A report shared by Africa CDC in August 2024 finds that the threat presented by treatment-resistant diseases has increased in Africa, with children and other vulnerable groups at greatest risk. African Union AMR Landmark Report: Voicing African Priorities on the Active Pandemic, demands a “comprehensive, multi-sectoral approach involving the entire society” to address the challenges of antimicrobial resistance (AMR), which extend beyond morbidity and mortality.
“The comprehensive measures outlined in this report are essential for curbing the threat of AMR in Africa, ensuring the health and prosperity of future generations, and achieving sustainable development goals across the continent.”
The global and continental burden
The authors describe the “existential impacts” of AMR as “far-reaching”; it represents a “significant public health challenge”. 4.95 million deaths in 2019 were associated with bacterial AMR, of which 1.27 million deaths were “directly attributable” to AMR, surpassing the burden of HIV and malaria. This highlights that AMR is a leading cause of mortality, but sub-Saharan Africa suffers greatest burden. Beyond death and disability, AMR “carries substantial economic implications at personal, national, and global levels”. AMR is projected to result in an additional US$1 trillion in healthcare expenses by 2050.
The report acknowledges that antibiotics are considered the “cornerstone of modern medicine”. However, the emergence and re-emergence of AMR could “potentially revert us to an era when antibiotics did not exist”.
“AMR not only threatens to roll back decades of development gains and disrupt healthcare services but also poses a significant barrier to achieving global health security and economic development.”
The highest burden of AMR is in low-resource settings, which have the greatest infectious disease burden and “weaker” health systems. In 2019, sub-Saharan Africa (SSA) experienced the highest rate of AMR burden; 23.7 deaths per 100,000 people and 255,000 deaths were attributed to AMR. Notably, this surpasses malaria and HIV/AIDS mortality.
Although The World Health Assembly adopted the Global Action Plan on AMR, endorsed in the 2016 UNGA high-level meeting on AMR, the adoption and implementation of AMR interventions in Africa is “limited”. This is attributed to “misalignment of priorities, lack of resources, and inadequate coordination”. Thus, the imminent UNGA high-level meeting on AMR offers Africa the opportunity to “elevate its priorities and secure commitments” to address the challenge.
Implementation of AMR One Health National Action Plans (NAPs) has had “mixed” progress. The report suggests that this has been “fragmented” due to dependence on foreign funders and a “lack of awareness, knowledge, and appreciation” of the threat. However, the authors recognise “commendable progress in certain areas”. For example, Africa has made “significant strides in stewardship and surveillance”; 57% of African countries have adopted the AWaRE (Access, Watch, Reverse) classification of antibiotics on National Essential Medicine Lists (NEMLs). 50% of African countries have implemented integrated surveillance systems for AMR. These improvements, though slow, highlight “potential and ongoing efforts”.
A key challenge is access to antibiotics, with “many” countries relying on imports for over 90% of their pharmaceutical needs. This results in “frequent shortages and chronic out-of-stocks”. Additionally, global supply chain pressures can affect access in LMICs and undermine the resilience of health systems. Lack of access leads to over-reliance on the few available drugs, even if they are not the primary choice, and can result in “severe health outcomes”.
The registration process for some antibiotics is lengthy, which discourages pharmaceutical companies from entering and limits the availability of essential medicines. Furthermore, continental investment in research and development is “inadequate”; “very few countries” have the infrastructure for Phase III clinical trials and local data on AMR remain “insufficient”.
“By aligning African needs with global efforts, the continent can effectively enhance its capacity to combat AMR and contribute to the global response.”
The challenges
The effort required to address AMR in Africa faces “specific challenges”:
- Strengthening governance and leadership – governance and coordination structures are still not completely aligned with the frameworks outlined in the Global Action and National Action Plans. This misalignment creates gaps in integrating diverse stakeholders and sectors and hinders accountability.
- Addressing the driver of AMR in Africa – addressing the drivers of AMR in Africa involves tackling multiple contributing issues. These include gaps in IPC/WASH programmes, poor adherence to biosecurity and animal husbandry practices, vaccination challenges, regulatory barriers, socio-economic barriers, low public awareness, and underdeveloped public health systems.
- Building evidence and improving reporting – understanding the landscape and responding with informed decisions requires robust evidence and effective reporting systems. Data collection, analysis, and utilisation systems are often inadequate, with only a few comprehensive AMR surveillance systems. A lack of standardised reporting mechanisms and integration of surveillance data across human, animal, and environmental health sectors hinder the creation of a cohesive evidence base.
- Mobilising and coordinating resource effectively – the continent often depends on sporadic international funding, which leads to fragmented efforts and short-term projects that neglect the enduring nature of AMR threats. Lack of sustained financial commitment undermines the continuity and effectiveness of AMR control measures.
