By Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia
The WHO South-East Asia Region is committed to preventing and combating antimicrobial resistance (AMR), a global health and development threat. AMR occurs when antimicrobial drugs – including antibiotics – are used inappropriately, causing mutations in infectious bacteria that reduce drug efficacy. Globally, unless urgent action is taken, by 2050 AMR will be responsible for 10 million deaths annually at a cost of US$ 100 trillion. If current trends continue, AMR could reduce the GDP of low-income countries by 5%, pushing up to 28 million people into poverty. AMR already kills an estimated 700 000 people every year in what is a “slow tsunami” that is compromising modern medicine and the global economy, and impeding progress on the Sustainable Development Goals. Since as early as 2011, the WHO South-East Asia Region has been working to address AMR, which in 2014 was identified as a Flagship Priority. WHO will continue to support all countries in the Region to prevent and combat AMR and avoid the post-antimicrobial future that will otherwise emerge.
The Region has in recent years made substantial progress against AMR, which will be accelerated by a new WHO-convened regional taskforce. All countries are implementing multisectoral national action plans to address AMR. Ten of the Region’s 11 countries have signed on to the Global Antimicrobial Resistance Surveillance System (GLASS), which is more than two-and-a-half times the proportion of countries taking part globally. In 2019 the Region continued to be the only WHO region in which all Member States carried out the Tripartite AMR self-assessment exercise. Member States continue to enhance regulatory capacity and antibiotic stewardship, for example by implementing WHO’s AWaRe classification tool. Commendably, all countries participate annually in the world’s most important AMR awareness-raising event – World Antimicrobial Awareness Week.
As we begin this year’s campaign, WHO, together with its Tripartite partners the Food and Agriculture Organization of the United Nations and the World Organization for Animal Health, is calling on all sectors to rally around the “One Health” approach required to defeat this global health and development threat. This is especially important as countries and partners continue to respond to the COVID-19 pandemic, which has the potential to accelerate AMR. For example, across the Region and world, individuals presenting with mild COVID-19 disease are too often prescribed antibiotics when they do not require them. Health service disruptions have in some cases interrupted TB and HIV treatment, which could lead to selection for drug resistance. Disruptions to vaccination services have the potential to increase the risk of infection from vaccine-preventable diseases, potentially leading to an overuse of antimicrobials. The Region’s remarkable efforts to revive and maintain essential health services and to implement appropriate antimicrobial stewardship must continue to be strengthened.
Several key interventions are required to integrate the battle against AMR into the wider pandemic response. First, targeted trainings should be deployed to increase the clinical competence of health workers treating COVID-19. Health workers must have the capacity to identify the signs and symptoms of severe COVID-19 and those of a superimposed bacterial fungal disease. They must also be provided the capacity to evaluate the need for medical devices that increase the chance of a health-care-associated infection, and to implement infection prevention and control protocols. Second, the continuity of essential health services must continue to be secured, including a regular supply of quality-assured and affordable antimicrobials. Access for all to antiretroviral and tuberculosis drugs, as well as vaccination, must be a core priority. Third, maximum caution should be exercised in the use of biocides for environmental and personal disinfection. Wherever possible, biocidal agents with a low or no selection pressure for antibiotic resistance should be prioritized. Fourth, research on AMR within the pandemic response must continue to be promoted. High-quality evidence is essential to the development of high-impact innovations.
On the launch of this year’s World Antimicrobial Awareness Week, WHO reiterates its commitment to support Member States in the Region to prevent and combat AMR and to avoid the post-antimicrobial future that will otherwise emerge. AMR is a complex problem that affects all of society, and which provides a significant threat to human and animal health, in addition to agriculture and ecosystems. We can only prevail through a whole-of-government, whole-of-society approach that unites all stakeholders under the One Health banner, in recognition of the multiple drivers of AMR, our shared vulnerability and our shared capacity to promote change. For a healthier, more sustainable South-East Asia Region, together we must act.
WHO’s South-East Asia Region comprises the following 11 Member States: Bangladesh, Bhutan, Democratic People’s Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste.