Health Systems Trust spoke to Professor Sabiha Essack, the South African Research Chair in Antibiotic Resistance & One Health, a Professor of Pharmaceutical Sciences and the Director of the University of KwaZulu-Natal's Antimicrobial Research Unit. She is a prolific researcher and Vice-President and General Secretary of the Academy of Science of South Africa (ASSAf).
Essack said in order to raise antimicrobial awareness, it is important to understand that, "Antimicrobial resistance occurs when a micro-organism can survive or continue to thrive in the presence of an antimicrobial medicine that previously killed the micro-organism." Micro-organisms or microbes are microscopic organisms that are not visible to the naked eye; they are made up of viruses, bacteria, fungi and other parasites.
She explained that AMR is an overarching term that encompasses resistance to anti-viral, anti-bacterial, anti-fungal and anti-parasitic medicines. In particular, she described antibiotic resistance as specific to bacteria that occurs when bacteria no longer respond to antibiotics that previously killed the bacteria and cured infection.
Essack said AMR is evident in both community- and hospital-acquired infections and, of concern, is the fact that resistance to broad-spectrum antibiotics is escalating at community level. AMR exists and is escalating in South Africa as it is in other parts of the world. "South Africa, like other countries around the world, has reported resistance to every single antibiotic in clinical and veterinary practice, even the last resort antibiotics for 'difficult-to-treat' infections, but the nature, extent and sequalae is unquantified because we are yet to put into place comprehensive surveillance systems. Surveillance in human health is most advanced in blood stream infections from the public and private sector, surveillance in food animals is in its infancy, while surveillance in the environment is limited to research projects at academic institutions," she explained.
South Africa's commitment to combatting AMR
There is hope! According to Essack, AMR has been prominent on the global public health and political agendas since 2015 (although it was recognised as a public health threat since 1998) when the World Health Organization published its Global Action Plan on AMR. "All countries have committed to develop[ing] National Action Plans on AMR as signatories of the World Health Assembly Resolution and the United Nations General Assembly Political Declaration on AMR.
According to Essack the Global Action Plan has five strategic objectives, the first being improving awareness of AMR through communication, education and training. The vast majority of countries have instituted AMR awareness campaigns, particularly during World Antimicrobial Awareness Week. South Africa has also launched the Antibiotic Guardian Campaign where everyone from government ministers to civil society can pledge to use antibiotics correctly to ensure their efficacy for future generations.
Understanding AMR in the time of COVID-19
Although it goes unnoticed by many, AMR is the slow-moving pandemic that is adversely affecting humans, animals, crops, the environment, and their various interfaces and ecologies. "AMR is a One Health issue and its impact is so much more far-reaching than COVID-19," said Essack. "COVID-19 highlighted the lack of preparedness of health systems to deal with pandemics and it is imperative that our health, agricultural and environmental health systems are capacitated to prevent, contain and mitigate AMR as a matter of urgent priority, especially as AMR surveillance stewardship appears to be deprioritised as resources were channelled to deal with COVID-19."
The slogan for WAAW 2020 is "Antimicrobials: handle with care" applicable to all sectors, as declared by the World Health Organization. The theme for the human health sector for WAAW 2020 is "United to preserve antimicrobials".
Because millions of South Africans live with chronic conditions such as diabetes, high blood pressure or HIV, HST encourages patients on chronic medication to register for a free and convenient service called CCMDD (Central Chronic Medicine Dispensing and Distribution) – the National Department of Health's programme which dispenses and distributes medicine from a central point to patients with a chronic condition who are stable on their medication. To find out more about it you have to visit the HST-managed website for the CCMDD campaign funded by the Centers for Disease Control and Prevention called Get checked. Go collect..
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