You can stop delaying action on antimicrobial resistance

Global strategies to address AMR in conflict-affected areas: The example of a Brazilian worker who lived in the hospital and was treated with antibiotics

Although investment must be made globally in interventions to mitigate resistance, I urge all funders and aid organizations to factor AMR into humanitarian relief efforts. More research is required on the impact of war on communities living in conflict affected areas and on context-specific solutions. Extra resources must be devoted to improving supply chains and access to antimicrobials and diagnostic tools, and to improving their use in these regions. And AMR surveillance, infection control and health systems as a whole must be strengthened in conflict-affected areas.

Another issue that affects Bangladesh in particular is the lack of protocols and basic interventions in and around health care that, if implemented, would greatly improve the situation.

Many people think resistance is ubiquitous because of the biases in the data. Although early-generation drugs can still work, many physicians give late-generation or last-resort antibiotics. This in itself might be worsening resistance.

For the babies at Shishu hospital, the most effective approach to saving lives is preventing infections from taking hold in the first place. Strategies that could substantially reduce AMR include investing in parental nutrition during gestation (which, in turn, would improve babies’ birth weights and reduce their susceptibility to infection), ensuring that pregnant people receive antenatal and perinatal care and promoting delivery practices that minimize the risk of babies (and birthing parents) getting infections.

Five years ago, a 15-year-old boy was brought into the hospital where I work in São Paulo, Brazil, after developing an infection. He had cut his ankle while retrieving a kite from a stream. The boy developed a severe, systemic infection caused by methicillin-resistant Staphylococcus aureus and died around five weeks after being admitted.

But as illustrated by the case I described, AMR does not occur only in hospital settings. And in Brazil, one of the biggest challenges is people’s failure to recognize AMR as a public-health problem. Most people who don’t work in hospitals lack the knowledge needed to understand what AMR is and how it could affect their health. The country is battling endemic diseases, such as malaria, leishmaniasis and Chagas disease. Brazil has experienced several epidemics caused by mosquitoes over the past decade, including the one caused by Oropouche fever. It is more difficult for the public to pin a cause on such diseases than it is on AMR.

Increasing investment could help improve prevention and control of infections in health-care facilities. In 2020, the Nigeria Centre for Disease Control and Prevention released updated guidelines on infection control and prevention. A modelling study5, published in May as part of the Lancet series, indicates that by following such guidelines judiciously, health-care providers could prevent antimicrobial-resistant infections in health-care settings, which currently account for about 300,000 deaths worldwide.

Nigeria has been rolling out pneumococcal vaccines since 2014 and rotavirus vaccines since 2022. According to data from the UN children’s charity, the coverage needs to be extended. The vaccine for malaria and typhoid-conjugate is yet to be deployed. In the last year, the global shortage of vaccine for the disease has made it hard for people to use it. All of these vaccines could reduce levels of AMR — by lowering the chance of complications arising that involve bacterial infections, and of people administering antibiotics inappropriately. The modelling study reported that vaccines could prevent 180,000 deaths per year.

One-quarter of Nigeria’s population defecates outside, such as in fields, gutters and forests, instead of using a toilet, some or all of the time. And data from a 2024 report3 I was involved in show that most city residents rely on household water from wells or boreholes that is contaminated by faeces. In Ibadan, this is the case. Resistance genes that can be transmitted tobacteriorptiy can be transmitted from non-harmful organisms tobacteriorptiy. One such commensal microorganism is Escherichia coli, which is typically found in the intestine. The impact of enteric infections in people could be reduced by providing them with safe water and better Sanitation, which could lead to an estimated return of US$5 or more.

My mother, who has a recurrent infection of the urinary tract, will need antibiotics and access to health-care services if she is not able to get them. In case she has to flee in the event of a military attack, I remind her to keep her passport and antibiotics with her.

Global Action for Combating AMR: Nigeria’s AMR system and the challenges of addressing its impact on children, animals and the environment

Nigeria launched its own AMR system in 2017). Once this system covers a greater geographical area and more comprehensive data are collected — from people, animals and the environment — investigators will be able to quantify the impacts of each of these tools and support the prioritization of interventions for national deployment.

This is the second year in a row that it has been featured at a UN meeting. The problem is associated with nearly five million deaths per year worldwide, and it was highlighted in the first one. Although there has been some progress in the past eight years, such as the development of national action plans by many countries, the pace of change has been slow. I am presenting at the upcoming meeting, and I hope to convince attendees that the next eight years could look very different.

Malaria and most bacterial infections do not last as long as do tuberculosis or AIDS, from which people tend to die months or years after infection. A child with an illness, who develops a high temperature in the morning, can die the day after unless they receive the correct antibiotics. They are not in many public-sector clinics in low and middle income countries. Parents and other carers must frequently turn to their local pharmacies for help. Hundreds of millions of people are using inappropriate, fake or poor- quality drugs because of the difficulty in setting up systems that limit their entry at pharmacy stores.

The Global Fund must step up. People with HIV have a higher risk of getting infections than other people. Providing people with access to effective diagnostics and antibiotics targeting bacterial infections more broadly would be a natural extension of the Global Fund’s existing mandate.

As well as Gavi, the Vaccine Alliance and the United States Agency for International Development, prevention strategies need to be supported by other organizations and bilateral donors. They also need to be prioritized in national budgets in low- and middle-income countries.

With investment from global funders, targets and accountability through an independent panel, there is a much higher chance of this year’s discussions at theGeneral Assembly leading to global action to tackle AMR.