As we start World Antimicrobial Resistance (AMR) Awareness Week (WAAW) 2023, I’ll cover a variety of areas about this important topic.
Why do we even care about AMR?
AMR is an urgent international problem. It threatens the healthcare (human and animal) gains that we’ve made over the past century. It’s estimated that AMR was associated with almost 5 million deaths globally in 2019 (Murray at al. 2022). The World Bank has estimated that, by 2050, AMR could reduce the global gross domestic product (GDP) by 3.8% and push 28 million people into poverty.
Those are pretty striking numbers, but despite that, AMR is also an overlooked problem… a “silent pandemic.” For something that kills millions, harms more, will almost inevitably get worse, and which has major social and economic impacts, the “give a crap” factor by the general public is really low. People will march in the streets about climate change (another serious and complex problem) but they don’t seem to give a thought to AMR, unless they or someone close to them is directly affected by it.
Why doesn’t the public seem to care about AMR?
AMR is insidious. It’s not seen by most people. It’s hard to understand. It’s poorly communicated. It’s oversimplified. It’s not well understood.
It’s a “wicked problem.”
Wicked problems, like AMR and climate change, are tough to define, tough to address and tough to fix. There are lots of definitions of a “wicked problem” but they share some similar characteristics (see diagram below):
- The problem is hard to clearly define.
- Data are weak, lacking or contradictory.
- There’s no clear pathway to solving the problem, with a start and end.
- There are lots of stakeholders, often with different agendas, needs, perspectives and motivations.
- True solutions are hard to identify, difficult or costly to implement and often can’t be tested without implementation.
- There are lots of interconnections between disparate issues and groups, leading to massive social complexity.
- Possible solutions might cause new problems, or solutions that work for one component (e.g. humans) may harm another (e.g. animals).
There is no magic bullet to fix the AMR problem. And backing up another step, I’d argue about the use of the “AMR problem” term I used above.
AMR isn’t really the problem.
Yes, it’s what we’re worried about. However, AMR is largely the end result of antimicrobial use (AMU).
AMU is the problem.
Realistically, AMU isn’t even the root problem. Why we use antimicrobials (so many and so often) is the issue. That’s because of health, or more specifically, sub-optimal human and animal health (real or perceived)(see diagram below).
To address AMR, we need to address AMU.
To address AMU, we need to address healthcare (human and animal) access, equity, food security, innovation, preventive medicine, how we raise animals, how people live and myriad related issues that go beyond the bug-drug-disease triad.
The science is challenging, but in some ways it’s the easy part.
The biggest barrier to addressing AMR is the human brain. That’s in part because antibiotics are often used for their profound psychoactive properties: they make the prescriber feel better because they are doing something, even when that something may be harmful.
Is it hopeless? No.
Do we have the tools to address the problem? Yes.
Do we have the expertise to address the problem? Yes, but we need more.
Do we have the political will to do what’s needed?
- Not usually. It varies, but in most places it’s not really on the radar and politicians are often reluctant to take the steps we really need to take without drive from the people who elect and support them.
Do we have the necessary financial support? Not a chance.
Pretty pessimistic overview? Yes, but there are encouraging signs:
- AMR is getting more attention. There’s still a lot of room for improvement but it’s coming along and some countries are taking a lead.
- Lots of good research continues to be done, with increasing involvement of social scientists, a key aspect to addressing behaviour (of both patients and prescribers).
- There’s a UN General Assembly High Level Meeting on AMR in 2024 – a big deal, and one that can help drive action.
- Numerous national, international and sector initiatives are underway.
- Ground level support for antimicrobial prescribers is increasing. For veterinarians, that includes our Firstline: OVC/CPHAZ prescribing app for companion animals.
So, as we embark on WAAW 2023, I’ll cover some interesting (to me, at least) topics in the AMR field.
We’re not going to fix this problem with one tool, one discovery, one action or one group. We’re going to do it through myriad small, incremental gains by a massive number of individuals. Like climate change, the impact of a single person seems inconsequential, but fixing AMR will rely on small actions by everyone involved in researching, making, distributing, prescribing and using antimicrobials.