Challenges

Antimicrobial resistance (AMR) is an increasing threat to the effective treatment of an ever-increasing range of infections. AMR results in reduced efficacy of antibacterial, antiparasitic, antiviral and antifungal drugs, and is increasingly rendering the treatment of patients at imminent risk, costly or even impossible. The impact of AMR is often felt hardest by the most vulnerable populations, as it can result in prolonged illness and increased mortality. However, little is known about the impact of AMR at the community level, especially from a One Health perspective. So far, experiences addressing AMR from a community perspective are scarce. Good practices (e.g., hygiene, food safety, vaccinations, natural remedies for the treatment of diseases) and their possible impact on the prevention or containment of AMR are not well documented.

AMR is poised to impede attainment of the Sustainable Development Goals (SDG), not only restricting achievement of SDG3 (good health and well-being), but also impacting SDG1 (poverty reduction), SDG 10 (reduced inequalities), SDG8 (economic growth), SDG 6 (clean water and sanitation) and SDG2 (food safety and security). Several of the SDGs depend upon the sustained availability of affordable and effective antibiotics. At the same time, AMR could also undermine Universal Health Coverage (UHC) due to the increased costs of second or third-line drugs, longer treatment times and increased hospitalizations.

Toward a Solution

Empowering communities through social participation is central to effectively tackling the complex One Health challenge of AMR. Communities in all countries have an important role to play in many aspects of the cross-sectoral AMR response: from awareness-raising to contributing to enhanced communications and strengthening One Health approaches – such as improving responsible and appropriate antimicrobial use in both animals and humans – at the local level. In 2019, the United Nations Inter-Agency Coordination Group (IACG) emphasized the criticality of community work in AMR, by “providing political, financial and technical support to civil society organizations to enhance their engagement, including to work effectively with governments and to ensure that their efforts are aligned with and contribute to evidence-based national policies and approaches.”[1]

From that need, was born the collaboration between PAHO/WHO’s Antimicrobial Resistance Special Program, Communicable Diseases and Environmental Determinants of Health (CDE/AR), PAHO/WHO’s Health Promotion Unit and ReAct Latin America to stimulate community participation under a One Health approach. PAHO/WHO and ReAct jointly developed an engagement strategy for key actors across sectors, elaborated a first event and calling for stories from communities related to AMR and antimicrobial use. PAHO/WHO’s established technical cooperation with governments in Latin America and ReAct’s extensive networks of civil society organizations and groups active at the community level combined to bridge the gap between policy and the community. Florida International University facilitated the dissemination of event information. Launched in November 2021 during the World Antimicrobials Awareness Week, a four-day virtual regional dialogue between community and civil society members, non-governmental organizations, academics, representatives of governments and international organizations, took place to discuss tackling AMR. Through a powerful combination of poetry, music, presentations and discussions, this dialogue sought to capture, share, and learn from different community experiences with addressing the pandemic and glean relevant lessons for how to better engage communities and enable active participation to address AMR more effectively. 

In the lead-up to this meeting, a contest collected stories about community-level infection prevention and control, antimicrobial use and bacterial resistance in Latin America. More than 2,100 people registered for the event. While most participants were from the Americas region (Argentina, Bahamas, Barbados, Belize, Bolivia, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, El Salvador, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, St. Vincent and the Grenadines, Trinidad and Tobago, United States of America, Uruguay and Venezuela), cross-regional dialogue was also achieved with the participation of 18 non-regional countries (Australia, Belorussia, Brunei, Denmark, Egypt, France, India, Indonesia, Ireland, Italy, Jordan, Kenya, South Africa, Spain, Sweden, Switzerland, Tanzania and Togo). Participant profile professions were very diverse, including social worker, nurse, doctor (general practitioners and specialists), economist, biologist, professor, educator/teacher, student, veterinarian, pharmacist, health care administrator, biochemist, architect, lawyer, environmental administrator, journalist, microbiologist, AMR advisor, agricultural engineer, communicator, among others. The platform offered an opportunity to share communication and education materials, operational plans, policy briefs and document good practices on community organization and AMR relevant multisectoral work between countries of the region and with other parts of the world.   

The dialogue closed with a declaration from all signatory participants recognizing the depth of the AMR problem and the need to learn from and empower communities to actively share their knowledge and practices to work together to tackle AMR. Specifically, the declaration requested that governments take steps to promote active community involvement in One Health and use the process of development and implementation of intersectoral national AMR action plans to strengthen community contributions and engagement and take stock of and share lessons about successful examples of community practice – from health systems and research centres – at the local and national levels.

Given its success, the Empowered Communities Against AMR will continue to grow, maintaining an annual dialogue and developing communication and education workshops throughout the year. It will actively identify, document and disseminate examples, strategies and plans for community engagement on AMR. 2022 activities are focused on the importance of youth and education in building awareness about AMR, preventing infections and using antimicrobials responsibly.

Other regions may benefit from this initiative that stems from the recognition of the value of work carried out by civil society in areas and sectors related to AMR and requires mapping of and engagement of these groups and organizations to link their efforts to current strategies to counter AMR and address other health challenges. 

[1] Interagency Coordination Group on Antimicrobial Resistance. Report to the United Nations Secretary General,  “NO time to wait: Securing the future form Drug- Resistant infections,” April 2019.