- Strengthening community engagement and education – gaps in community engagement and education limit public understanding and support for initiatives. Without comprehensive community involvement and educational outreach, efforts to encourage responsible antimicrobial use and enhance infection prevention and control measures are weakened.
- Enhancing research and innovation – progress is hampered by various obstacles such as limited funding, inadequate infrastructure, and a shortage of skilled researchers. Development and implementation of solutions is also hindered by lack of collaboration between institutions and restricted access to advanced technologies.
Priority actions
The report offers the following priority actions in response to these challenges:
- Enhance leadership commitment, implement integrated governance structures, strengthen coordination and communication, define clear terms of reference, promote legislative support and institutional mechanisms, engage diverse stakeholders.
- Improve adoption of IPC, WASH, biosecurity, and animal husbandry measure in human, animal, and environmental sectors, increase vaccination rates for high-priority pathogens in high-risk African countries, raise public, professional, and policymaker awareness of AMR, increase uptake of alternatives to antimicrobials, increase availability of high-quality diagnostics, vaccines, and antimicrobials for high-priority pathogens in high-risk African countries.
- Establish country-level baselines for antimicrobial consumption and resistance, consolidating country-wide reporting, define a core set of indicators to measure the impact of AMR in Africa, measure the cost of inaction in the African context, strengthen data and information sharing platforms.
- Endorse targets applicable for Africa to support AMR actions, mobilise funding to close the gap for AMR actions across Africa, support fully costed NAPs with funding tied to milestones, promote the One Health approach by incorporating AMR into broader agendas to coordinate resources.
- Develop and implement comprehensive public education campaigns, enhance community-based interventions, strengthen pre-service-based education programmes, facilitate professional development and training, leverage technology and social media.
- Increase funding and investment in research, build and upgrade research infrastructure, promote interdisciplinary and cross-sector collaboration, streamline regulatory and ethical approval processes, support capacity building and talent retention.
Goals and conclusions
The short-term goals (0-6 months) focus on sharing the report with stakeholders and engaging these stakeholders to discuss recommendations, build consensus, and refine strategies for implementation. Medium-term goals (6-12 months) place an emphasis on key policy recommendations, including establishing “robust” regulatory frameworks, launching public awareness campaigns, and developing and strengthening surveillance systems.
“These efforts will involve significant investments in capacity building, technology upgrades, and the establishment of data-sharing protocols across countries and regions.”
Long-term goals (12+ months) focus on monitoring and evaluating progress, with assessments against the core objectives of the Global Action Plan (GAP) on AMR. This phase also involves “sustained efforts” to mobilise financial, technical, and human resources to support ongoing and new initiatives.
“Strengthening partnerships with international donors, private sector stakeholders, and regional bodies will be crucial to ensuring the continued availability of resources and support.”
The authors conclude the report by looking forward to the UNGA high-level meeting on AMR and reminding stakeholders of the importance of uniting in support of the recommendations. They highlight the significance of collaboration to implement the strategies and ensure progress is sustainable.
“The stakes are high, and the potential benefits of addressing AMR are immense. Investing in AMR initiatives will save lives, improve health outcomes, boost economic productivity, and strengthen healthcare systems across the continent. We call upon the global community to recognise the urgency of the AMR crisis in Africa and commit to taking bold and coordinated actions.”
Comments
Africa CDC Deputy Director General Dr Raji Tajudeen, speaking at the launch of the report, commented that the “silent threat” of AMR must not be ignored.
“Fighting disease requires resources and working with member states and our partners; we need to do all we can to save lives.”
Dr Huyam Salih, director of the African Union-Inter African Bureau for Animal Resources (AU-IBAR), drew attention to the fact that AMR is “not just a health issue”.
“It is a threat to our agrifood systems, food safety, food security, livelihoods, and economies.”
This is “particularly alarming” in Africa, where 37 countries report the prevalence of AMR in animal farms, but on 16% of countries are conducting routine AMR surveillance in animals.
“Our health, our food, and our future depend on the actions we take now.”
Nqobile Ndlovu, head of the African Society for Laboratory Medicine, emphasised the organisation’s commitment to strengthening laboratory capacities to address AMR.
“Our goal is to ensure the continued efficacy of treatments and promote data-driven solutions to safeguard public health across the continent.”
For more on the role that vaccines can play in global efforts against AMR, why not join us at the Congress in Barcelona this October? Get your tickets here and don’t forget to subscribe to our weekly newsletters here. You can also check out our Congress interview from Washington with Dr Yewande Alimi, who led and wrote the report, for her insights into AMR in Africa.
