Death by antimicrobial resistance
“Global leaders not only need to sign agreements but be real leaders [and] understand what they are signing.” These were the resounding words of Yvtenis Andriukaitis, the outgoing Health and Food Safety Commissioner at last Monday’s European Antibiotic Awareness Day. The event was organised by the ECDC in coordination with the European Commission’s Representation.
It is estimated that only half of the antibiotics consumed are correctly used. Not taking antibiotics as prescribed leads to antibiotic resistance; we speak of antibiotic resistance when bacteria develop resistance to a drug we talk of antibiotic resistance. Antimicrobial resistance, on the other hand, is a broader term encompassing resistance to drugs to treat infections caused by other microbes as well, such as parasites (e.g. malaria), viruses (e.g. HIV) and fungi (e.g. Candida) (WHO).
What does antibiotic/antimicrobial resistance mean in practice? Life-saving interventions and procedures which are standard practice, including treatment for cancer patients are in manifest jeopardy. The patient would not die because of cancer or by going under the knife but because of a bad bacterial strain we can no longer treat. For long, we have taken “it foregranted that it works always” but this is no longer the case. We are at crossroads, and we need to educate individual patients and clinicians about the use of antibiotics and AMR. This was the emotional plea of Anne Lise Ryel, the secretary-general of the Norwegian Cancer Society, when opening the exhibition at the event ‘Hanging by a thread’.
Living in an era of self-determination and online pharmacies, the fight against AMR faces an uphill battle. Some individual patients may believe that it is their right to access antibiotics irrespective of the nature of their ailment. This is most problematic in countries where antibiotics are available over the counter. The latter is “unacceptable”, Commissioner Andriukaitis stated, and we must educate all individuals about the need for a diagnosis before demanding, or even considering, antibiotics. National action plans are here essential if we want to ensure that antibiotics are only accessed when necessary. Both Sweden and Italy reported a decrease in antibiotic misuse after putting national action plans in place.
But how do we go about convincing governments to take action? The advice of Nedret Emiroglu to international organisations and civil societies is to go to national governments and show them the burden that inaction has. The increased deaths and higher economic loses should in themselves get national governments on board. Nevertheless, multisectoral action among the different ministries and departments within a country is essential. Emiroglu is the director of Health Emergencies and Communicable Diseases at WHO Regional Diseases at the WHO Regional Office for Europe.
Our attention needs to also be on the use of antimicrobials in the veterinary industry. The bulk of antimicrobials (80%) are consumed by animals and not humans. Since it also travels from animals to humans, AMR in animals is also of significant concern. Saija Kalenius from the World Organisation for Animal Health acknowledged that most countries are still learning. However, “no organisation is an island,” and there is a need for greater collaboration between international organisations and countries.
AMR is set to be one of the predominant challenges for incoming Commissioner for Health Stella Kyriakides. The EU’s One Health Action Plan against AMR necessitates implementation and translation into national legislation. The
Stakeholder Network on Antimicrobial Resistance’s roadmap for action on AMR goes over and above the EU’s action plan. It identifies five key strategies, including helping countries mobilise resources for better implementation of national AMR policies, put prevention at the heart of AMR policymaking, and tackle the environmental dimension of AMR in the framework of the European Green Deal.
At the end of the event, the ECDC also released its findings of a survey of healthcare workers’ knowledge and attitudes about antibiotics and antibiotic resistance. The findings should not be used for a comparative exercise between countries but rather as an indication of how each country is performing. The findings, how Malta is doing in the fight against AMR and what we as individual patients can do to join the movement are the subject of next week’s column.