Drug resistance kills 1.27 million annually, says WHO

Greatest burden is in sub-Saharan Africa and South Asia where crisis has huge human cost and is top killer.

In Summary

• Antimicrobial resistance occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines.

• This makes infections harder to treat and increases the risk of disease spread, severe illness and death.


The World Health Organization has raised the alarm over the rate at which bacteria, viruses, fungi and parasites are resisting medicines.

WHO Director for Global Coordination and Partnership on Antimicrobial Resistance Dr Haileyesus Getahun described the situation as worrying.

“Bacterial antimicrobial resistance is a major cause of mortality and morbidity directly causing 1.27 million annual deaths and indirectly causing 4.95 million annual deaths,” he said.

Getahun said the greatest burden is in sub-Saharan Africa and South Asia where the crisis has huge human cost and is a top killer.

So serious is the challenge that the World Bank in a 2017 report estimated that there will be $1.2 trillion additional health expenditure by 2050 due to drug resistant infections.

Getahun was among the top experts who addressed journalists during a webinar on Wednesday ahead of World Antimicrobial Awareness Week set for November 18-24.

The Kenya Environment and Science Journalists Association was part of the organisers of the webinar.

The week is a global campaign that is celebrated annually to improve awareness and understanding of antimicrobial resistance and encourage best practices among the public, One Health stakeholders and policy makers. 

This year, the theme of the week is “Preventing Antimicrobial Resistance Together”.

Antimicrobial resistance occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines.

This makes infections harder to treat and increases the risk of disease spread, severe illness and death.

As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become increasingly difficult or impossible to treat.

Researchers estimated that AMR in bacteria caused an estimated 1.27 million deaths in 2019.

Getahun said the proportion of antimicrobial compounds with resistance was higher than 50 per cent in chicken, cattle and pigs in the last decade.

He said poor sanitation and hygiene were making matters worse.

Getahun said a quadripartite strategic framework for collaboration has since been put in place to help address the global challenge.

“The goal is to ensure antimicrobial efficacy and ensure sustainable and equitable access to antimicrobials for responsible and prudent use in humans, animals and plants health,” he said.

He said another goal is to optimise the production and use of antimicrobials throughout the whole life cycle, from research and development to disposal.

Getahun said they also aim to decrease incidences of infections in humans, animals and plants.

“Countries have the capacity to design and sustainably implement evidence-based informed One Health response,” he said.

Getahun said evidence has shown that investments made in intervening have returns.

He said investing one dollar in TB intervention can yield 30 dollars while investing a dollar in vaccinations can yield 15 dollars.

Getahun said the six areas that have been identified in the action plan are political action, transformation systems, surveillance, financing, research and development and environmental dimensions.

He said during the upcoming third global high level ministerial conference on antimicrobial resistance set to be held in Muscat, Oman, from November 24 to 25, three targets will be proposed as the main outcomes of the event.

“One of the proposed targets that members have been discussing and set to be endorsed next week is to reduce the use of antimicrobials in agrifood systems by between 30 and 50 per cent by 2030,” Getahun said.

He said another target is zero use of medically important antimicrobials in animals and plants, especially when they are not needed.

“For humans, we want to ensure that access to antibiotics that are not very much susceptible to developing drug resistance to make sure that they are prescribed in 60 per cent of all prescriptions in patients,” Getahun said.

FAO senior animal health officer and antimicrobial resistance coordinator Junxia Song said 76 per cent of antimicrobials are commonly used in food animals and are also imported for humans.

UNEP’s chemicals and health branch, economy division chief Jacqueline Álvarez said the global community is facing triple planetary crisis of  climate change, biodiversity loss, pollution and chemicals.

Álvarez said the planetary crisis and microbial resistance are a leading threat to global health as they affect the sustainability of the planet.

She said there is a need to create and build a healthier environment to support human beings for generations to come.

Head of antimicrobial stewardship and awareness unit at WHO, Thomas Joseph, said with universal access to clean water for sanitation and hygiene, antimicrobial resistance could be reduced by 60 per cent.

In May 2015, a global action plan to tackle the growing problem of resistance to antibiotics and other antimicrobial medicines was endorsed at the Sixty-eighth World Health Assembly.

One of the key objectives of the plan was to improve awareness and understanding of AMR through effective communication, education and training.

In 2017, the Kenyan government developed a Policy and National Action Plan aimed at reducing the burden of antimicrobial resistance due to public health concerns.

This was after data from sentinel sites indicated high rates of resistance for respiratory, enteric and hospital acquired infections, indicating that many available antimicrobial regimens such as penicillins and cotrimoxazole were unlikely to be effective against common infections.

In livestock, antimicrobial resistance was reported in E. coli isolates from beef and poultry.

There was resistance to common antimicrobial agents such as tetracycline, cotrimoxazole, streptomycin, ampicillin, quinolones and third generation cephalosporins at varying frequencies.

The underlying causes of antimicrobial resistance and barriers included limited awareness of its implications in human and animal health among the general public, policy makers and animal and public health practitioners.

Other causes include a high burden of infectious diseases due to impoverished living conditions of many people, high HIV-Aids burden and poor infection control practices in hospitals and high burden of diseases in animals associated with poor husbandry practices.

Low vaccination coverage, medicated animal feeds, weak healthcare systems, antimicrobial misuse and overuse as a result of easy over-the-counter access were also identified as common causes of resistance.

Others are high levels of self-medication, unreliable access to medicines and diagnostics, weak surveillance systems, poor enforcement of regulation, inadequate investment in laboratory infrastructure, diagnostic tools and human resources, and inadequate research and development of new antimicrobials, diagnostics and vaccines.

The joint venture between the ministries of Health and Agriculture used the One Health approach to promote prudent use of antimicrobial agents to ensure continued successful treatment and prevention of microbial diseases.

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