By Jonathan Babuya
For correspondence: email@example.com
Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites evolve over time and no longer respond to medicines designed to target them, making infections harder to treat and increasing the risk of disease spread, severe illness and death. AMR is among the leading causes of the deaths in the world, with 1.27 million deaths attributed to resistant bacterial infections in 2019, according to research done by The Lancet.  Apart from the burden on health, AMR also affects other areas like the economy, by increasing hospital costs for affected individuals and governments.
With this statistically significant impact, AMR is without doubt a global problem that requires global interventions. But addressing AMR also requires each country to take action. Even with significant strides made in Uganda towards the fight against AMR, are we where we ought to be as a country?
To begin with some history, in 2015, The 71st United Nations General Assembly (UNGA), the 68th World Health Assembly, and organizations including the World Health Organization (WHO), the Food and Agriculture Organization (FAO), and the World Organization for Animal Health (OIE) came up with The Global Action Plan against Antimicrobial Resistance, which was a key collaboration to combat AMR using a One Health approach involving multidisciplinary efforts.
The Global Action plan against AMR outlined the following objectives; to improve awareness and understanding of antimicrobial resistance through effective communication, education and training; to strengthen the knowledge and evidence base through surveillance and research; to reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures; to optimize the use of antimicrobial medicines in human and animal health and to develop the economic case for sustainable investment that takes account of the needs of all countries; and to increase investment in new medicines, diagnostic tools, vaccines and other interventions.
These objectives were to be attained through the implementation of clearly identified actions by Member States, the Secretariat, and international and national partners across multiple sectors. The actions to optimize use of antimicrobial medicines and to renew investment in research and development of new products were to be accompanied by actions to ensure affordable and equitable access to those who needed them. Following the introduction of the Global Action Plan and the signing of a political declaration on AMR in commitment to a broader multisectoral approach, member states of the United Nations were tasked to respond by coming up with National Action Plans on AMR.
Accordingly, Uganda came up with its own National Action Plan for the years 2018-2023 through the Uganda National Academy of Sciences, with the following objectives; Raising awareness and understanding of the AMR problem and containment options; improving prevention, detection and control of infectious agents; optimizing the use of antimicrobial medicines; and generating knowledge and evidence through surveillance, research and innovation. The implementation of this plan was to be coordinated and overseen by the Uganda National Antimicrobial Resistance Committee, which would also monitor the progress of the interventions. The principles of the action plan included; whole-of-society engagement, including a One Health approach; prevention first; access; sustainability and incremental targets for implementation.
Furthermore, the One Health Strategic Plan laid emphasis on seven priority zoonotic diseases, AMR, public health threats and related bio-security issues in its initial 5-year period (2018-2022). The Plan had 5 strategic objectives, each with sub-objectives and activities that were to be implemented to achieve the goal and realize the vision of the plan.
The strategic objectives included; Establishing and maintaining high-level commitment at all relevant levels of government and among the key stakeholders including the private sector; institutionalizing the One Health concept within Government of Uganda structures to achieve sustainability and legitimacy of the One Health Platform to coordinate multisectoral collaboration; strengthening prevention, preparedness and response to zoonotic diseases, AMR and biosecurity threats; strengthening capacities (competencies, tools, strategic thinking, leadership, coordination) of the One Health platform and other stakeholders to effectively address zoonotic disease threats, biosecurity and AMR; and enhancing behavior change, communication and awareness of the value of One Health.
Some achievements have been made since the establishment of the National Action Plan, such as the establishment of centers for combating multidrug resistant infections like tuberculosis in hospitals across the country like Mbale Regional Referral Hospital, and the establishment of centers for surveillance and reporting about AMR (though their data has not yet reflected on the global platforms like the Resistance Map). Additionally, research centers like Mbale Clinical Research Institute and Uganda Virus Research Institute (UVRI) have been funded to carry out work on AMR. Public awareness campaigns have been carried out by the government and other support organizations to enforce primary prevention of disease as an early measure, while also enforcing rational use of antibiotics and regulating access and excess.
Recently there have been efforts by the USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program to form the National AMR Charter, which will have a mandate of enforcing the inclusion of AMR on the teaching syllabus of undergraduate and graduate programs. There have been mass vaccination programs against disease as a means of primary prevention. Establishment of the National One Health platform, which came up with the One Health strategic plan was an achievement on its own along with several efforts to include One Health in academia. The One Health approach was included in the national budget framework as the strategy 10.2, which stated to support public education and mobilize the public to participate in Environment and Natural Resources management and operationalization of national One Health approach development..
The achievement of these objectives has occurred with different urgencies as perceived by the different stakeholders, ranging from politicians, civil servants, and other leaders that participate in the planning process for the country. Some programs were implemented earlier than others according to the national strategic plan. However, improvements in the limited amount of quality data and lack of harmonization in assessing the burden of AMR are also needed. Challenges to the One Health approach are related to inadequate; coordination across sectors, government commitment, advocacy and awareness creation and research. For systematic and sustainable One Health engagements, urgent efforts should be made by the government to address current and related future challenges.. Among these challenges is the alternative medicine sector, which embodies herbal medicine and has proved a difficult sector to regulate, as substandard products without proper safety information are still on market.
To sum it all up, a great percentage of Uganda’s National Action Plan on AMR has been achieved, except for a few areas still lacking enforcement. AMR has been popularized in the country, with appearance in the different important national strategic plans, and the budgets of measures that are intended on alleviating the burden of AMR show that the different stakeholders are aware of it. Though more efforts are still needed, they will hopefully be achieved with upcoming programs and the installment of the National AMR Charter. With these efforts, Uganda and the world at large can and will defeat AMR.
About the Author: Jonathan is pursuing is pursuing a Bachelor of Medicine and Surgery at Busitema University in Uganda. He is an active AMR champion and writer.