By Mary Hearty

Antimicrobial resistance (AMR) is one of the most complex public health threats with root causes in multiple sectors ranging from health, food safety, and agriculture, to environment and trade.

Studies have predicted a continued rise in AMR globally, leading to 10 million people dying every year and 3% reduction in Gross Domestic Product (GDP)by the year 2050.

Moreover, the 2022 gram report estimated that at least 1.27 million deaths per year are directly attributable to AMR. In 2019, the highest rates of AMR burden were in sub-Saharan Africa, where six pathogens accounted for 73.4% of deaths.

From the 2021 AMR surveillance report, Kenya is no exception to this threat with increasing rates of AMR being reported in hospitals and communities.

In response to this, the Ministry of Health in partnership with the Ministry of Agriculture, Livestock and Fisheries and Co-operatives have been part of the regional and international efforts to reduce AMR, and ensure the availability of effective antibiotics now and into the future.

The two ministries have consolidated national efforts to implement sustainable measures to mitigate any further emergence and spread of AMR.

Speaking during the National AMR Forum, Dr Rashid Aman, Chief Administrative Secretary (CAS), at the Ministry of Health, stated that the complexity posed by AMR demonstrates that no single government department or independent organization can tackle it alone.

Dr. Rashid Aman, CAS Health

The containing, controlling and preventing the emergence of AMR demands engagement and well-coordinated actions across multiple levels, sectors, and disciplines with a broad range of stakeholders.

Using this one health approach, the ministries developed a policy and from there, the national action plan (NAP) and the implementation of the policy is well underway.

Dr Aman said implementation of NAP is not an overnight success. It takes functional and integrated systems with well-coordinated, appropriately resourced governance structures to successfully and effectively implement the interventions in these plans at the national level, noting that governance and coordination mechanisms are implemented through the national antimicrobial stewardship inter-agency committees (NASICs) and the supporting secretariat.

This has been cascaded to the devolved units in the county level with the implementation of the NAP being carried out by the county antimicrobial stewardship inter-agency committees (CASICs).

So far, he explained, 14 counties have established their CASICs, and the ministry is committed to ensure that other counties have developed theirs as well. Of these 14 counties, eight have already developed their county-specific action plans on AMR namely. Some of these counties are: Bungoma, Nyeri, Murang’a, Trans-Nzoia, Kisumu, Kilifi, Kiambu.

“This progress is commendable, and I believe we will be able to get all the 47 counties on board, and have them develop their own action plans and have them incorporated with the budget from the counties,” Dr Aman acknowledged.

The government with the support of the development partners has taken several measures on various sectors to intensify actions against AMR through the implementation of the national policy and action plan on AMR, and accompanying strategies on surveillance, communication, infection prevention and control (IPC), and antimicrobial stewardship.

According to Dr Aman, this will go a long way towards addressing the challenges identified in the situation analysis on awareness, surveillance systems, IPC, rational use of antibiotics, and research and development.

As much as notable progress has been made, the CAS ministry of health said there is still a bit of work and ground to cover, especially with the ongoing COVID-19 pandemic as several studies globally have indicated a high rate of antimicrobial prescribing and self-medication of those with symptoms of COVID-19, much of which is unnecessarily promoting AMR as most of the initial illnesses being treated have been from COVID-19 viral infection.

In this regard, he said optimal utilization of laboratories is critical in ensuring that the continuous engagement of patients, the clinician and laboratory teams supporting judicious use of antimicrobial agent continues as guided by the national antimicrobial stewardship.

“We need to improve our health systems and our health diagnostic systems to make it much easier to be able to identify the problem and its source,” Dr Aman advised.

At the moment, antimicrobial susceptibility testing (AST) is based on culture even though there are new technologies- molecular technologies.

“We have been able to go through COVID-19 using the new technologies and it is possible to adapt these technologies also to AMR in order to cut down on the time to get the results of the resistance, and guide treatment,” he stated, adding that inaction would have dire consequences on animal, plant and environmental health.

Hence, the call to accelerate action in curbing the growing threat of AMR in the next version of the national action plan, which targets eliminating or significantly reducing the sales of antimicrobial drugs that are important for medical or veterinary purposes; reducing the overall need for antimicrobial drugs by improving IPC, hygiene, biosecurity and vaccination programs in humans, agriculture, and aquaculture.

In addition, he advised that we need to end the use of antimicrobial drugs that are of critical importance to human medicine, in promoting growth in animals limiting the amount of antimicrobial drugs administered to prevent infection in health animals and plants, and ensuring that the use is performed with regulatory oversight; ensuring access to quality and affordable antimicrobials for animals and human health; and promoting innovation of evidence-based and sustainable alternatives to antimicrobials in food systems.

Also, he said oversight and governance are critical in the event of proposed interventions, noting that there is need to ensure that there is effective governance and professional oversight of the sales and use of antimicrobials and stewardship of antimicrobials in all sectors including the development and implementation of evidence-based guidelines for treatment, control and prevention.

Dr Aman further emphasized the need to establish mechanisms to improve and broaden appropriate access to good quality antimicrobials.