Health system inequalities in East Africa drive antimicrobial resistance

The COVID pandemic has exposed long-standing structural fault lines in societies – especially in health systems. These same inequalities also drive another major global health concern: antimicrobial resistance.

The World Health Organization defines antimicrobial resistance as the process by which microbes change over time and no longer respond to medicines. This makes infections harder to treat. It also increases the risk of disease spread, severe illness and death. Resistance of bacteria to antibiotics is especially worrying.

Global deaths from antimicrobial resistance are projected to increase from the current 700,000 a year to 10 million by 2050. These losses disproportionately affect the world’s poorest and most vulnerable populations in low- and middle-income countries. For example, across sub-Saharan Africa, rates of deaths due to antibiotic resistance are 24 per 100,000 people. In high-income countries, the death rate is 13 per 100,000.

Antimicrobial resistance is a complex problem and difficult to tackle. It also encompasses a broad range of factors. These include the biomedical, political, economic and socio-cultural, and go beyond individual disciplines and sectors. Yet most efforts to address antimicrobial resistance tend to use a biomedical lens. These efforts fail to consider the experiences of those most affected, including those responsible for health provision and those receiving it.