Imagine a world where life-saving antibiotics and other antimicrobial medicines will no longer work, rendering them ineffective to treat diseases like pneumonia, gonorrhoea, tuberculosis, or malaria. We do not have to imagine it – antimicrobial resistance (AMR) is already happening around the world, including in the Pacific.
AMR happens when pathogens such as bacteria, viruses, fungi and parasites change over time so that they are able to withstand the drugs that were supposed to kill them. This then means that the diseases caused by these pathogens will be harder to treat, leading to increased risk of the disease spreading, more severe illness, or even death.
Drug resistance may occur naturally over time, but the current rate of drug resistance is increasing dramatically. This is largely driven by irresponsible activities in the human health and animal health sectors, such as the misuse and overuse of antimicrobials (for example, antibiotics) in humans and animals; inadequate infection prevention and control measures in healthcare facilities and livestock production; lack of access to proper water, sanitation and hygiene for humans and animals; and limited access to vaccines, diagnostics and medicines.
Antimicrobial resistance is one of the most serious public health threats of our time. Current estimates indicate that AMR contributes to almost 5 million deaths per year globally. It also has a significant economic cost. Around 28 million people will plunge into extreme poverty because of AMR, and those living in low- and middle-income countries are already being disproportionally affected.
“When antimicrobial resistance happens, when some of our most-used medicines no longer work, we are going to need more intensive and expensive treatment. And when the last-defence antimicrobials fail, people are at higher risk of dying from their drug-resistant infection,” said Dr Nuha Mahmoud, Officer in Charge, WHO South Pacific.
AMR in the Pacific
Challenges persist when it comes to addressing AMR in Pacific island countries and areas. One of the main challenges in the Pacific is access to sustainable resourcing, including for workforce and capacity needs. Some Pacific nations do not have dedicated staffing for AMR and there are differences in technical competencies for the existing health workforce. There is also a gap in surveillance and reporting of AMR.
However, Pacific island countries and areas are making headway in addressing AMR, in line with the Framework for accelerating action to fight antimicrobial resistance in the Western Pacific Region and the new WHO Strategic Priorities on Antimicrobial Resistance. These are some of the important measures being done in the Pacific.
Leading multi-stakeholder partnerships for AMR response
AMR is a complex issue that requires a coordinated response amongst multiple stakeholders. At the global level, a quadripartite (that is, four-party) partnership between WHO, the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE) and the United Nations Environment Programme (UNEP). Together, the four organizations are taking a “One Health” approach, engaging with the human, animal, plant and environmental health sectors to address AMR.
During the World Health Assembly in 2015, countries committed to develop multi-stakeholder national action plans (NAPs), with clear, implementable interventions and a dedicated budget to stop the spread of AMR. Using the “One Health” approach, NAPs are being developed across the Pacific to outline activities for each sector to strengthen the AMR response. So far, seven Pacific island countries and areas have developed multi-stakeholder national action plans: Cook Islands, Fiji, Marshall Islands, Federated States of Micronesia, Nauru, Tonga, and Tuvalu. Other countries have initiated the development of their plans and are working towards finalizing them.
Ensuring that there is a national mechanism to coordinate the implementation of AMR interventions is also very critical. For example, in Fiji, they have established a dedicated committee to coordinate activities on AMR, made up of members from the Ministries of Health and Medical Services, Agriculture, Waterways and Environment, Fisheries, and Forestry, as well as other government agencies, professional societies and academic institutions. The AMR committee members actively participate in the planning and implementation of activities.
Piggy-backing on the COVID-19 response for progress on AMR
The peak of the ongoing COVID-19 pandemic temporarily drew attention away from the critical work on AMR, as the health sector made sacrifices and worked under tremendous pressure to save lives. However, some of the work done to strengthen health systems and save lives during the pandemic is also contributing to the AMR response.
For example, many countries have worked to strengthen infection prevention and control (IPC) during the pandemic, including through the provision of supplies such as personal protective equipment (PPE) and hand hygiene products, ensuring IPC protocols and healthcare waste disposal in healthcare settings, and training the health workforce. WHO and the Pacific Community (SPC) worked together with ministries of health to strengthen IPC measures across the Pacific. During the first community transmission of COVID-19 in Kiribati, WHO and SPC provided technical assistance on IPC in Tungaru Hospital and other clinics and isolation centres in the country.
A health worker puts on personal protective equipment as part of the IPC measures in a health facility in South Tarawa, Kiribati. Photo: WHO/Victor Itaea
The COVID-19 pandemic has similarly seen increased investments in national public health laboratories. With quality laboratory services in-country and timely referrals to proper treatment and care, AMR can be detected and managed early. Work is currently ongoing to strengthen microbiology laboratory services in Pacific island countries and areas for quality AMR testing and clinical decision-making.
Strengthening surveillance for AMR
It is important to understand the emergence and spread of AMR in the Pacific through quality surveillance data and reporting. One of the recommendations in the WHO Strategic Priorities on Antimicrobial Resistance is to strengthen the monitoring of the AMR burden, its drivers, and the AMR response. Having robust AMR surveillance in countries allows for early detection of drug-resistant pathogens, facilitating timely response and clinical management.
In the Pacific, capacities vary when it comes to AMR surveillance. WHO is supporting countries to help develop capacity for surveillance as well coordinating and providing tools on monitoring and reporting.
Since 2019, WHO has collaborated with partners such as SPC, the Pacific Pathology Training Centre (PPTC), Pacific Island Health Officers Association (PIHOA) and Fiji National University (FNU) to help build national capacity on microbiology, infection, prevention and control and antimicrobial stewardship. So far, Cook Islands, Fiji, Kiribati, Nauru, Samoa, Solomon Islands, Tonga and Vanuatu have completed the training. Further collaborations are being planned in 2023 to strengthen AMR surveillance in the Pacific.
“We are glad to see some progress in the health sector in addressing AMR, under the leadership of ministries of health across the Pacific,” said Dr Mahmoud. “We hope to see more collaborative work across different sectors so we can save lives and protect our future generations against the threat of antimicrobial resistance.”