December 5, 2022

Some microbes are essential to life, while others cause sickness in plants and animals, including humans. For decades, the global health system has kept most infectious diseases under control, thanks to vaccines and antibiotic and antiviral medicines. However, it’s estimated that growing antimicrobial resistance has the potential to kill 10 million people globally per year by 2050.

Antimicrobials include:
• Antibiotics
• Antivirals
• Antiparasitic
• Antifungals
• Anthelmintics
• And others

What is antimicrobial resistance?

Antimicrobials are a class of medications that treat infections from tiny organisms called microbes or germs. Antibiotics are a sub-class of antimicrobials that specifically treat bacterial infections, although sometimes these terms are used interchangeably.
Unnecessary and improper use of antimicrobials can lead to resistance. Antimicrobials are designed to either kill or inhibit the growth of disease-causing microbes such as bacteria. These microbes react to this threat – as to any threat from their environment – by evolving. Random mutations (changes in the microbe’s genetic makeup) occur through natural processes, and some of these mutations may lead to the microbe developing resistance to the antimicrobials. As these microbes continue to be exposed to the antimicrobial, mutations or changes to their genetic make-up become more likely and thus there is a higher chance of resistance to the antimicrobial being used developing. Meanwhile, successive mutations allow the microbe to become resistant to ever-higher concentrations of the antimicrobial medicine. It can also gain resistance via gene transfer from other microbes, even between microbes of different species.

Breaking it down
In layman’s terms, if you continuously take antimicrobials unnecessarily (even ones as common as amoxicillin) whenever you feel a little under the weather and for conditions that do not require antimicrobials, resistance (the ability of microbes to fight the effects of these medications) may develop.

Meaning, the antimicrobials will stop having any effect on the germs over time.

This is because the diseases causing microbes such as bacteria which made you feel unwell become resistant to the antibiotic which you have been taking. This resistant strain then spreads to other people around you; making antibiotics or other antimicrobials useless for other people as well.

The antibiotic consumption behaviour

Easy access to antimicrobials/antibiotics and their consequential misuse and overuse by consumers is a big challenge worldwide. Some people are unable or unwilling to see a doctor for medical advice so, they opt to take the already available or leftover antibiotics without a clear diagnosis and prescription.

Instead of trained and qualified medical professionals, consumers tend to rely on their own perceived knowledge and experience or the advice of their family, friends, and neighbours. Some consumers may also put pressure on pharmacists to sell them antibiotics over the counter without a doctor’s prescription. This irrational use of antibiotics can lead to antimicrobial resistance (AMR). Over time the spread of AMR in society renders many antibiotics, used to treat many common bacterial infections, ineffective.

The Consumer Council of Fiji creates a Multisectoral Platform for AMR discussion

Key facts – adapted from WHO
• Antimicrobial resistance (AMR) is a global health and development threat. It requires urgent multisectoral action in order to achieve the Sustainable Development Goals (SDGs).
• WHO has declared that AMR is one of the top 10 global public health threats facing humanity.
• Misuse and overuse of antimicrobials are the main drivers in the development of drug-resistant pathogens.
• Lack of clean water and sanitation and inadequate infection prevention and control promotes the spread of microbes, some of which can be resistant to antimicrobial treatment.
• The cost of AMR to the economy is significant. In addition to death and disability, prolonged illness results in longer hospital stays, the need for more expensive medicines and financial challenges for those impacted.

Given the alarming facts stated above by WHO, the Council is kickstarting an advocacy campaign in order to raise awareness on AMR and the responsibility of consumers in trying to prevent a future pandemic arising from AMR.

In order to address this issue and create awareness surrounding it, there is a need to get different stakeholders together to share ideas, research, propose policies and launch campaign on AMR. To do this, the Council conducted a multisectoral three tier panel discussion on ‘The Role of Policy, Practitioners, Academia and Consumers in Addressing Public Health Threat Due to Antimicrobial Resistance’ this week (30 November 2022).

The event dived deep into the role of three particular groups or thematic areas: research and knowledge building, as a group that may provide innovative solutions and evidence from different fields of expertise for this positive transformation; the consumers, as key actors in AMR through consumption and policy and practitioners

The aim of this panel discussion was to explore how these groups of actors may engage more efficiently with others in this multi-sectoral behemoth of a task, identify entry points for their action and get a better understanding on current challenges for participation and best ways to address these challenges.

Whilst officially opening the event, the Head of Wellness, Ministry of Health and Medical Services, Dr Devina Nand stressed that misuse of antibiotics is among the main drivers underpinning the development of AMR. Resistance to last-line antibiotics also compromises the effectiveness of life saving medical interventions.

“Fiji is committed to adopting the One Health Approach against AMR now and onwards to 2030. This is more critical than ever with the global fight against COVID and other emerging diseases. Fiji became the first Pacific Island country to develop and launch a National Action Plan for AMR. The Fiji National Action Plan of 2015 emphasises the One Health agenda recognizing the quadripartite forum that needs to work cohesively to combat AMR in the country,” stated Dr Nand.

CCoF Chief Executive Officer Ms Seema Shandil in her opening address emphasized that as antimicrobial resistance is increasing, it is vital to encourage consumers to change and adopt smarter antibiotic behaviour. Despite World Health Organization’s efforts to combat antibiotic resistance and their emphasis on the importance of public involvement, the role of consumers has been overlooked.

“The manifold responsibility for antibiotic resistance extends across different actors, including food retailers and consumers. Given this shared responsibility, a cohesive action is required without pushing responsibility on a particular group. To overcome this status quo situation, we not only draw attention to the potential role of individual responsibility to adopt smart antibiotic behaviour but also to empower them; this is what the Council has ventured into,” stated Ms Shandil.

Ms Shandil also highlighted that conditions must be put in place to enable consumers’ critical evaluation of the health-related and ethical aspects of their consumption choices. Such behaviour is now being promoted and will be facilitated using digital innovations to support informed choices, in store and online.

Meanwhile, the Council’s Manager Alternative Dispute Resolution – Ms Jessica Lal who was one of the panellists in the consumer segment of discussions highlighted that improving awareness and understanding of AMR through effective communication, education and training is imperative now more than ever.

“One way to help deal with AMR is to promote behavioural change, including consumer behaviour. Generally, consumers’ understanding of antibiotic resistance is characterised by misconceptions and low levels of awareness and knowledge. Public knowledge regarding the harms of AMR and its implications is generally limited. Hence, the Council is striving to address this gap and build a consumer movement which is conscious of the consumption-health relationship,” stated Ms Lal.

The Council will be advocating and creating awareness on AMR via social and mainstream media together with directly visiting communities with other stakeholders.

Antimicrobial Resistance (AMR) – IN A NUTSHELL
4 Things To Know
AMR is one of the most urgent threats to public health. AMR is a “one health” problem and connects to the health of people, animals, and the environment.

1. AMR occurs when germs gain the ability to defeat the drugs designed to kill them.
   It does NOT mean the body is resistant to antibiotics
2. AMR can affect people at any stage of life.
   Infections caused by resistant germs are difficult(sometimes impossible)to treat. In many cases, these infections require extended hospital stays, additional follow-up doctor visits, and the use of treatments that may be costly and potentially toxic to the patient
3. Healthy habits can protect you from infections and help stop germs from spreading.
   Get recommended vaccines, keep hands and wounds clean, and take good care of chronic conditions, like diabetes
4. Antibiotics save human and animal lives. Any time antibiotics are used, they can lead to side effects and resistance.
   Antibiotics do not work on viruses, such as colds and the flu. Talk to your healthcare provider or veterinarian about whether antibiotics are needed.