Understanding Antimicrobial Resistance

AMR occurs when pathogens such as bacteria, viruses, fungi, and parasites—evolve to withstand the effects of antimicrobial drugs, rendering once-effective treatments not working. As a result, infections that were previously treatable become harder, or even impossible, to cure. The consequences of AMR are dire, leading to worse health outcomes for patients, prolonged illnesses, and higher mortality rates in scenarios which were not previously a risk to life. Beyond the immediate health impacts, AMR also poses significant economic challenges, straining healthcare systems and affecting the livelihoods of communities, especially in . The spread of AMR is driven by a complex array of factors, creating a "biological arms race" between human innovation and evolving pathogens. Key contributors to this phenomenon include:

• Overuse and misuse of antimicrobials in healthcare settings, at the community level, and in agriculture and animal husbandry. Inappropriate prescribing practices, self-medication, and inadequate infection control measures all contribute to the proliferation of resistant pathogens.

• Widespread use of antibiotics in agriculture and animal husbandry to promote growth and prevent disease in livestock exacerbates the spread of resistance across human and animal populations.

• Environmental contamination with resistant genes and antimicrobial residues. Discharge from pharmaceutical manufacturing, hospitals, and agriculture can introduce antimicrobials, resistant pathogens and genetic mobile elements into water sources, creating hotspots for resistance.

• Insufficient investment in research and development of new antimicrobials and diagnostic tools. The current pipeline for novel antibiotics is sparse, with few new drugs available to combat resistant infections. Similarly, diagnostic innovation lags, limiting the ability of healthcare providers to quickly and accurately identify infections and guide appropriate treatment.

• Lack of access to rapid and accurate diagnostics at the point of care. The absence of reliable and affordable diagnostic tools, especially in low-resource settings, leads to overprescription of antimicrobials and delays effective treatment.

• Limited access to basic health provisions and essential medicines, such as antibiotics and vaccinations. Inadequate water, sanitation, and hygiene (WASH) infrastructure, coupled with insufficient healthcare facilities, particularly in low-resource settings, further contributes to the spread of AMR by facilitating the transmission of infections and reducing the capacity to treat them effectively.

The interconnected nature of human, animal, and environmental health factors influencing the incidence of AMR, means that a holistic multifaceted solution aligning with the One Health approach is required. As part of the One Health approach, solutions to tackle AMR include improving antimicrobial stewardship, promoting sustainable agriculture practices, enhancing diagnostic capabilities, ensuring effective surveillance programs tracking emerging resistance and continually investing in innovative drug, vaccine and diagnostic development to ensure sustained and equitable access to these solutions for combating AMR. In addition to these, strengthening health systems and the provision of basic healthcare and public health intervention strategies (such as access to WASH, vaccination campaigns etc) are key to protecting the long-term health and well-being of communities.