Ian Ellis: Antimicrobial resistance (AMR) - a major public health challenge for governments across the globe

​An important and timely World Health Organisation (WHO) report published earlier this year focuses on a subject that has been the topic of much public discussion of late - antimicrobial resistance (AMR).

Ex-chief medical officer Dame Sally Davies has spoken movingly of how she lost her god-daughter - who had been born with cystic fibrosis - after she developed a bug that was resistant to treatment, leading to her death 18 months ago. Dame Sally said antimicrobial resistance (AMR) was now 'the third most important underlying cause of death across the world, after heart disease and stroke'

It is a matter on which we naturally defer to scientific experts with in-depth understanding of the relevant issues.

The development of the report, entitled “WHO Bacterial Priority Pathogens List, 2024: Bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance”, was led by the WHO antimicrobial resistance division in collaboration with the WHO global tuberculosis programme.

It describes AMR as “a major global public health challenge”, quoting an estimated 4.95 million deaths in the year 2019 associated with it, and declaring the tackling of AMR as requiring global efforts.

Canon Ian M Ellis is a former editor of The Church of Ireland Gazette

Describing AMR as “an evolving threat that challenges the effectiveness of existing treatments”, the report adds that research and development of new antibacterial agents has not kept pace with “the rapid evolution of resistance, leaving a substantial gap in the ability to properly address the unmet needs of patients”.

The WHO says its bacterial priority pathogens list acts as a guide for prioritising research and development, emphasising the need for “regionally tailored strategies to effectively combat resistance”.

Indeed, writing in last year's UN Environment Programme report, “Bracing for Superbugs”, the organisation's executive director, Inger Andersen, stated: “There is strong evidence that bacteria, parasites, viruses and fungi are becoming resistant to antimicrobials. Infections in humans, animals and plants are becoming difficult, sometimes impossible, to treat. AMR has therefore emerged as a principal public health problem.”

Last month, the UK government announced an £85m package to support efforts to meet the challenges of AMR.

Speaking to the BBC, Dame Sally Davies, a former chief medical officer for England and the UK's special envoy on AMR, described it as the way infectious organisms mutate when they encounter treatments that try to kill them, in order to develop resistance. She said that this is now “the third most important underlying cause of death across the world, after heart disease and stroke”.

Dame Sally spoke movingly about her own god-daughter, a young woman who had been born with cystic fibrosis but, having survived two lung transplants, nonetheless developed a bug that was resistant to treatment, leading to her tragic death eighteen months ago.

She added: “It is a risk for every one of us, and I was shocked. I've been working on this for twelve years, trying to advocate round the world, working with our government who've been generous... But when it comes to your family, it is tough.”

Historically, the churches have been deeply committed to health care across the world. In the mid-19th century, missionary societies started in earnest sending doctors and nurses abroad.

The Christian Medical Fellowship (CMF) reports how, in 2008, the Gates Foundation commissioned the African Religious Health Assets Programme to study the extent of the contribution of religious institutions to health in sub-Saharan Africa.

The study found that “the proportion of services provided by faith groups of all kinds varied across the continent, ranging from 25% in some Francophone Muslim countries to as much as 70% in parts of East and Southern Africa”, with the CMF stating that mission hospitals and church-based clinics are the main providers of facility-based services.

CMF also points out that the Christian contribution to healthcare does not consist only of work done by health providers, but that the local church itself “plays a big part in the health and wellbeing of individuals and society”.

It continues: “Worldwide, the local church is present in more communities than any other organisation and it is often a focus for community action and social cohesion, which form the bedrock for development and community health. It has wide coverage, reaching marginalised groups who often fall under the radar of larger organisations, and immense sustainability; the church will still be there when donors and aid organisations have moved on and moved out.”

Then again, the churches' Nairobi-based Ecumenical Pharmaceutical Network is particularly concerned with AMR, which it describes as a growing global threat, and points out that currently AMR national action plans are available in the majority of African countries. These provide “a policy framework and priority actions to contain the emergence and spread of AMR”.

However, the progress of implementation has been mixed across the continent.

With AMR impacting both human and animal medicine, the Northern Ireland Department of Health told me for this column that both Robin Swann when health minister and agriculture and environment minister Andrew Muir welcomed the recently launched UK-wide plan to tackle AMR which had been “jointly developed across the four nations”.

The plan, “Confronting antimicrobial resistance 2024 to 2029”, says that much like the coronavirus (Covid-19) pandemic, AMR affects people in all parts of the world and that “infectious diseases do not respect national borders”, adding that according to an Organization for Economic Cooperation and Development (OECD) health policy study, “if we fail to take sufficient action, the costs associated with treating resistant infections could compare to having a Covid-19 pandemic every five years”.

Hopefully, the Covid pandemic emergency experience will make it clear to all concerned that action against AMR is both necessary and urgent.

Canon Ian Ellis is a former editor of The Church of Ireland Gazette.