South Africa a leading light in placing antimicrobial resistance on the global agenda

Will antimicrobial resistance (AMR) be the greatest societal leveller of our time? “It doesn’t distinguish between colour, economic status or political systems. It affects all seven billion of us and we need to do something about it.” This is the view of esteemed British Economist, Lord Jim O’Neill, who was a speaker at the 9^th Discovery Leadership Summit held on Thursday in Sandton, Johannesburg.

O’Neill (the creator of the “BRIC” acronym) was, in 2014, tasked by UK Prime Minister David Cameron to establish and chair a Review into AMR to analyse the global problem of rising drug resistance. The purpose was also to propose concrete actions to tackle what the World Health Organization has called one of the three major threats to global healthcare.

“In the absence of a solution, AMR could, by 2050, cause 10 million deaths a year – which is far more deaths than cancer causes today,” added Lord O’Neill. “The BRICS countries share a considerable vulnerability. One third of global AMR-linked deaths could stem from drug-resistant tuberculosis alone. Very worrying signs show that the rise of drug resistance is only set to worsen with time. We need to do something about this urgently, otherwise the BRICS countries - even China and India - will never reach their potential.”

Lord O’Neill hastened to add: ”South Africa has played a key leadership role in giving a voice to this global threat. If not for South Africa’s leadership around AMR within the BRICS countries, this theme would not have been on the G20 agenda.”

The Review sets out 10 key focus areas to guide global action on the efforts required to tackle AMR. “I call them ‘The 10 commandments of AMR’,” adds Lord O’Neill:

1. We need a global public awareness campaign.
2. We must improve sanitation as polluted environments fuel illness and the overuse of antibiotics. Strong preventive health systems are key.
3. We must reduce unnecessary use of antimicrobials in agriculture and their dissemination into the environments. For 10 years the EU has banned use of antibiotics for growth promotion in animals. Last week, the EU introduced a law that will come into effect in 2022 and ban last-in-line antibiotics (intended for humans) in animals.
4. We must improve global surveillance of drug resistance and antimicrobial consumption in human and animals. “Leading surveillance research on AMR is being done in South Africa by institutions like the University of Cape Town and others,” added Lord O’Neill.
5. We must promote new, rapid forms of diagnosis to reduce the unnecessary use of antimicrobials. “Mobile technologies could assist doctors greatly,” he added.
6. We must promote the development and use of vaccines and alternatives to antimicrobials.
7. We must improve the number, pay and recognition of people working on infectious disease.
8. We must increase the supply of new antimicrobials effective against drug‑resistant bugs.
9. We need a global innovation fund for the supply of new antimicrobials effective against drug resistance bugs.
10. We need better incentives to promote investment for new drugs and improving existing ones.

The Review estimates that interventions require $42-billion of finance and Lord O’Neill has formerly said, “$42-billion over 10 years is less than one quarter of a tenth of a percent (0.025%) of global GDP. Yet, if we do nothing about it, the world would lose approximately $100-trillion of accumulated GDP over the next 35 years.”

Lord O’Neill added that there has been progress on several of the ’10 Commandment’ recommendations but emphasised that global, collaborative efforts towards overcoming AMR remain paramount. “We are intricately connected on this planet. This is evidenced by the overuse of Colistin – a last-in-line antimicrobial – which is used on animals in China, and which has recently been detected in Denmark – a country that has, in my judgment, led global efforts to stop the use of antimicrobials in animals. International cooperation is therefore critical to overcoming this challenge.”

“I plead with you to make sure South Africa continues to keep AMR on the BRICS agenda, as well as when using its own voice in the G20. To my mind, the efforts South Africa has made, more than justify the small ‘s’ in the BRICs acronym, used before South Africa joined the initiative, being capitalised to represent a country doing much to keep AMR top of mind.”