“Our Time with Antibiotics is Running Out”

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Editor’s note: Each November, countries around the world commemorate World Antibiotic Awareness Week (WAAW). WAAW aims to increase global awareness of antibiotic resistance and to encourage best practices among the general public, health workers, and policymakers in order to avoid the further emergence and spread of antibiotic resistance. This article recaps World Antibiotic Awareness Week activities in Eritrea.

Since their discovery, antibiotics have served as the cornerstone of modern medicine. However, the persistent overuse and misuse of antibiotics in human and animal health have encouraged the emergence and spread of antibiotic resistance, which occurs when microbes, such as bacteria, become resistant to the drugs used to treat them. Commemorated every November, World Antibiotic Awareness Week (WAAW) aims to increase awareness of global antibiotic resistance and to encourage best practices among the general public, health workers, and policymakers to avoid the further emergence and spread of antibiotic resistance.

Speaking at an event commemorating WAAW in Eritrea on 12 November, Ms. Amina Nurhusien, Eritrea’s Minister of Health, stated, “The misuse of antibiotics is causing antimicrobial medicines to fail. The spread of antimicrobial resistance (AMR) is outpacing the world’s capacity for antibiotic discovery. This will lead the world towards a post-antibiotic era in which previously easily treatable common infections will become challenging to treat.” At the event, held at the National Confederation of Eritrean Workers’ (NCEW) conference hall, Minister Amina also announced that Eritrea is developing a national action plan to combat AMR and that the plan will be based on an integrated approach (referred to as “one health”).

An important feature of this year’s local WAAW activities is the close cooperation between the Ministry of Health and the Ministry of Agriculture. As well, the wide-ranging events at the NCEW conference hall included presentations and extensive discussions. The need to reinforce the national surveillance system, which identifies the national burden of AMR, was discussed at length by attendees at the WAAW events. Additionally, many healthcare and agricultural professionals called for improving local disposal systems and effectiveness of infection prevention mechanisms. There was a broad consensus among speakers that these efforts could significantly reduce the threat of AMR. Other topics discussed include the need to strengthen train in quarantine systems, train experts, and improve preventive measures to combat AMR. Several speakers also suggested that Azel Pharmaceutical Share Company, a local firm, explore the possibility of producing antibiotics for animals.

In Eritrea, the growth and spread of AMR is associated with a number of factors, including: negligent handling or disposal of pesticides; farmers’ growing dependence on pesticides; lack of early treatment of diseases; and low levels of public awareness about AMR. During discussions, agricultural experts from across the country noted that counterfeit and obsolete medicines and pesticides can contribute to AMR. They recommended that stronger regulations and policies be put into place to guide the use and distribution of medicines and pesticides. Several experts suggested that an unequal distribution of drugs and pesticides may also be a factor in the growth of AMR. For example, some regions in the country have an excess supply of antibiotics, leading to medicines being stored and exposed to AMR, while other regions suffer from deficits, which can lead people to turn to counterfeit products. According to most experts, national laboratories must be upgraded and linkages should be developed between the Ministry of Health and Ministry of Agriculture in order to more effectively combat AMR.

Dr. Josephine Namboze, the World Health Organization (WHO) representative in Eritrea, conveyed the message of Dr. Matshidiso Moeti, the WHO regional director for Africa. Pointing out that researchers have a critical role to play in identifying resistant bacteria, Dr. Josephine revealed that there is a paucity of data on the extent of antibiotic resistance in Africa. She went on to state that the WHO prioritizes the fight against antibiotic resistance and is currently partnering with many African governments to develop action plans to combat antibiotic resistance.

In Eritrea, the national action plan to combat AMR has been finalized. According to Mr. Berhane Gebretinsae, Director General of the Department of Medical Services in the Ministry of Health, close cooperation by all stakeholders in the country will be vital, since it is impossible to effectively combat AMR by working independently.

An annual highlight of WAAW is the series of research presentations. Over the years, the presentations have been highly interesting and very informative. This year, the presentations were again of high caliber and they drew large audiences.

In a presentation titled, “Antibiotics Resistance: A Global Threat”, Mr. Iyassu Bahta, Director of the National Food and Medicines Administration, provided a detailed overview of AMR. Mr. Afeworki Mihreteab, Head of Animal and Plant Health in the Ministry of Agriculture, gave a presentation titled, “AMR in Animals and Plants”, while Mr. Keleab Haile presented a paper titled, “Disposal of Pesticides: Eritrea’s Case”. Mr. Mosana Ghebru and Samuel Zeru, both from Hamelmalo Agricultural College, presented a research paper titled, “Therapeutic Efficacy of Invermectin and Albendazole in Sheep in Hamelmalo, Eritrea”. Their findings reveal that the sheep have developed resistance to drugs and that farmers may now need more powerful drugs to ensure the health of their sheep.

One interesting revelation during the discussions was that there have been several instances of misuse of animal vaccines and pesticides by farmers in different areas of the country. Farmers often do not fully understand the implications of their actions. Thus, this is one of the reasons that increasing public awareness is a central objective of WAAW. According to Mr. Kaleab, Eritrea follows international standards guiding pesticide use and disposal. For example, pesticides accumulated during the pre- and post-independence period have been collected and sent abroad for proper disposal.

The collaboration between the Ministry of Health and Ministry of Agriculture allows the two ministries to more efficiently utilize their resources toward combating AMR. In recent years, Eritrea has made significant progress in terms of pharmacovigilance. Mr. Mulugeta Russom, Head of Pharmacovigilance Center in Eritrea, described how rapid diagnostic tests (RDTs) may fail to detect malaria. He pointed out that about 80% of RDTs lead to false negative results since the RDTs fail to detect the target antigen. As a result, tests may show that some patients are free of malaria, even though they actually have malaria. Since this poses significant threats to health, 135 million RDTs were recalled from the African market.

One of the primary objectives of WAAW is expanding public awareness of AMR. Mr. Arefaine Berhe, the Minister of Agriculture, stated that there was a need to establish a supportive environment for local professionals to convey health-related messages to the general public. He also mentioned that finalizing the national action plan is an important step in the fight against AMR.

Antibiotic resistance poses significant challenges to humanity. Moving forward, it is vital that we do all we can to avoid the further emergence and spread of antibiotic resistance.