Education maybe the key to an antimicrobial resistant free generation

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By Ngoni Veddie Muzondo

What if there exists a generation free of bacteria (or microorganisms) resistant to antibiotics (Cars, 2015)?

What if there exists a cohort of antimicrobial stewards whom use antibiotics rationally?

What if there exist farmers that rear animals and grow crops that are free from antibiotics?

These are some of the intriguing questions with which if we meditate upon them we can arrive to a conclusion as to why we are not adhering to antimicrobial stewardship practices (Larsson, 2021).

Why is AMR a global concern?

The evolution and spread of drug-resistant bacteria with novel resistance mechanisms, resulting in antimicrobial resistance, continues to jeopardize our capacity to treat common diseases (WHO, 2020).

 Water, soil, and other environments with highly diverse ecological niches provide an unrivalled gene pool with a variety that much exceeds that of human and domestic animal microbiota. Antimicrobial resistance (AMR) arises when microorganisms such as bacteria, viruses, fungi, and parasites evolve in such a manner that the drugs used to treat the diseases they cause are rendered ineffective (WHO, 2017). When germs develop resistance to most antimicrobials, they are dubbed “superbugs.” Indeed, the most remarkable aspect of the ambient microbiome is its enormous variety, which provides several genes that pathogens may possibly acquire and utilize to negate the action of antibiotics. This means that in as much as stewards amongst us are trying to mitigate AMR, the superbugs are busy finding new strategies to counteract them. Recent research has shown that in 2021 the world’s population was around 7.9 billion (Worldometer, 2022). The first complete research of the worldwide effect of AMR has shown that it has directly caused 1.27 million deaths in 2019 while AMR-related diseases caused 4.95 million fatalities. Estimates for 204 nations and territories show AMR as a worldwide health hazard, with the greatest effect in Low- and Middle-Income Countries (LMICs), however higher-income countries are also seeing disturbingly high levels of AMR (Lancet, 2022).

Rapid investment in innovative medicines, enhanced infection control measures, and optimized antibiotic usage are just a few of the steps that governments may take to defend their health systems from the threat of AMR. As many as we are there is a great chance that we can fight this pandemic to an end. What is needed is adherence and compliance to strategies and tools which are informed by evidence (JCDR – Antimicrobial Resistance, Antibiotic, Control and Prevention, Infection, Rational Use, 2018).

 What are the key factors driving AMR?

There are many interlinked factors encompassing human health, animal and environment as well as economic and societal structures. One key problem is misuse of antimicrobials driven by people’s behaviours and beliefs. Behaviour change as one of the leading factors decelerating the drive of AMR awareness (Edgar et al., 2008). This means that no matter how many times people are educated on AMR, they need behavioural change interventions for them to practice antimicrobial stewardship procedures (ASP) in order to mitigate its effects. The proceeding question would be: why do people have an attitude towards AMR and yet it’s killing them. There are many answers there but some of the important ones are lack of knowledge, and poverty. For example inequalities in the American Health care system disproportionately affect persons of colour and other disadvantaged groups and these disparities lead to gaps in health insurance coverage, unequal access to treatments and poorer health outcomes (Taylor, 2019). These are compounded by resistance to change, mob psychology, difficulty in comprehending the message and other issues. The closest answer in as much as behavioural change is concerned is to catch them young.

Can we teach younger generation about AMR and how to practice responsible use of antibiotics?

A good solution would be to invest in AMR awareness and stewardship programs, and fostering education from early childhood. There is no harm in creating new generations, which are AMR aware.

