Staphylococcus aureus is the source of a skin infection that can turn deadly if the bacterium is drug-resistant. Estimates regarding the most common resistant variation, methicillin-resistant Staphylococcus aureus (MRSA), show it was the cause of more than 100 000 deaths globally in 2019.
But, until recently, we did not have a solid grasp on how much of a problem MRSA — or any other antimicrobial-resistant pathogen — was in Africa. After testing 187 000 samples from 14 countries for antibiotic resistance, our colleagues found 40% of all staph infections were MRSA.
Africa, like every other continent, has an antimicrobial resistance problem. But Africa stands out because we have not invested in the capacity and resources needed to determine the scope of the problem or how to fix it. Take MRSA. We still don’t know what’s causing the bacteria to become resistant, nor do we know the full extent of the problem.
We are failing to take antimicrobial resistance seriously, perhaps because it is not glamorous and relatable. The technology we use to identify resistant pathogens is not fancy or futuristic-looking. Combatting antimicrobial resistance does not involve miracle drugs, expensive treatments or fancy diagnostic tests. Instead, we have bacteria and other pathogens that are commonplace and have learned how to shrug off the good old medicines that used to work.
The global health and pharmaceutical industries do not seem to consider solving this problem to be profitable. Compare that to the urgency of solving Covid-19, which has been embraced — and interventions such as diagnostics subsidised — by governments eager to end the pandemic. The Covid-19 response has been characterised by innovations popping up every other week.
Why can’t we mobilise resources and passion for antimicrobial resistance? Are resistant pathogens too boring? Is the problem too difficult to solve through innovations? Are the prospects for quick wins and fast returns on investment too elusive, especially when compared to Covid-19 and other infectious disease outbreaks?
The World Health Organisation has repeatedly stated that antimicrobial resistance is a global health priority — and is one of the leading public health threats of the 21st century. A recent study estimated that in 2019, nearly 1.3-million people died because of antimicrobial-resistant bacterial infections, with Africa bearing the greatest burden of deaths. A high prevalence of antimicrobial resistance has also been identified in foodborne pathogens isolated from animals and animal products in Africa.
Collectively, these numbers suggest that the burden of antimicrobial resistance might be on the level of — or greater than — that of HIV/Aids or Covid-19. The growing threat of antimicrobial resistance is likely to take a heavy toll on Africa’s health systems and poses a major threat to progress made in attaining public health goals set by individual nations, the African Union and the United Nations.
The lack of accurate antimicrobial resistance information limits our ability to understand how well commonly used antimicrobials actually work. This also means we cannot determine the drivers of antimicrobial resistance infections and design effective interventions in response.
We have just wrapped up a project that gathered data on many of the scariest pathogens in 14 countries, revealing stark insights into the under-detected and under-reported depth of the antimicrobial resistance crisis across Africa. Less than 2% of the medical laboratories in the 14 countries examined can conduct bacteriology testing, even with conventional methods that were developed more than 30 years ago.
While providing national stakeholders with critical information to advance their policies on antimicrobial resistance, we have also trained and provided basic electronic tools to more than 300 health professionals to continue this important surveillance. While a strengthened workforce is critical, many health facilities on the continent are coping with interrupted access to electricity, poor connectivity and serious, ongoing, staff shortages.
Our work has painted the dire reality of the antimicrobial resistance surveillance situation, making concrete recommendations for improvement that align with the new continental public health ambition of the African Union and Africa Centre for Disease Control. The challenge is to find the funding to expand this initiative to cover the entire continent.
Antimicrobial resistance containment requires a long-term focus — especially in Africa, where health systems are chronically underfunded, while also being disproportionately challenged by infectious threats. More funding needs to be dedicated to the problem and this cannot only come from international aid.
We urge African governments to honour past commitments and allocate more domestic funding to their health systems in general, and to solve the crisis of antimicrobial resistance, in particular. We also call on bilateral funders and global stakeholders to focus on improving the health of Africa’s people. This requires more attention on locally relevant evidence to inform investments and less attention on profit-driven market interventions, as well as prioritising the scale-up of technologies and strategies proven to work, whether or not they are innovations.
Containing antimicrobial resistance means we have to fix African health systems. The work starts now.