To tackle the growing threat of antimicrobial resistance (AMR), the Federal Government has introduced the National AMR Policy. This initiative aims to improve public health, boost economic productivity, and integrate human, animal and environmental health for a comprehensive One Health approach. CHINYERE OKOROAFOR reports that the initiative will mitigate the impact of AMR on public health and the economy, promoting effective disease management and safeguarding future generations
In an effort to forestall a significant public health crisis, the Federal Government has unveiled the National Antimicrobial Resistance (AMR) Policy, under the leadership of the Minister of State for Environment, Dr. Iziaq Salako. This far-reaching policy aims to combat the escalating threat of antimicrobial resistance, safeguarding public health and ensuring the effective management of infectious diseases. Through the implementation of this policy, the government seeks to reduce the impact of AMR on healthcare systems and the population, fostering a coordinated and strategic response to this urgent issue.
At the landmark event in Abuja, Dr. Salako highlighted the substantial socio-economic benefits that the nation stands to gain from the successful implementation of the AMR Policy. Dr. Salako emphasised that the policy is designed to significantly enhance public health outcomes, which will, in turn, boost productivity across various sectors. By addressing the critical issue of antimicrobial resistance, the policy aims to create a healthier population, thereby driving economic growth and development.
“Nigeria, as a responsible member of the global community, is committed to adopting a holistic approach to addressing AMR; to ensuring all sector involvement; no duplication and efficient use of scarce resources. To achieve this and protect public health, food security and the environment, the recognition of the interconnectedness between human, animal and environmental health in line with the One Health principles is central.’’
Dominique Koffy Kouacou, the Head of the Food and Agriculture Organisation (FAO), also underscored the importance of the AMR policy, noting that the scourge of antimicrobial resistance affects not only humans but also animals, plants and the environment. This holistic approach ensures that the policy tackles AMR on all fronts, promoting a safer and more sustainable ecosystem. “Antimicrobial resistance, which is a one health issue, needs to be tackled by all sectors and therefore important for countries to put in place actions that would reduce and control the scourge. It is estimated that 10 million people would die annually by 2050 and the economies of nations negatively affected if AMR challenge is not mitigated.”
Kouacou explained that it was for this reason the FAO supported the Federal Ministry of Environment in developing the policy in 2022. According to the United Nations Environmental Programme (UNEP), AMR is a global crisis intrinsically linked to the broader triple planetary crisis, which encompasses climate change, biodiversity loss, and pollution. This holistic approach ensures that the policy tackles AMR on all fronts, promoting a safer and more sustainable ecosystem.
The UNEP report highlights the urgent nature of the antimicrobial resistance (AMR) threat, revealing its rapid and alarming escalation. This swift rise in AMR complicates treatment protocols, leading to prolonged hospital stays, increased mortality rates, and significantly higher healthcare costs. AMR is also listed by the World Health Organisation (WHO) as one of the top 10 threats to global health. According to the Nigeria Centre for Disease Control and Prevention (NCDC), Nigeria faces a burden of 64,000 deaths annually associated with AMR. The country ranks 185th out of 204 for age-standardised mortality rates linked to AMR.
The launch of an initiative in Abuja by the government underscores a renewed focus on this silent but potent health problem. As many have advocated, enlightenment campaigns must be vigorously pursued in the fight against resistant infections. These campaigns should emphasize the dangers of self-medication and the abuse of antibiotics, stressing that such medications should only be used when absolutely necessary. Additionally, precautionary measures against infections need to be highlighted.
Understanding AMR
In an exclusive interview with The Nation, Prof Iruka Okeke, a Pharmaceutical Microbiologist scholar at the University of Ibadan and a Calestous Juma Science Leadership Fellow, simplified the concept of antimicrobial resistance (AMR). She explained, “Most of us have taken antibiotics when we’re sick. These medicines kill the germs causing the illness, helping us recover. However, AMR occurs when these germs become unresponsive to the medicines. Instead of dying, they continue to live, rendering the drugs ineffective. This makes it harder for patients to get better and leads to more serious health problems.”
She also noted that bacteria develop resistance through various mechanisms. According to her, bacteria may “pump the antibiotic out,” akin to installing burglary proofs to prevent intrusion, or they can “destroy the antibiotic” by breaking it down. Some bacteria even alter their internal targets, making them impervious to the antibiotic’s effects.
“Bacteria that would normally be sensitive to an antibiotic can actually gain the ability to pump the antibiotic out of the bacterium so that it cannot harm them, kind of like putting burglary proofs around your home so that external people can’t come in. Sometimes they can actually destroy the antibiotic. They can actually break it down. Or other times, if the antibiotic attacks a particular target inside the bacteria, the bacteria can create a new version of that target that is no longer attackable by the antibiotic,” she said.
According to Prof Okeke, the high mortality rates associated with AMR in Nigeria can be attributed to several factors. These include the ineffectiveness of first-line antibiotics, limited access to more expensive alternative drugs, and insufficient diagnostic facilities. “Antimicrobial resistance is a major killer in Nigeria primarily because of inadequate diagnostic capabilities. Often, we cannot determine who has a resistant infection versus a susceptible one, nor can we identify the most effective first-line drug to use. This lack of precise diagnostics means that patients are more likely to receive ineffective treatments, which increases the risk of death from resistant infections,” she said.
