Tackling Antimicrobial Resistance: Integration and Systems Strengthening
As the world prepares for the next pandemic, the insidious threat posed by antimicrobial resistance (AMR) must be addressed. While diseases like Ebola, COVID-19, and Mpox capture the headlines, AMR is a “creeping pandemic” lurking behind these better-known threats. Hidden—yet everywhere—resistant bacteria are thriving in our healthcare settings, social spaces, and within the systems we need to survive. Across Africa, AMR causes more deaths than malaria, HIV and TB, according to Devex Newswire, and the continent needs $2 billion to $6 billion annually to counter it.
Recent estimates report 5 million deaths annually are associated with AMR—a quarter from drug-resistant tuberculosis alone—and the projected economic impacts of AMR are in the trillions of dollars. When doctors and veterinarians are unable to prescribe effective antibiotics, antivirals, and antifungal products, because infectious agents become resistant to accessible, preferred prevention and treatment options, the impact on people and animals is devastating. We lose our ability to safely provide modern healthcare. With the United Nations General Assembly (UNGA) High Level Meeting on AMR beginning, global health leaders are discussing practical paths to addressing this global threat. Abt’s two cents:
Addressing AMR through isolated, disease-specific, or population-specific approaches will not be sufficient to curb its rise. A strengthened health system, with a robust primary health care (PHC) foundation, and cross-sectoral approaches involving human, animal, and environmental health, is critical for an effective and sustainable response to AMR.
Let’s briefly review how we got here.
Human Behavior and Healthcare
In healthcare settings, antibiotic misuse—including overprescription, improper dosing, and poor adherence to infection prevention measures—has led to resistant pathogens like MRSA and multidrug-resistant Klebsiella pneumoniae. These healthcare-associated infections burden health systems through increased disease, death, and healthcare costs. Excessive use of antibiotics in surgical prophylaxis and routine procedures without infection risk contributes to AMR. Patient demand for quick fixes, particularly for viral infections where antibiotics are ineffective, drives overuse. Many health systems lack adequately resourced antimicrobial stewardship programs or have strained diagnostic networks that delay cultures, creating obstacles to prescribing first-line antibiotics in a timely manner.
In health supply chains, continued access to unregulated and poor-quality antimicrobials without prescriptions in drug posts and pharmacies also drives AMR. Substandard medications often lack the necessary potency to effectively treat infections, leading to prolonged illness and eventually drug resistance. Without regulation, drug marts selling these antimicrobials, contributing to misuse and overuse. All of this undermines efforts to control infectious diseases and exacerbates the global AMR crisis.
Animal Health, Agriculture, and Environmental Pathways for AMR
The widespread use of antibiotics in animal farming for growth promotion and disease prevention drives AMR-related zoonoses, such as drug-resistant Campylobacter and Salmonella. And the reservoirs for antibiotic residues and resistant bacteria are in the environment at large. Residues from healthcare facilities, agricultural practices, and pharmaceutical manufacturing often enter waterways and soil, spreading resistance genes. Resistant bacteria in natural ecosystems spread through water, soil, and wildlife, creating a continuous feedback loop affecting human and animal health—while environmental monitoring and management strategies are gaps in many countries.
Integrated Approaches: One Health and Health Systems Strengthening
Addressing AMR requires integrated approaches to strengthening the multiple systems that intersect with human health. Here's how various systems play a critical role:
Healthcare Systems. At the heart of AMR management is a strong primary health care (PHC) system that ensures timely access to appropriate care, preventing unnecessary antibiotic use and promoting patient education on AMR risks. Robust antimicrobial stewardship programs help monitor antibiotic use, reduce overprescription, and track emerging resistance patterns. Ensuring infection control measures such as hand hygiene, sanitation, and safe medical practices reduces the spread of resistant bacteria in health facilities.
Surveillance Systems. Integrated surveillance systems must track antibiotic use and resistance patterns across the healthcare continuum but also across human and animal datasets to improve countries’ capacity to track and respond to AMR. Strengthening these systems ensures timely detection of resistant pathogens and enables faster, more targeted responses to outbreaks. Surveillance systems in animal farming and veterinary practices help monitor antibiotic use and resistance patterns in livestock, ensuring that misuse in agriculture doesn’t exacerbate human AMR risks. Strengthening surveillance for antibiotic residues and resistant bacteria in water, soil, and wildlife helps identify environmental sources of resistance affecting human and animal health.
Last-mile diagnostic networks in DRC drive progress against multidrug resistant TB
The Democratic Republic of Congo is gaining ground in detecting and treating drug-resistant TB, even in remote regions. Watch
Regulatory and Policy Systems. Strengthened regulatory systems for responsible antimicrobial use are critical to ensure laws governing antibiotic use in healthcare, agriculture, and environmental sectors are enforced. Subnational governments must be held accountable for operationalizing national strategies, implementing and monitoring adherence to policies that prevent the sale of over-the-counter antibiotics and control their use in animal farming. Health systems should align with international AMR frameworks, such as the World Health Organization’s Global Action Plan on AMR, to standardize approaches and collaborate across borders.
Supply Chain and Access Systems. Strengthening supply chain management is critical to ensuring consistent access to quality-assured antibiotics, preventing the circulation of substandard or counterfeit drugs, even in the context of health system shocks and stressors. Health systems must prioritize equitable access to diagnostics, treatments, and vaccines that reduce the need for antibiotics and strengthen early detection and prevention of the spread of resistant pathogens.
Workforce and Capacity Building. Continuous education for healthcare professionals on responsible antibiotic use, the risks of resistance, and effective stewardship practices is essential. A trained workforce is key to implementing AMR strategies at all levels of care. Veterinarians and agricultural workers form critical pieces of this integrated health workforce and must also be integrated into national workforce development, supportive supervision and continuing education strategies to ensure proper antibiotic use and biosecurity measures to prevent resistance from emerging in livestock that can affect human health.
Community Engagement Systems. Strengthening systems that engage communities in understanding AMR is essential for promoting responsible antibiotic use. Community health workers, and in a growing number of countries community animal health workers, can play a critical role in raising awareness and changing behaviors that contribute to AMR. Strong risk communications and community engagement approaches can shift public behavior toward antibiotic use, adherence, infection prevention measures, vaccination and strengthen identification and referral of new cases of AMR.
Addressing antimicrobial resistance requires a holistic, integrated approach that strengthens health systems (both public and private) across all levels. AMR is a complex issue that impacts human health, animal health, and the environment. Tackling it effectively necessitates robust, coordinated efforts that include not only healthcare interventions but also broader systemic improvements. Strengthening healthcare delivery, surveillance, regulatory frameworks, supply chains, and workforce capacity addresses AMR from multiple angles. Only by reinforcing these interconnected systems and addressing them within human, animal and environmental sectors can we build a resilient health infrastructure capable of addressing the complex and multi-sectoral challenges posed by AMR to sustain progress in reducing its global threat.
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