Staphylococcus aureus causes a skin infection that can become fatal in the event of drug resistance. Estimates for the most common resistant variation, methicillin-resistant Staphylococcus aureus (MRSA), have a global death toll of more than 100,000 in 2019.
But until recently, we had no solid knowledge of the magnitude of the problem that MRSA — or any other antimicrobial resistant pathogen — poses in Africa.
After testing 187,000 samples from 14 countries for antibiotic resistance, our colleagues concluded that 40% of Staph infections were linked to MRSA.
Africa, like every other continent, has an RAM problem. But the continent stands out because we have not invested in the capabilities and resources to determine the extent of the problem, or how to solve it. Take MRSA. We still don’t know what causes the bacteria to become resistant. We have not taken the full extent of the problem either.
We don’t take RAM seriously enough, perhaps because it’s not a glamorous, selling topic. The technology we currently use to identify resistant pathogens is neither sophisticated nor futuristic.
Fighting AMR doesn’t involve miracle drugs, expensive treatments, or elaborate diagnostic tests. Instead, we have bacteria and other ordinary pathogens, which have learned to dodge the good old drugs that worked before.
“Africa, like every other continent, has an RAM problem. But the continent stands out because we have not invested in the necessary capabilities and resources…”
The global pharmaceutical and healthcare industries do not seem to consider solving this problem to be very cost-effective. Compare this to the urgency to tackle COVID-19, which governments eager to end the pandemic have embraced, including by subsidizing interventions such as diagnostic tests. The response to COVID-19 has been characterized by innovations emerging literally every other week.
Why can’t we harness the resources and passion on the RMA? Are resistant pathogens too boring? Is this problem too difficult to solve through innovations? Does that make the prospect of quick fixes and quick returns on investment too elusive for RMA, especially when compared to COVID-19 or other infectious disease outbreaks?
The World Health Organization (WHO) has repeatedly asserted that RMA is a global health priority. It is in fact one of the main threats to public health in the 21st century.
A recent study estimated that in 2019 nearly 1.3 million people died due to antimicrobial resistant bacterial infections. Africa bears the heaviest burden in terms of deaths. A high prevalence of AMR has also been identified among foodborne pathogens isolated from animals and animal products in Africa.
Together, these figures suggest that the burden of RMA might be similar to that of HIV/AIDS or COVID-19, or even worse. The growing threat of AMR is likely to weigh heavily on health systems in Africa. It seriously jeopardizes the progress made towards achieving the public health goals set by individual countries, the African Union and the United Nations.
“A recent study estimated that in 2019 nearly 1.3 million people died due to antimicrobial resistant bacterial infections”
And the lack of accurate information regarding RMA limits our ability to understand how well commonly used antimicrobials actually work. It also means that we cannot determine what drives RMA infections and design effective interventions in response.
We have just completed a project that has collected data on many of the pathogens of greatest concern in 14 countries. This unearthed stark findings on the under-detected and under-reported severity of the AMR crisis across Africa.
Less than 2% of medical laboratories in the 14 countries surveyed are able to conduct bacteriological testing, even with conventional methods developed more than 30 years ago.
While empowering national stakeholders with essential information to advance their policies on RMA, we also provided training and electronic tools to more than 300 healthcare professionals to continue this important surveillance.
While strengthening staff is critical, many health facilities on the continent are facing power cuts, poor connectivity and severe and ongoing labor shortages.
“The lack of accurate information regarding RMA limits our ability to understand how well commonly used antimicrobials actually work”
Our work has portrayed the harsh reality of the AMR surveillance situation, informing concrete recommendations for improvement that align with the new continental public health ambition of the African Union and the African Center for Control. and disease prevention (Africa CDC). The challenge is to find the funding to expand these initiatives to cover the entire African continent.
RMA requires a long-term approach, especially in Africa, where health systems are chronically underfunded, while being overly strained by infectious threats. More funds must be devoted to this problem. This funding cannot come solely from international aid.
We urge African governments to honor their past commitments, fund their health systems in general, and address the AMR crisis in particular. We also call on bilateral donors and global stakeholders to focus their priorities on improving the health of African people.
This may require paying more attention to locally relevant evidence to inform investments and less concern with profit-driven market interventions. It is also necessary to prioritize the expansion of proven technologies and strategies, whether they are innovations or not.
Stemming AMR means we need to fix Africa’s health systems. The work begins now.