Specific challenges facing Nigeria in the fight against AMR
Nigeria faces substantial challenges in combating AMR, though they are not insurmountable. Prof Okeke highlights that the country’s large population, high infection rates, and a struggling healthcare system significantly exacerbate the problem. “We don’t have enough healthcare professionals, and many are leaving the country, worsening the existing shortages. Infrastructure issues, such as lack of potable water and proper sanitation, further contribute to the spread of infections. Access to healthcare is another major issue. In remote regions, people often travel long distances to reach medical facilities, delaying treatment and increasing mortality risks. Moreover, the unavailability and unaffordability of essential drugs and diagnostics impede effective healthcare delivery,” she said.
At the inauguration, Dr. Salako emphasised that AMR’s impact reaches beyond mere health concerns, influencing global economic stability and security. He stated, “AMR is not just a public health threat; it poses significant challenges to global economic wellbeing and security, impacting both developed and developing nations alike.”
Dr. Salako explained that the spread of resistant pathogens can disrupt international trade and travel, as countries may impose restrictions to prevent outbreaks, thereby affecting global economic stability. The World Bank has projected that antimicrobial resistance (AMR) could result in an additional $1 trillion in healthcare costs by 2050. Additionally, AMR is expected to cause annual Gross Domestic Product (GDP) losses ranging from $1 trillion to $3.4 trillion by 2030. The projected $1 trillion increase in healthcare costs by 2050 reflects the growing expense of treating infections resistant to antibiotics and other antimicrobials. This rise in costs will demand more resources for healthcare services, lead to longer hospital stays, and necessitate the use of more expensive medications. By 2030, the economic impact of AMR could result in global GDP losses ranging from $1 trillion to $3.4 trillion annually.
Prof. Okeke explained that the economic impact of AMR stems from several factors: reduced productivity due to prolonged illness and higher mortality rates, increased healthcare costs that divert funds from other economic activities, economic strain on families and communities, and a burden on healthcare systems. Additionally, AMR leads to a decreased labour supply as more people are affected by resistant infections, long-term health consequences, and potential disruptions in trade and economic activities due to the spread of resistant pathogens.
With commitment and focus, the challenges posed by AMR can be overcome in the nation’s best interest. Experts in the health sector believe that an aggressive implementation of AMR policies will bring substantial benefits. These include combating AMR, a major public health threat that contributes to longer hospital stays, increased mortality, and higher healthcare costs. By effectively addressing AMR, Nigeria stands to gain significant socio-economic benefits, such as improved productivity and reduced healthcare costs. The World Bank estimates that AMR could cost the global economy trillions of dollars by 2050; thus, mitigating this threat could conserve substantial resources.
AMR is a global challenge impacting both developed and developing nations, and Nigeria’s dedication to addressing it aligns with international efforts to enhance health security and economic stability. The policy underscores the interconnectedness of human, animal, and environmental health, adhering to One Health principles. This holistic approach is essential for effectively managing AMR, ensuring that actions in one sector bolster and complement efforts in others. Additionally, robust AMR surveillance will safeguard wildlife from antimicrobials and drug-resistant microorganisms, thereby mitigating the risk of zoonotic disease outbreaks that could have serious public health consequences.
The development of the policy, supported by the Food and Agriculture Organisation (FAO), underscores the critical role of international cooperation in combating AMR. It emphasizes the need for sustained support and collaboration to tackle this global health threat. The policy advocates for the involvement of all relevant environmental stakeholders, promoting a comprehensive and inclusive approach to addressing AMR. This broad engagement is expected to enhance the effectiveness of implemented measures and secure widespread support. With projections estimating up to 10 million deaths annually by 2050 if AMR is not addressed, the policy positions Nigeria to proactively manage and mitigate this threat, ensuring the protection of future generations.
How to prevent AMR
Prof Okeke emphasized that preventing AMR requires stringent infection control measures in hospitals. “Infection prevention is essential,” she said. “By providing nurses and doctors with access to water for handwashing, we can significantly reduce the spread of infections. This simple yet effective practice helps prevent one infection from transmitting to another patient, thereby avoiding further complications.” She highlighted that such improvements could potentially prevent nearly half of the deaths attributed to AMR.
She further underscored the importance of improved water and sanitation, stating, “Access to clean water and proper sanitation in communities can prevent approximately 250,000 deaths annually from AMR. By reducing the spread of infections, we decrease the reliance on antibiotics and the associated risk of resistance.” She also highlighted the role of vaccines, explaining, “Vaccines are crucial in preventing infections that could otherwise lead to antibiotic use. For children, vaccines could save nearly 200,000 lives each year from AMR. While not free, these vaccines are relatively affordable and provide long-term protection by shielding children from illnesses that could otherwise impede their development.”
Prof. Okeke underscored the critical need for the responsible use of antibiotics, stating, “Educating healthcare providers and the public on the appropriate use of antibiotics is essential to prevent misuse and overuse, which are major contributors to resistance. Implementing regulatory measures to control antibiotic distribution and sales is also crucial for curbing AMR.” She highlighted the necessity for new antibiotics and alternative treatments to keep pace with resistant pathogens. “Developing rapid diagnostic tools is key to ensuring antibiotics are used only when necessary and that the correct antibiotic is selected,” she explained.
She concluded by emphasising the importance of international cooperation in combating AMR. “Global collaboration through organisations like the World Health Organization (WHO) enables countries to share data, strategies, and resources effectively. Coordinated global surveillance programs to monitor antibiotic use and resistance patterns are vital for a unified response,” Okeke said.