One of the challenges with AMR education is that it’s a phenomenon that has been framed as a very scientific problem and yet it affects a larger population of people who are not even scientists. This has siloed the public from grasping AMR as a global health threat. There are good examples of public health issues, which have become part of common knowledge.  Unlike HIV and AIDS education which has been simplified and translated into terms that accommodate almost everyone across different fields, children and adults. The same should be practised to AMR education and awareness starting with the inclusion of it in students’ curriculums from early childhood to tertiary education. Everyone should be empowered to understand and participate in the fight against AMR, to be responsible with their actions with respect to the use of antibiotics, thus antimicrobial stewardship. The easier way to do it is to cultivate that spirit in children. If we do that they can find areas where they can fit in the fight.  Failure to do so when spreading the AMR gospel to these people would be as bad as telling stones and trees what to do. A few or no one will listen and take action towards the fight. With time whoever is working on communication and awareness will get an unpleasant societal feedback, becoming weary though in actual fact the process is supposed to be sustainable in order to achieve its goals.

I’m calling on all health practitioners, policy makers and other related stakeholders to include children and students in this fight because they are the future leaders. They will take over what they are grasping now to generations to come. These are the convenient distribution channels of AMR education and antimicrobial stewardship to the desired targets. The same principle that occurs when children inform their parents about what was taking place at school, be it events in the class, outside, exciting and boring is the same way that can be taken advantage of. The parent-children relationship is one of the strongest ever and studies reveal that parents listen very well to their children. Each time they are relayed messages from school by their children, parents do not ignore; rather they try to make sense out of that information and come to a good conclusion with them. If there is anything that needs to be done quickly they do so in an effort to promote smooth learning for their children. Primary, secondary and tertiary institutes can be hubs of information distribution. Research also shows that students quickly understand and relate to information shared during events or moments which they enjoy the most (The National Research Council, 2000). This means that the materials designed should contain awareness information relevant to the target age. Right awareness campaigns can effectively create ambassadors of the stewardship.

Another obvious advantage related to education of younger generations can be a long-term benefit in terms of innovation of treatments for drug resistant infection. There are vast intelligent and innovative mind-sets in colleges, universities, primary and secondary schools, which require empowerment and involvement. As the research and development of new antibiotics has stalled since the ‘80s, we ought to come up with new and effective treatments as an alternative to counteract superbugs. This fight requires each and every individual on earth to be involved to save livelihoods. Drug discovery and development is one of the most important fields in the health field. Nowadays the renowned manufacturers like Pfizer are no longer producing new medicines because of scientific difficulties, financial and regulatory hurdles and lack of know-how (ReAct, 2016). They are now calling for private sectors, independent researchers and other related stakeholders to lessen the burdens incurred in these clinical trials. Students play a pivotal role in this ideology since they would help in terms of drug research and development in their respective associations and learning institutes. There are student initiatives already available like SAS-Africa which have taken steps on the spread of awareness on AMR (SAS Africa, 2020).

Collaboration between organisations fighting AMR, be it the government or non-governmental organisations, will make impactful changes. There are also various students’ clubs like Interact, Roteract, LEO, Toast masters, Early Act to name a few, which are flexible to collaborations like these.

This global pandemic is going to be the next most deadly ever in the history of humankind as alluded to earlier on the approximated statistics of deaths as justified by futurological studies.  As superbugs think of smarter ways to counteract antibiotics we should also come up with even better strategies to counteract them quickly (Edwards, 2019).

I believe in the power of engaging students in this fight because they are going to be the AMR free generation if they are well educated about the proper stewardship procedures to practise in the society. Students should participate in workshops, conferences, symposiums in which issues of AMR are discussed. This will not only make them feel accommodated but they will take responsibility in whatever they would take in respect to rational drug use and other stewardship procedures (Appiah et al., 2022). When all the engagements are done in the correct manner in 15 years or so down the line we would have created an AMR free generation.  

As Muhammad Ali once said: “Impossible is just a big word thrown around by small men who find it easier to live in the world they’ve been given than to explore the power they have to change it. Impossible is not a fact. It’s an opinion. Impossible is not a declaration. It’s a dare. Impossible is potential. Impossible is temporary. Impossible is nothing.” (Muhammad Ali Quotes and Facts: A Real Look at His Life, n.d.). The AMR fight is very much possible to win as long as we practise smarter ways towards it. Smart thinking comes from changing behaviour and changing behaviour comes from education and tutoring. More education means more impact.

