It is possible and affordable to delay action on antimicrobial resistance
A patient’s experience with AMR in a hospital setting: The case of an So Paulo, Brazil, boy who lost his life five years ago
One of the main factors driving the global rise of AMR is the use of inappropriate or substandard antibiotics. Indeed, people in low- and middle-income countries, which often lack ‘second-line’ antibiotics — more effective, and often more expensive, than those that are the first choice for treatment — are much more likely to die of infections caused by resistant bacteria than are those in high-income nations. A modelling study published in The Lancet in May (which I was involved in) indicates, however, that even a fairly modest global investment — in the range of hundreds of millions of US dollars — to help prevent bacterial infections and improve access to relatively inexpensive antibiotics could avert millions of deaths (J. A. Lewnard et al. 2439–2454, is the most recent volume of the Lancet.
In Bangladesh, and in low- and middle-income countries more generally, there must be a global commitment to support research and data collection as well as the basic interventions to reduce it.
Thanks to biases in the available data, many people think, for instance, that resistance is ubiquitous. Even though early-generation drugs can still be used, physicians often give last resort antibiotics to patients. This could possibly be worsening resistance.
The best way to save the lives of the babies at Shishu hospital is to prevent infections. Strategies that could substantially reduce AMR include investing in parental nutrition during gestation (which, in turn, would improve babies’ birth weights and reduce their susceptibility to infection), ensuring that pregnant people receive antenatal and perinatal care and promoting delivery practices that minimize the risk of babies (and birthing parents) getting infections.
Five years ago, a 15-year-old boy was brought into the hospital where I work in São Paulo, Brazil, after developing an infection. He had cut his ankle and was trying to retrieve a kite. The boy died five weeks later after becoming ill with a severe, antibiotic-resistance Staphylococcus aureus.
An example of the case I described was that of hospital settings. And in Brazil, one of the biggest challenges is people’s failure to recognize AMR as a public-health problem. Most people who aren’t in a hospital do not have the knowledge required to understand how AMR can affect their health. Malaria, leishmaniasis, and Chagas disease are some of the endemic diseases the country is battling. And over the past 10 years, Brazil has experienced numerous epidemics caused by mosquito-borne viruses, including Zika, chikungunya, yellow fever, dengue and, most recently, Oropouche fever. More attention is given to diseases like these and it’s harder to pin down a cause.
There are things you can do to protect yourself from infections at health-care facilities. In 2020, the Nigeria Centre for Disease Control and Prevention released updated guidelines on infection control and prevention. According to the modelling study published in May, when followed carefully, guidelines could be used to prevent infections that cause 300,000 deaths a year.
People have been able to buy antibiotics for their own use only since a law was introduced. Over the past few years, the government has invested millions of US dollars in research on AMR — and in surveillance, both in state laboratories and in hospitals. Furthermore, Brazil has developed a national plan to reduce the problem using a multisectoral and transdisciplinary ‘One Health’ approach, which is currently under review.
One-quarter of Nigeria’s population defecates outside, such as in fields, gutters and forests, instead of using a toilet, some or all of the time. And data from a 2024 report3 I was a part of a show that showed that most city dwellers rely on wells for their water, if it is contaminated by faeces. This is the case in Ibadan, where I live. The agents of disease can spread easily and non-harmful organisms can be carriers of resistance genes. One such commensal microorganism is Escherichia coli, which is typically found in the intestine. Providing people with safe water could reduce the impact of enteric infections caused by the same germs as an estimated return of US$5 or more for every $1 spent.
I am constantly worrying about whether my mother, who has a recurrent infection of the urinary tract (which is resistant to most antibiotics), will be able to keep accessing the health-care services and antibiotics she needs. She lives in Beirut, Lebanon, and I am always reminding her to keep her passport and antibiotics to hand in case she has to flee in the face of a military attack.
The challenges of AMR surveillance in low- and middle-income countries: a U.N. High-Level Meeting Report on the 2017 AMR Action Plan
In 2017, Nigeria launched an AMR surveillance system. Once the system covers a greater geographic area and more comprehensive data for people, animals, and the environment is collected, investigators will be able to quantify the impacts of each of the tools and support the prioritization of interventions for national deployment.
This is the second time that AMR has been featured at a high-level UN meeting. The first one, in 2016, highlighted the importance of the problem, which is associated with nearly five million deaths each year worldwide. Although there has been some progress in the past eight years, such as the development of national action plans by many countries, the pace of change has been slow. I am presenting at the upcoming meeting, and I hope to convince attendees that the next eight years could look very different.
Malaria and most bacterial infections do not last as long as do tuberculosis or AIDS, from which people tend to die months or years after infection. A child with an infection who develops a fever in the morning can be dead the next day if they don’t receive the right antibiotics. It’s unavailable in low- and middle-income countries. Parents and other carers must frequently turn to their local pharmacies for help. Hundreds of millions of people are using drugs that are fake or poor-quality, in part because it is difficult to set up systems that limit the entry of these types of drugs.
International funders, such as the Global Fund, must step up. People with HIV have a high risk of developing bacterial, viral, fungal and protozoal infections. The Global Fund has a mandate to give people access to effective diagnostics and antibiotics, and it would make sense to broaden that mandate to include more people.
The United States Agency for International Development in Washington DC, as well as the Vaccine Alliance, need to support prevention strategies that include vaccines, safe water, and good sanitation. In low- and middle- income countries, they need to be priorities in the national budgets.
With investment from global funders, specific targets and accountability through an independent panel, there is a much higher chance of this year’s discussions at the General Assembly translating into global action to tackle AMR.
A new study has found that people in low- and middle-income countries, which often lack’second-line’ antibiotics, are much more likely to die of infections caused by resistant bacteria than are those in high-income nations. It said even a small global investment to help prevent bacterial infections and improve access to relatively inexpensive antibiotics could avert millions of deaths.