One Health approach tackles antimicrobial resistance

Antimicrobials have been hailed as one of the most important discoveries in medical history as they have successfully treated many diseases promoting the health and well-being of individuals. Antimicrobial resistance is when medicines that are given to us when we not feeling well due to an infection are unable to treat us.

This is due to the fact that the micro-organisms that cause diseases would have changed, making the medication useless. Antimicrobial resistance also known as AMR develops from changes at genetic levels through mutations or as acquired traits in the micro-organism.

As a naturally occurring phenomenon, AMR is accelerated by selection pressure in the environment of the micro-organism. Because micro-organisms are present in the natural environment, when AMR develops, it can also escalate and spread in the environment with implications on the well-being of all forms of life.
Events precipitating AMR in micro-organisms can therefore have implications on pathogenicity and therefore plant, animal and human health.

This puts pressure on the ability of human and animal health systems as well as agricultural production, particularly as the pace of discovery and innovation of more effective antimicrobials has significantly slowed down over the last three decades. AMR is also caused by irrational use of these antimicrobials (medications).

The Government of Zimbabwe through the antimicrobial resistance (AMR) core group conducted an analysis of the AMR situation in Zimbabwe in the human, animal, plant and environmental sectors following the One Health approach advocated by World Health Organisation (WHO), World Organisation for Animal Health (OIE), and Food and Agriculture Organisation of the United Nations (FAO).

However, the gains achieved through the use of antimicrobials are now being threatened by development of resistance.
By 2050 it has been estimated that antimicrobial resistance (AMR) will be causing 10 million deaths annually worldwide and this will cost the world 100 trillion dollars. If left unattended this crisis will have worse effects as compared to the HIV and TB pandemics combined.

This interest is borne out of the fact that AMR is a cross cutting problem affecting human, animal and the environment that calls for coordinated action across these sectors, hence the One Health approach.

Following the adoption of the Global Action Plan (GAP) on Antimicrobial Resistance by the 68th World Health Assembly in May 2015, Zimbabwe immediately put in place a framework towards developing the AMR National Action Plan by starting with a situational analysis to help understand the situation around AMR and any efforts to contain it that were in place.

The Global Action Plan urges Member States “to have in place, national action plans on antimicrobial resistance and with standards and guidelines established by relevant intergovernmental bodies.”
Findings of the AMR situation analysis that was carried out showed that AMR will grow in Zimbabwe if it is not tackled in a holistic manner. The Zimbabwe national action plan on AMR is in line with the Global Action Plan and outlines the following five strategic objectives:-

To improve awareness and understanding of AMR through effective communication, education and training;
To strengthen the knowledge and evidence base through surveillance and research;
To reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures;
To optimise the use of antimicrobial medicines in human and animal health;
To develop the economic case for sustainable investment that takes into account the needs of all countries and to increase investment in new medicines, diagnostic tools, vaccines and other interventions.

Therefore, the three governmental departments and other relevant stakeholders whose responsibilities intersect on human, animal, plant and environmental health outcomes, and therefore are responsible for implementing the “One Health” approach in Zimbabwe, have committed themselves to investing resources in designing sound strategies and interventions to preserve the effectiveness of our antimicrobial agents, in order to ensure sustainable dependence on them and to slow down the emergence and spread of AMR in Zimbabwe.

Zimbabwe has commenced implementation of its NAP in carrying out a number of activities. Zimbabwe has commenced running an integrated laboratory surveillance system with support from the WHO, FAO and OIE.

The central laboratories that are in charge of this surveillance network are the Central Veterinary Laboratory which processes specimens of animal origin, the Government Analyst which processes food samples and the National Microbiology Reference Laboratory processes human samples. The later is the National Coordinating Centre that receives isolates of priority pathogens including the antimicrobial susceptibility testing data.

During the World Antibiotic Awareness Weeks that take place during the periods of November and December each year worldwide, the country has done a number of activities such as public lectures, TV shows, guest lectures at universities — such as the University of Zimbabwe and the National University of Science and Technology, road shows in Dzivarasekwa, Warren Park, Kuwadzana and Epworth and university students from all departments have been involved.

Slowing down antimicrobial resistance is everyone’s responsibility. We would not want to lose our loved ones or yourself when no medicine can no longer work for your infection.

As individuals :-

Do not use antibiotics to treat viral infections, such as influenza, the common cold, a runny nose or a sore throat. Ask your doctor for other ways to feel better.
Use antibiotics only when a doctor prescribes them.
When you are prescribed antibiotics, take the full prescription even if you are feeling better. Ensure that members of your family do the same.
Never share antibiotics with others or use leftover prescriptions.
Do not save antibiotics for the next illness. Discard any leftover medication once the prescribed course of treatment is completed.
Do not ask for antibiotics when your doctor thinks you do not need them. Remember antibiotics have side effects.
Prevent infections by practising good hand hygiene and getting recommended vaccines.

Remember, each time you take an antibiotic when it is not necessary, the effectiveness of the antibiotic decreases and it might not work the next time you really need it.

Doctors, nurses, veterinarians and other health workers

Do not prescribe or dispense antibiotics unless they are truly necessary and you have made all efforts to test and confirm which antibiotic your human patient or the animal you are treating should have.
Prescribe antibiotics correctly — get cultures, start the right drug promptly at the right dose for the right duration. Reassess the prescription within 48 hours based on tests and patient exam.
Document the dose, duration and indication for every antibiotic prescription.
Stay aware of antibiotic resistance patterns in your facility.
Participate in and lead efforts within your hospital to improve prescribing practices.
Follow hand hygiene and other infection control measures with every patient or animal.

To protect patients and preserve the power of antibiotics, hospital CEOs/medical officers can:
Adopt an antibiotic stewardship programme that includes, at a minimum:-

1. Leadership commitment: Dedicate necessary human, financial, and IT resources.

2. Accountability: Appoint a single leader responsible for programme outcomes. Physicians have proven successful in this role.

3. Drug expertise: Appoint a single pharmacist leader to support improved prescribing.

4. Action: Take at least one prescribing improvement action, such as requiring reassessment within 48 hours to check drug choice, dose, and duration.

5. Tracking: Monitor prescribing and antibiotic resistance patterns.

6. Reporting: Regularly report to staff prescribing and resistance patterns, and steps to improve.

7. Education: Offer education about antibiotic resistance and improving prescribing practices.

Work with other health care facilities to prevent infections, transmission, and resistance.

Farmers and those in the agriculture sector
Ensure that antibiotics given to animals are used only to control or treat infectious diseases and under veterinary supervision.
Misuse of antibiotics in livestock, aquaculture and crops is a key factor contributing to antibiotic resistance and its spread into the environment, food chain and humans. Clean and uncrowded conditions and vaccination of animals can reduce the need to use antibiotics.

Our city councils

Ensure our environment is clean with refuse being collected on time.
Provide un-interrupted clean safe water

Universities and industry
Universities and industry needs to move faster and more aggressively to research and develop new antibiotics, but there is need to implement new ways of stimulating research and development.
Despite talk of an antibiotic “discovery void” since the late 1980s, we are currently in a race between drug development and bacterial evolution. — Ministry of Health and Child Care public relations department.