Mitigating AMR: Lessons from the COVID-19 Pandemic
Prof Essack – AMR Insights blog
Sabiha Y. Essack PhD, BPharm, MPharm
South African Research Chair (SARChI) in Antibiotic Resistance and One Health and Professor in Pharmaceutical Sciences at the University of KwaZulu-Natal (UKZN)
With over a million deaths globally,1 the health, economic and societal impact of COVID-19 has been devastating. The pandemic response has, however, spotlighted areas in healthcare and infection prevention that can be amplified to help avert the silent antimicrobial resistance (AMR) pandemic.
It has been well documented that, without prompt action, by 2050, around 10 million people could die each year because of AMR.2 Learning from the non-pharmaceutical interventions (NPIs) to limit the spread of COVID-19 offers an opportunity to also mitigate AMR by preventing infection. The use of masks, social distancing measures and hand washing are measures to prevent the transmission of infection. Reducing infection rates automatically reduces antimicrobial prescription and use, thereby decreasing selection pressure for the development and/or escalation of AMR.
A position paper recently published in the American Journal of Infection Control, developed by the Global Hygiene Council, a group of global AMR, infection prevention and control and public health experts, provides an extensive review of evidence demonstrating that practicing good hygiene in homes and community settings can reduce infections, antibiotic use and subsequent resistance in common infections.3
One of the strategic objectives of the Global Action Plan on AMR is to improve hygiene, sanitation and infection prevention and control in an effort to prevent infection and preclude the need for antimicrobials. Yet, most of the 138 National Action Plans on AMR have focused on infection prevention and control in healthcare and some mention vaccination programmes at a community level. However very few, if any, have mentioned community-based infection control programmes or hygiene and sanitation within the home or everyday settings like schools and workplaces. It is important that all stakeholders now recognise the vital role of hygiene in the home and community as an effective part of the solution, to help reduce not only COVID-19 but also AMR. The return in investment is significant with the US already showing that implementing improved hygiene strategies in the home can save $138 million in direct medical costs.4
COVID-19 can be leveraged to reinstate AMR on the global and national public health agendas. AMR must be explicitly acknowledged as the silent pandemic, that adversely affects humans, animals, plants, the environment, and their various interfaces and ecologies. AMR is a One Health issue and its impact is so much more far reaching than COVID-19. The collateral damage of COVID-19 in escalating AMR because of excessive and inappropriate antimicrobial use should be highlighted.
Policy makers should be made aware of the fact that every single AMR indicator will be worsened, and several sustainable development goals (SDGs) that are directly or indirectly associated with AMR will be compromised as will be progress on the International Health Regulations (IHR). Policy makers should equally be made aware of infection prevention strategies that will prevent, contain and mitigate AMR such as vaccination, WASH and infection prevention and control in health facilities. AMR requires the same whole of society, whole of government response, the top-down and bottom-up mobilization from policy makers to civil society that is currently in place for COVID-19. Essential to the success of the AMR response will be consistent, accurate and tailored messaging at all levels, taking due cognizance of differences in health literacy, to ensure the whole of society ownership in mitigating AMR.
- Review on Antimicrobial Resistance: Tackling Drug-resistant Infections Globally. 2014. Available from: https://amr–review.org/Publications.html.
- Azor-Martinez E, Yui-Hifume R. Effectiveness of a hand hygiene program at child care centers: a cluster randomized trial. Pediatrics. November 2018;142 (5). Available from:
https://www.ncbi.nlm.nih.gov/pubmed/30297500 (Accessed 15 April 2020)
- Duff et al. Cost-Effectiveness of a Targeted Disinfection Program in Household Kitchens to Prevent Foodborne Illnesses in the United States, Canada, and the United Kingdom. Journal of Food Protection. November 2003. Available from: https://meridian.allenpress.com/jfp/article-lookup/doi/10.4315/0362-028x-66.11.2103