By Hafeez Hamza

For correspondence: hzhafeezhz@gmail.com

It was a bright Monday morning, the sky was an expanse of sapphire blue dotted with feathery white clouds as the radiant rays of the sun shone through brightly, I was eagerly waiting for this day as we would be resuming our face-to-face classes after a gap of close to two years due to the COVID-19 pandemic.

It felt good to be back, but at the same time it felt quite different from what I last remember. There were massive aesthetically pleasing posters reminding everyone to put their mask on and practice social distancing, along with disinfectants stationed every 20 meters apart.

I arrived at my class exactly at 9am and proceeded to greet my friends who I missed dearly, just as we started to chitchat, our professor walked in wearing a slick navy-blue coat suit, everyone quickly took their seats, which were spaced 2 meters apart. Suddenly, there was a pin-drop silence, ‘Good morning everyone! Welcome back, I am very happy to see you all!’ he said.

‘For close to 2 years now, we have indeed been living in unprecedented times, before we begin today’s lesson I would like to ask every one of you, what have you learnt personally in these past 2 years?’ he asked the class.

Just as we all took a moment to understand and prepare to answer the question posed by our professor, ‘l learnt how to cook!’ screamed Adam and the whole class burst into laughter.

He paused and then continued to explain further. ‘Honestly, I was bad at cooking despite trying my best but over the past 2 years, I learnt from my mistakes and kept practicing until I improved my cooking skills.’

‘Very interesting, anyone else?’ quipped the professor

‘Professor, I learnt something that could save our future!’ said Elliot in a passionate voice

‘Please do share with us what you have learnt,’ said the professor

‘The COVID-19 pandemic has cost us many lives and impacted our social and economic lifestyles but the devastating impact of Antimicrobial Resistance will be much greater in the future, so I would like to share with you the lessons we can take from the COVID-19 pandemic and use them in the fight against AMR.’ said Elliot in an engrossing tone, drawing the attention of everyone in the classroom

The COVID-19 pandemic has brought into sharp focus the impact of pandemics, in which millions of people have died, trillions of dollars have been lost, expenditures cut and international efforts to achieve the Sustainable Development Goals put in jeopardy. There are vital lessons to learn from this tragedy to fight one of the biggest health challenges the world is facing – Antimicrobial Resistance

Antimicrobial resistance (AMR) occurs when pathogens (e.g., bacteria, viruses, fungi or parasites) that cause infections evolve, to resist the effects of the medicines used to treat them.  As a result, infections become harder to treat, increasing the risk of disease spread, severe illness and death [1].

There were an estimated 4.95 million deaths in 2019 due to bacterial AMR, according to comprehensive research published in The Lancet on January 19, 2022. More individuals died from drug-resistant illnesses than from HIV/AIDS (864,000 fatalities) or malaria (643,000 deaths) [2,3]. Furthermore, a 2016 review on antimicrobial resistance projected that by 2050, ten million people could die each year due to AMR! [4]

In fact, the COVID-19 pandemic may have exacerbated the situation since there were a lot of sick people, who were prescribed antibiotics unnecessarily while in the hospital [5].Additionally, the COVID-19 pandemic has led to sharp focus of attention towards tackling viral threats, which could seriously deprive AMR of attention and investment. [6] However, the experience and insights gained from fighting the COVID-19 pandemic has left behind many valuable lessons that can be applied to AMR.

Information is a primary resource for enabling a population to make informed decisions on how to take care of their health as well as preventing misinformation [7]. One of the biggest lessons we can learn from COVID-19 is regarding effective public health messaging to prevent infections in the first place. AMR for a long time has faced the problem of effective communication to the general public, the COVID-19 pandemic demonstrated that informing populations about the health risks posed by the disease, as well as measures they can take to protect themselves (from general hygiene, mask-wearing, social distancing) is key to mitigating the spread and reducing the likelihood that people will become infected. People are better positioned to make better decisions and adopt positive behaviors to safeguard themselves and their loved ones when they have access to accurate, timely and frequent information in a language they can understand and a source they can trust

Another lesson is to explore the use of immunization as a tool in the fight against AMR. Immunization can prevent diseases requiring antibiotic treatment just as much as it can tackle viral infections. The rapid advances in the field of vaccinology driven by the COVID-19 pandemic could therefore be beneficial in addressing AMR. [6] Currently, close to 12 billion doses of COVID-19 vaccine have been administered and over 4.7 billion people fully vaccinated worldwide suggests that vaccination may be more widely accepted in future by the public [8].

As of today, the development of AMR diagnostics has faced many hurdles, reflecting both market barriers and technological challenges. The rapid pace of innovation that has been observed in coronavirus testing as well as the widespread acceptance of such tests among the general population demonstrates what is achievable The revolution in mass diagnostic testing unleashed by the pandemic may open the door for major advancements in the detection of antibiotic-resistant infections. Fast and efficient point-of-care diagnostics will be key in the superbug fight, both to identify pathogens and then test their susceptibility to different antibiotics. [6]

There are opportunities to learn from the shortcomings of COVID-19 as well. 

