Stop escalating antibiotic resistance or perish

The New York Times recently narrated how a desperate mother in Nairobi’s informal settlement of Kibra who could not afford to consult a qualified healthcare professional used multiple cheap antibiotics inappropriately to treat her infant’s febrile illness.

KILLING 45,000

This resonated with me deeply since my mother did the same to us when we lived at Olympic Estate, in Kibra, in the late 1990s. No wonder, antibiotic resistance rates in Kenya are increasing.

Nearly 70 per cent of salmonella infections in Kenya do not respond to the most widely available antibiotics, killing 45,000 children yearly, yet the United States and the United Kingdom record no death by the bacteria. Infectious diseases such as tuberculosis and typhoid — both highly prevalent in Kenya — are primarily treated with antibiotics and, with increasing resistance levels, treating them is gradually becoming more difficult.

While the UN’s Global Tuberculosis Report states that Kenya is on track to reach the 2020 target of a 20 per cent reduction in cases and deaths, the escalating antimicrobial resistance (AMR) trend threatens this.

To tackle inappropriate use of antibiotics and forestall the spread of AMR, we need to take three urgent steps: Better fund and implement the Kenya AMR National Action Plan, improve on leadership and accountability for progress, and get all players to work in partnership.

POLICYMAKERS

First, it’s imperative that the AMR National Action Plan is fully funded and implemented. While at the UN General Assembly in 2016, I was proud to see Kenya featuring prominently at the UN High-Level Meeting on AMR as the only African country with such a bold plan that has clear action points for policymakers, healthcare professionals and citizens.

But a recent WHO report has asked local policymakers to improve surveillance and infection control measures of AMR. Healthcare professionals should prescribe and dispense antibiotics only when necessary — using diagnostic tools, for example — and report antibiotic-resistant infections to surveillance teams.

The AMR National Action Plan also calls on Kenyans to play their part in fighting AMR by only using antibiotics when prescribed by a certified health professional, never demanding antibiotics, and preventing infections through cleanliness, hygiene and vaccinations. Secondly, as reported from a recent meeting between ReAct — a global civil society group with a footprint in Kenya — and invited Kenyan policymakers, effective leadership, governance and accountability can catalyse the fight against AMR.

ENFORCE LAWS

We need to better enforce laws and regulations on antimicrobial stewardship, including stronger regulation of unlicensed healthcare professionals and pharmacies. We need affordable, quality assured antibiotics to safeguard public health and, as noted in the 2018 Access to Medicine Foundation’s analysis of the access issues on antibiotics, this is a core responsibility of governments, supported by regulators and the industry.

One of my favourite teachers at Starehe Boys Centre, Nairobi, Francis Wang’endo, liked using the Kiswahili saying “Umoja ni nguvu” (unity is strength) to beg us to collaborate with one another. No entity can tackle AMR on its own, so we must focus on building and strengthening new and existing partnerships.

Companies must work closely with governments and non-governmental organisations (NGOs) to break down barriers to access to antibiotics.

It’s significant that a diverse coalition of biotechnology, diagnostics, generics and large research-based biopharmaceutical companies and associations — the AMR Industry Alliance — has come together to add their expertise and resources to the fight against AMR. 

EXISTENTIAL THREAT

Focusing on four key areas, the members are investing in research and science, ensuring responsible environmental manufacturing, guaranteeing appropriate use of antibiotics and tackling limited access.

More companies need to join their ranks to stem the rapid spread of AMR by implementing its commitments, including ensuring promotional activities for antibiotics are aligned with the goal of advancing stewardship; work to reduce the prevalence of substandard and falsified AMR-relevant products and collaborate with policymakers to create an economic and regulatory environment that enables the sustainable supply of quality-assured antibiotics.

Kenya is among a handful of African countries with an AMR action plan. With increasing rates of AMR, now is the time to overcome this existential threat to our lives and modern medicine.

Dr Sekidde, director of Antimicrobial Resistance Policy and Partnerships at GSK, is a board member of the AMR Industry Alliance.