Creating a virtuous cycle of AMR investment

Antimicrobial resistance (AMR) is undermining the effectiveness of modern medicine, threatening lives and livelihoods. Predictable, long-term funding for AMR surveillance provides quality data about the problem, leading to informed decision-making and better returns on investment, writes Patrick Mubangizi, regional director for Africa for the Fleming Fund Grants Programme.

The World Bank estimates that antimicrobial resistance (AMR) could result in US$1trn additional healthcare costs by 2050. As antimicrobial drugs become less effective at combating infections, patients get sick for longer, treatments become more expensive and health systems achieve worse outcomes. It’s a downward cycle that damages lives and livelihoods.

More than 39M deaths from antibiotic-resistant infections could occur between now and 2050, according to a recent study by the Institute for Health Metrics and Evaluation. In addition, the economic impact of AMR could be between $1trn and $3.4trn of lost gross domestic product per year by 2030 due to higher levels of economic inactivity, lower productivity and higher costs, according to the World Bank.

Drug-resistant infections threaten lives and livelihoods without investment in global surveillance (Credit: Fleming Fund)

But there are ways to avoid these alarming projections becoming reality. Crucially, better data is needed about the problem. A lack of data – particularly in low- and middle-income countries – makes it challenging to design interventions that would bring AMR under control. In Africa, where my work is focused, a study funded by the Fleming Fund and carried out by the African Society of Laboratory Medicine showed that five years ago only 1.3% of laboratories were able to carry out AMR testing.

Surveillance data allows healthcare policymakers to monitor antibiotic resistance patterns among the patient population. Antibiotic use data allows them to monitor the over-use of certain classes of antibiotics in hospitals and review drug prescribing and dispensing practices across the public and private sectors.
More farm-level data on the use of antibiotics in meat production would give policymakers leverage to increase controls on the use of antibiotics as growth promoters in cattle, poultry and fish farming.

Better AMR data enables policymakers to plan, develop and implement effective policies. It also enables them to evaluate interventions and direct investment where it delivers the highest returns – creating a virtuous cycle of investment.

Supporting global surveillance

Generating quality, reliable and representative AMR data requires predictable, long-term investment in global surveillance. The Fleming Fund, a cornerstone of the UK government’s action on AMR, has been working with regional and national stakeholders in up to 25 countries in Asia and Africa to strengthen surveillance of antimicrobial drug use and improve understanding of patterns of drug resistance.

Mott MacDonald has been managing the grants and technical assistance programme for eight years, bringing together over 100 grantees to support governments and stakeholders in generating and using AMR data to inform policy and practice.

Predictable, long-term funding for AMR surveillance provides quality data about the problem, leading to informed decision-making and better returns on investment.

One million AMR samples have now been collected in countries supported by the Fleming Fund, which have been reported by national surveillance systems. In the 2022 call for data, there were 14 countries submitting data from 116 sites to the Global Antimicrobial Resistance and Use Surveillance System (GLASS).

Laboratories in 152 hospital laboratories are now providing improved diagnostic services for patients, supported by 25 national reference laboratories . In addition, 92 animal health laboratories are carrying out culture and sensitivity testing and 12 countries in Africa are contributing genomic data at the continental level on five or more of the priority pathogens.

One Health progress

Taking a multidisciplinary One Health approach to combating AMR – across human health, animal health and the environment – is an integral part of the Fleming Fund programme. Cross-sector collaboration is needed to understand and control the spread of drug-resistant viruses, bacteria, fungi, and parasites between animals, humans and the environment.

Animal health surveillance, however, has received far less resources – equipment, infrastructure and human resources – than human health. Governments have not prioritised diagnostic services in animal health, yet the sector contributes significantly to the AMR problem. Antimicrobial drugs have become over-used in intensive meat production and fish farming to control the spread of disease.

Informing policymakers

In Malawi, antimicrobial drugs used to be routinely overprescribed, and the country’s policymakers had limited data about the problem. That changed with the development of AMR surveillance sites with Fleming Fund support.

Armed with data, the government has taken steps to update national policy documents to promote more appropriate use of antimicrobials, including the Malawi Standard Treatment Guidelines and Essential Medicines List. Data from human health surveillance sites is also used locally at hospitals to inform the treatment of patients.

The government of Ghana is also taking a major step forward in understanding AMR in food supplies and ensuring food safety. With support from the Fleming Fund, the government developed and piloted a framework for sampling live birds from open commercial markets for population-based surveillance in poultry.

Long-term funding commitments

Eight years since the first UN High-Level Meeting, when global leaders first committed to global action on AMR, there is evidence that investment in global AMR surveillance in countries, such as Malawi and Ghana, is changing policy and practices.

But there is insufficient funding nationally and globally to tackle the scale of the AMR threat to public health. Although many countries across Africa and Asia have developed national action plans on AMR, many of these remain unfunded.
The UN High-Level Meeting on AMR in September 2024 is a major milestone and a time for renewed focus and collective action on AMR.

It’s an opportunity to begin a virtuous cycle where investment in AMR data and surveillance leads to effective policies to combat AMR, which, in turn, reduces health costs, boosts productivity and saves lives – an investment worth making.

Download the report from the African Society for Laboratory Medicine

Patrick Mubangizi is regional director for Africa for the Fleming Fund Grants Programme