The development of antibiotics and antivirals are some of the most prolific medical inventions to date. The introduction of these magnificent tools marked one of humanity’s biggest successes, saving millions of patients, increasing the average life expectancy and catapulting the advancement of medical sciences. Envisioning a world without antibiotics and antivirals seems nearly impossible, yet the threat of antimicrobial resistance could turn this nightmare into a reality.

What Are Antimicrobials? 

Antimicrobials are substances used to prevent, slow down and treat various infections caused by a variety of microorganisms including bacteria, viruses, fungi and parasites. Common antimicrobials are antibiotics, antivirals, antifungals and antiparasitics.

What is Antimicrobial Resistance? 

Antimicrobial resistance occurs when bacteria, parasites, viruses and fungi have a diminished response to medications designed to fight and kill them. In severe cases of antimicrobial resistance, microorganisms have absolutely no response to therapeutics. Antimicrobial resistance results in infections that are increasingly difficult or even impossible to treat. Moreover, antimicrobial resistance increases the risk of disease spread, severe illness and ultimately death. 

What Drives Antimicrobial Resistance? 

Microbes develop advantageous genetic mutations over time, which allow them to resist pre-existing therapeutics including antibiotics and antivirals. This process is accelerated by a multitude of factors largely revolving around the misuse and overuse of antimicrobials. Furthermore, antimicrobial resistance is driven by a lack of sanitation and hygiene in both animals and humans, poor access to quality health care services, lack of access to clean water, unregulated production and distribution of antimicrobials and several additional circumstances which are inextricably tied to poverty-driven conditions and actions. 

The World Health Organization (WHO) recognizes the relationship between poverty and antimicrobial resistance, stating that “more than any other issue, poverty and inadequate access to drugs continue to be a major force in the development of resistance.”

Elaborating on Poverty and Antimicrobial Resistance

Unfortunately, factors driving antimicrobial resistance are more pronounced in socioeconomically disadvantaged countries. Impoverished countries are more likely to have inadequate environmental regulations, which results in the spread of infectious diseases through the water, air and soil. Moreover, improper sanitation and hygiene services exacerbate this problem. Ensuring access to clean water and sanitation can greatly decrease the risk of antimicrobial infections such as gastrointestinal diseases by up to 60%. Moreover, promoting and practicing proper hand hygiene in a clinical setting has the potential to alleviate the risk of infectious disease by 40%. 

Poor countries are also more likely to experience inaccessibility to health care services which results in higher rates of antimicrobial resistance. Without access to health care facilities, qualified health care professionals and effective antimicrobials, poverty-affected areas are more likely to propagate the spread of infectious diseases. Also, insufficient funding for drug research and development leaves those most vulnerable without a way to counteract the spread of disease and drug resistance. Even when antimicrobials are available, they are oftentimes expensive and unaffordable to poverty-affected people. Thus, impoverished people are more likely to stop taking the necessary dosages of medicine in order to “split” it with other people. Alongside this, individuals may be more inclined to purchase cheaper, unregulated medicines that are substandard. Ultimately, these factors all contribute to the increased risk of antimicrobial resistance.

Misconceptions regarding Antibiotics

The issues faced by impoverished countries are compounded by a lack of awareness and knowledge. For example, misconceptions about antibiotics in poorer countries drive cultural practices that lead to self-medication and alternative forms of treatment. 

Alongside this, impoverished individuals may be less likely to understand treatment procedures such as using medications targeting the wrong type of infection (bacterial vs. viral) or discontinuing antimicrobial use too early. Lastly, impoverished communities may have less awareness of the risk of antimicrobial resistance in general.

Combating Antimicrobial Resistance

The Antimicrobial Resistance Multi-Partner Trust Fund (AMR MPTF) was launched by the Food and Agriculture Organization of the United Nations, the World Health Organization and the World Organization for Animal Health in 2019, with the United Nations Environment Programme becoming a co-signer in 2021. The AMR MPTF was initially slated to operate through 2024, but it has extended its efforts to 2030 in order to align with the Sustainable Development Goals timeline.

The AMR MPTF’s immediate funding appeal comprised more than $75 million dedicated to supporting countries most affected by antimicrobial resistance including Cambodia and Indonesia. The fund is dedicated to developing national action plans and strengthening surveillance of antimicrobial resistance. What’s more, this fund aims to increase the optimal use of antimicrobials in order to reduce the impact of antimicrobial resistance on both human and animal health. Ultimately, the AMR MPTF wants to prevent the inevitable deaths that will occur if no action is taken against antimicrobial resistance.

Looking Ahead

While the AMR MPTF is taking the necessary steps to combat antimicrobial resistance, it was listed as one of the top ten threats to global health by the WHO in 2019. Projected outlooks if action isn’t taken against antimicrobial resistance are bleak; this problem could result in 10 million deaths each year by 2050 and force up to 24 million people into extreme poverty. Considering the relationship between poverty and antimicrobial resistance, these problems would continue to magnify at an alarming rate. Ultimately, diminishing antimicrobial resistance is imperative to the well-being of millions, particularly those who are already most vulnerable. In addition, fighting poverty could save lives in the present and prevent devastating effects in the future. 

–Olivia Welling

Photo: Flickr