Africa is currently grappling with a disturbing expansion in antimicrobial resistance (AMR), contributing to a significant health crisis on the continent. According to the African Union Landmark AMR Report, African health officials have signaled the severe repercussions of AMR and have laid out a strategic plan to counter this growing concern. In 2019, AMR was linked to over 255,000 fatalities in Africa, which makes up more than a fifth of the worldwide total. This underlines the sheer burden of AMR in the continent, particularly in sub-Saharan Africa, registering the heaviest AMR burden globally with a rate of 27.3 deaths per 100,000 inhabitants.
Factors contributing to the surge in AMR include a paucity of diagnostic procedures and antibiotics, their overuse in humans and food livestock, low vaccination rates, significant lacunas in AMR surveillance, and restricted understanding of AMR. These concerns are amplified by further impediments such as limited access to hygienic and safe water, insufficient hospital infection control measures, and a shortfall in funding and political commitment.
Specific indicators highlight Africa’s lag behind the global average in its AMR response. For instance, a mere 13% of African nations have executed nationwide programs enforcing infection prevention and control (IPC), along with water, sanitation, and hygiene (WASH) measures, diverging significantly from the global average of 39%. Moreover, only 35% of African states utilize antimicrobial consumption and utilization data to inform policies, contrasting sharply with the worldwide average of 62%.
Scarcity of antibiotics poses another problem. Most antibiotics consumed in African healthcare facilities come from a narrow range of just four drugs, leaving WHO-recommended Reserve category antibiotics, utilized for multidrug-resistant infections, absent from national Essential Medicines Lists in 86% of cases. Furthermore, due to their dependence on imports for more than 90% of their pharmaceutical requirements, often, shortages occur. The resultant over-reliance on the few accessible drugs, even if they are not the primary treatment choice, escalates the risk of developing and spreading AMR.
Antimicrobial resistance surveillance further suffers due to a shortage of microbiology laboratories with analytical capabilities. An African Society for Laboratory Medicine survey of 14 countries found out that just a meager 1.3% of 50,000 laboratories scrutinized performed bacteriologic analysis. Also, testing was only targeted at a restricted number of pathogens.
The report underscores certain positive strides made by African countries. Up to half of the nations have established or have started the implementation of an integrated surveillance system for AMR. Additionally, 57% have adopted the WHO Access, Watch, and Reserve (AWaRe) antibiotic classification system, and 48% have implemented a One Health strategy to bridge communication between the human, animal, and environmental health sectors.
Several recommendations have been put forth in the not-yet-finalized report to help African nations implement a comprehensive approach to combat the AMR crisis. All proposals are aimed at bolstering governance and leadership; incorporating stakeholders from human, animal, and environmental health sectors; improving IPC and WASH protocols; increasing vaccination rates; enhancing AMR surveillance and awareness; and augmenting financial support for AMR mitigation efforts.
African officials are hopeful that the umbrella strategy will demonstrate the urgency of the AMR crisis in Africa and drive other parts of the global community into committed action and sufficient resource allocation.