References

  1. Antibiotic resistance: the race to stop the “silent tsunami” facing modern medicine. (2015, August 21). The Guardian. https://www.theguardian.com/society/blog/2015/aug/21/antibiotic-resistance-the-race-to-stop-the-silent-tsunami-facing-modern-medicine.
  2. Antimicrobial resistance. (n.d.). Www.who.int. Retrieved August 1, 2020, from https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance#:~:text=Why%20is%20antimicrobial%20resistance%20a
  3. ‌Appiah, B., Asamoah-Akuoko, L., Samman, E., Koduah, A., Kretchy, I. A., Ludu, J. Y., Odonkor, G., Nam, S. H., & Gyansa-Luterrodt, M. (2022). The impact of antimicrobial resistance awareness interventions involving schoolchildren, development of an animation and parents engagements: a pilot study. Antimicrobial resistance & Infection Control, 11(1). https://doi.org/10.1186/s13756-022-01062-6
  4. Edgar, T., Boyd, S. D., & Palame, M. J. (2008). Sustainability for behaviour change in the fight against antibiotic resistance: a social marketing framework. Journal of Antimicrobial Chemotherapy, 63(2), 230–237. https://doi.org/10.1093/jac/dkn508
  5. Edwards, E. (2019, November 13). Dangerous superbugs kill more people than previously thought. NBC News; NBC News. https://www.nbcnews.com/health/health-news/dangerous-superbugs-kill-more-people-previously-thought-n1081086
  6. Few antibiotics under development – How did we end up here? – ReAct. (2016). ReAct. https://www.reactgroup.org/toolbox/understand/how-did-we-end-up-here/few-antibiotics-under-development/
  7. The Lancet: An estimated 1.2 million people died in 2019 from antibiotic-resistant bacterial infections, more deaths than HIV/AIDS or malaria. (2022, January 18). Institute for Health Metrics and Evaluation. https://www.healthdata.org/news-release/lancet-estimated-12-million-people-died-2019-antibiotic-resistant-bacterial-infections
  8. Larsson, D. G. J., & Flach, C.-F. (2021). Antibiotic resistance in the environment. Nature Reviews Microbiology, 1–13. https://doi.org/10.1038/s41579-021-00649-x
  9. Muhammad Ali quotes and facts: A real look at his life. (n.d.). Www.easybib.com. Retrieved April 6, 2022, from https://www.easybib.com/guides/quotes-facts-stats/muhammad-ali/#:~:text=Muhammad%20Ali%20quotes%20impossible%3A
  10. ‌National Research Council. (2000). How People Learn. National Academies Press. https://doi.org/10.17226/9853
  11. The Century Foundation. 2022. Racism, Inequality, and Health Care for African Americans. [online] Available at: <https://tcf.org/content/report/racism-inequality-health-care-african-americans/#:~:text=The%20American%20health%20care%20system,health%20outcomes%20among%20certain%20populations.> [Accessed 30 May 2022].
  12. ‌Who Are We : SAS-AFRICA. (2020, May 14). https://www.studentsagainstsuperbugs.org/who-we-are/#:~:text=Students%20Against%20Superbugs%20(SAS)%20Africa
  13. Antimicrobial resistance. (n.d.). Www.who.int. Retrieved January 7, 2022, from https://www.who.int/news-room/questions-and-answers/item/antimicrobial-resistance#:~:text=Antimicrobial%20resistance%20occurs%20when%20microorganisms
  14. ‌ World Population Clock: 7.8 Billion People (2020) – Worldometer. (n.d.). Www.worldometers.info. https://www.worldometers.info/world-population/#:~:text=The%20current%20world%20population%20is

About the Author: Ngoni Veddie Muzondo is a pharmacy student at Harare Institute of Technology. He is an ardent AMR Champion and heads SAS Africa activities in Zimbabwe.

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