Amid a burgeoning mpox crisis, African health officials are drawing attention to the growing burden of antimicrobial resistance (AMR) on the continent and have laid out a roadmap for addressing the problem.
In the African Union Landmark AMR Report, launched last week, officials from the Africa Centres for Disease Control and Prevention (Africa CDC), the African Union Inter-African Bureau for Animal Resources, and member states reported that AMR was responsible for 255,000 deaths in Africa in 2019—more than 20% of the global total—and that sub-Saharan Africa experienced the highest AMR burden of any region in the world, with 27.3 deaths per 100,000 people.
Lack of antibiotics and diagnostics, overuse of antibiotics in people and food animals, suboptimal vaccination rates, significant gaps in AMR surveillance, and limited knowledge of AMR are some of the factors contributing to the problem, the report said. But officials said the issue is compounded by additional challenges, including lack of access to clean and safe water sources, inadequate infection prevention measures in hospital, and a shortage of funding and political will.
"We must not ignore this silent threat that disproportionately impacts the most vulnerable among us," Africa CDC Deputy Director General Raji Tajudeen, MD, MPH, said in an Africa CDC press release. "Fighting disease requires resources and working with member states and our partners we need to do all we can to save lives."
'Pervasive' lack of access to common antibiotics
The report spotlights several areas in which Africa has fallen behind on key AMR indicators.
For example, only 13% of African countries have implemented nationwide infection prevention and control (IPC) and water, sanitation, and hygiene (WASH) programs in line with World Health Organization (WHO) guidelines, far below the global average of 39%. Only 35% of countries on the continent use antimicrobial consumption and use data to inform decision-making and policies, compared with the global average of 62%.
Lack of access to antibiotics is also a major problem. The report notes that 67% of antibiotics used in African healthcare settings are skewed toward just four drugs, and that WHO-recommended Reserve category antibiotics, which are used for multidrug-resistant infections, are missing from national Essential Medicines Lists in 86% of cases. And because many African countries rely on imports for over 90% of their pharmaceutical needs, shortages are frequent.
"The pervasive lack of access to common antibiotics has led to an over-reliance on a few available drugs, even when they are not the primary choice for treatment," the report states. "This situation exacerbates the risk of developing and spreading antimicrobial resistance."
The continent also suffers from a lack of microbiology laboratories that can conduct AMR surveillance. According to a survey of 14 African countries by the African Society for Laboratory Medicine, only 371 (1.3%) of 50,000 surveyed laboratories performed bacteriologic analysis for priority bacterial pathogens, and even then, testing focused on only a limited number of pathogens. Just one of the surveyed countries reported data to the WHO's Global Antimicrobial Resistance and Use Surveillance System.
While roughly 80% of African countries have developed national action plans (NAPs) to address AMR, the report notes that many of those plans were developed without a detailed situation analysis and lacked local data, which compromises their effectiveness. Moreover, many African countries have lacked the funding to implement their NAPs.
The pervasive lack of access to common antibiotics has led to an over-reliance on a few available drugs, even when they are not the primary choice for treatment.
But the report also highlights some bright spots, noting that 50% of African countries have established or started implementation of integrated surveillance systems for AMR, 57% have adopted the WHO Access, Watch and Reserve (AWaRe) antibiotic classification system, and 48% have adopted a One Health strategy by formalizing or initiating coordination between the human, animal, and environmental health sectors. All those percentages are near the global averages.
"These improvements highlight the continent's potential and ongoing efforts to combat AMR through comprehensive and coordinated strategies," the report states.
Leadership and financial support needed
Although the report has yet to be finalized, it contains several recommendations to help African countries implement a "comprehensive and strategic" approach to mitigate the impact of AMR in Africa.
The first calls for strengthening governance and leadership across the continent by promoting high-level commitments to AMR interventions among African leaders. It also recommends that African governments create central AMR coordinating bodies that bring together stakeholders from the human, animal, and environmental health sectors.
Other recommendations include boosting IPC and WASH protocols at health facilities, increasing vaccination rates for high-priority pathogens in high-risk countries, strengthening AMR surveillance and monitoring, and raising AMR awareness among policymakers and the public.
The report also calls for increased financial support for AMR mitigations efforts.
"The financial requirements for an effective AMR response in Africa are estimated to be between USD 2-6 billion per year, yet current funding falls short by a factor of 10 compared to other major disease areas," the report states. "The estimated annual budget for AMR NAPs is around USD 100 million, indicating a substantial funding gap that necessitates additional support from both governments and the international community."
African officials say the upcoming United Nations High-Level Meeting on AMR will provide an opportunity to highlight the lack of resources on the continent and secure commitments for addressing AMR.
"Investing in AMR initiatives will save lives, improve health outcomes, boost economic productivity, and strengthen healthcare systems across the continent," they wrote. "We call upon the global community to recognize the urgency of the AMR crisis in Africa and commit to taking bold and coordinated actions."