The disintegration of global solidarity during COVID-19 has brought into sharp focus the fragile nature of international rules-based cooperation. COVID-19 has shown that existing approaches to global cooperation aren’t suited for managing and controlling a worldwide pandemic, for example, for instance, equitable access to vital health tools has been a major challenge during the pandemic [9]. Efforts to encourage coordination and collaboration to facilitate equitable access to health countermeasures have been undermined repeatedly with breakdowns of coordination and collaboration impacting access to vaccines, PPE and oxygen. The introduction of the COVAX Facility, a global risk-sharing mechanism for pooled procurement and equitable distribution of COVID-19 vaccines, has been a major international effort to attempt to overcome this problem [10].  For AMR to have a positive impact it will require a cohesive and enforceable global response. The international community should re-examine the feasibility of a coordinated global response to AMR under existing institutions and implement any necessary changes to promote solidarity and collaboration. Discussions of global targets or agreements for AMR must take local context and circumstances into account when determining national commitments, and any commitments should be reviewed frequently to ensure they are feasible and effective [9].

Structures at every level, must change to make prevention of emerging infectious diseases possible, however,  individual behaviors of people are crucial in protecting themselves and their communities, that is a key lesson we can learn from COVID-19, for example, regular hand-washing, social-distancing and getting vaccinated, all these practices performed by every individual was crucial to fight the COVID-19 pandemics. This begs the question, as an individual, what can I do to help limit the spread of AMR?

Here are a couple of pointers, see a healthcare professional when you are unwell, do not self-medicate with antibiotics. When prescribed with antibiotics ensure to follow treatment guidelines and complete the prescribed course of treatment. Ensure to wash your food before eating and practice self-hygiene, these actions prevent the spread of microorganisms and infectious diseases. Lastly, learn more about AMR and teach it to others, become an antibiotic resistance champion by helping to raise awareness in your community and being a good example to others. [12]

Antibiotics are one of the greatest achievements of mankind and one of the drugs, which has positively impacted healthcare globally. People must use antibiotics in a correct and responsible manner to sustain this achievement over time.

Conclusion

The impact of the COVID-19 pandemic on a social, political and economic level has been astronomical, but the consequences of AMR will be much greater if no action is taken. It is crystal clear from the lessons learnt in the fight against the COVID-19 pandemic that governments and international bodies must work hand-in-hand to fight the threat of AMR through a collaborative, coordinated and one health approach. More importantly, every human being plays a critical role in limiting the spread of AMR through responsible behaviors inching closer to a world free of AMR.

References

1. World Health Organization, Antimicrobial resistance. Available at – https://www.who.int/health-topics/antimicrobial-resistance
2. Antimicrobial Resistance Collaborators (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet (London, England), 399(10325), 629–655.
3. Thompson T. (2022). The staggering death toll of drug-resistant bacteria. Nature, 10.1038/d41586-022-00228-x. Advance online publication. https://doi.org/10.1038/d41586-022-00228-x
4. O’Neill J. Tackling drug-resistant infections globally: final report and recommendations (2016) LondonReview on Antimicrobial Resistance Available at – https://amr-review.org/sites/default/files/160518_Final%20paper_with%20cover.pdf
5. Langford, B. J., So, M., Raybardhan, S., Leung, V., Soucy, J. R., Westwood, D., Daneman, N., & MacFadden, D. R. (2021). Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 27(4), 520–531.
6. Brunswick, The Next Pandemic: Applying the Lessons of COVID-19 to AMR. (2022) Available at – https://www.brunswickgroup.com/the-next-pandemic-applying-the-lessons-of-covid-19-to-amr-i21028/#:~:text=To%20date%2C%20the%20development%20of,public%20shows%20what%20is%20possible 
7. Pan American Health Organization (PAHO), Communicating about COVID-19. (2021) Available at – https://www3.paho.org/hq/index.php?option=com_content&view=article&id=15751:communicating-the-risks-to-health-posed-by-covid-19-is-key-to-protecting-populations-and-mitigating-spread&Itemid=1926&lang=en/4% 
8. Our World in Data. Coronavirus (COVID-19) Vaccinations. Available at – https://ourworldindata.org/covid-vaccinations?country=OWID_WRL Last accessed – 10th June 2022
9. Wilson, L. A., Rogers Van Katwyk, S., Fafard, P., Viens, A. M., & Hoffman, S. J. (2020). Lessons learned from COVID-19 for the post-antibiotic future. Globalization and health, 16(1), 94.
10. The Global Antibiotic Research and Development Partnership (GARDP), Learning from Covid-19 To Tackle Antibiotic Resistance (2020) Available at – https://gardp.org/uploads/2020/11/GARDP-Learning-COVID19-Tackle-AMR-En.pdf
11. Wilson, L. A., Rogers Van Katwyk, S., Fafard, P., Viens, A. M., & Hoffman, S. J. (2020). Lessons learned from COVID-19 for the post-antibiotic future. Globalization and health, 16(1), 94
12. ReAct. 2022. As an individual – What can I do? Available at – https://www.reactgroup.org/toolbox/understand/what-can-i-do/as-an-individual/

About the Author: Hafeez Hamza is a finalist pharmacy student at Girne American University in Cyprus. He is also an an active AMR Champions and has engaged in multiple initiatives addressing this global health threat.