When Nobel laureate Alexander Fleming discovered penicillin, he also warned the world about the threat of antimicrobial resistance (AMR).
Since their first use, antibiotics have saved hundreds of millions of lives. But today, AMR is identified by the World Health Organisation (WHO) as one of the top 10 global public health and development threats.
AMR threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi. It is estimated that globally, bacterial antimicrobial resistance was directly responsible for 1.27 million deaths in 2019 and contributed to 4.95 million deaths.
Tackling AMR requires a multifaceted, coordinated approach that extends across sectors, borders, and disciplines. The engagement of institutions beyond the Health Ministry is key to the success of addressing the threat of AMR, as it poses a serious threat to human, animal health, food production and environment.
More than ever, it requires a "One Health" approach, requiring coordinated actions across sectors. Collaboration is essential to harness the collective knowledge, resources, and efforts of various stakeholders.
The World AMR Awareness Week from Nov 18 to 28 is a reminder and great opportunity, not just for the week dedicated to raise awareness and understanding of AMR but to continue promoting best practices all year to reduce the emergence and spread of drug-resistant infections. This year's theme — "Educate. Advocate. Act now" — calls on the global community to educate stakeholders on AMR (including the public), advocate for bold commitments and take concrete actions in response to AMR.
Without AMR containment, the United Nations Sustainable Development Goals for 2030 — such as ending poverty, ending hunger, ensuring healthy lives, reducing inequality, and revitalising global development partnerships — are also less likely to be achieved. The impacts of AMR on poverty are particularly concerning. Putting proper resources into AMR containment is one of the highest-yield investments countries can make.
Malaysia has taken proactive steps to combat AMR by establishing the National Antimicrobial
Resistance Committee (NARC) in 2017 for coordinating national AMR efforts.
The NARC has led to the development and implementation of the second Malaysian Action Plan on Antimicrobial Resistance 2022-2026 along with multiple stakeholders. And it is already working on the development of the revised action plan in collaboration with relevant sectors under the One Health approach.
The WHO launched a task force of AMR survivors to give a platform for and elevate the voices of those with experience of complications from drug resistant infections. The members of the task force serve as champions to shape the AMR global narrative and influence policies that address the challenge of AMR. Additionally, they provide a 'human face' to AMR alongside messages that increase awareness.
Efforts are continuing for advocating an enhanced integrated AMR surveillance, fostering private sector engagement, promoting public-private partnerships. Good knowledge and understanding are among the pillars in tackling increasing AMR.
The Malaysian government and WHO stand committed to ensure rational use of antimicrobials to reduce the threat of AMR. In this regard, several important tools to support the country's healthcare system were also launched recently, including the revised edition of the National Antimicrobial Guideline in line with the latest clinical data.
Along with the Malaysian Consensus Guidelines on Treatment of Multi Drug Resistant Infections, Parenteral Outpatient Service Guidelines, and antimicrobial therapy at national hospitals.
To further strengthen AMR surveillance, laboratory capacity, and outbreak response, WHO together with experts from Malaysia, have been conducting regular capacity building workshops aimed at increasing awareness, surveillance capacities, and management of AMR in the country.
As partners in the fight against AMR, we need to focus on increasing awareness, limiting transmission, integrated surveillance, supporting behavioural insights and change in both healthcare and veterinary practices, and supporting policy development and economic analysis.
Although, One Health AMR research strategies, interventions and policies are emerging, further evidence is required to understand what works, in which context and for whom. There is no one-size-fits-all approach with AMR, as its not disease specific
One major challenge for tackling AMR is understanding the true burden of resistance, particularly in locations where surveillance is minimal, and data are sparse. In the health sector this includes private sector practices and data sharing, while in agriculture it is linked to the use of antibiotics in animal husbandry and fish farming.
The sooner we come together in creating awareness and regulating the unnecessary use of antimicrobials the better we will become at addressing the increasing challenge of AMR.
As AMR control is part of a wider agenda of infectious disease management, the response to infectious diseases in turn depends on the robustness of countries' broader health systems. Universal health coverage (UHC) provides the best enabling framework to tackle AMR.
The UHC efforts will strengthen AMR containment through expanded coverage with services like vaccination, preventative care, and hygiene measures aimed at infection prevention and control that lower the need for antimicrobials and thus slow the spread of AMR.
The development of multisectoral national action plans in the country to further improve awareness, advocacy, and behavioural change to combat AMR will lead us ahead. These are key along with better quality of care, information with improved data collection systems and improved stewardship with smarter, fairer financing.
Malaysia is already implementing measures to phase out antimicrobial use as growth promoters through its veterinary services and strengthening veterinary prescribing practices. In addition, it promotes the use of alternatives to
antimicrobials in animal industries, while enhancing biosecurity measures.
Building laboratory capacities for better surveillance is another key factor of success in the fight against AMR. Malaysia contributes data for Tracking AMR through Country Self-assessment Surveys and through the Western Pacific Regional Antimicrobial Consumption Surveillance System which feeds into the WHO Global Antimicrobial Resistance and Use Surveillance System.
In addition, engaging with the public and other stakeholders to better educate and enhance their knowledge is essential in this becoming part of the solution to curbing AMR.
Efforts continue to bridge the significant gap in public awareness, with comprehensive educational campaigns to address misconceptions and promote responsible use of antibiotics.
Many studies have shown that antibiotics are usually ineffective against viruses and do not treat common cold or flu symptoms. This underscores the importance of awareness campaigns to improve public knowledge and to further educate themselves on the causes of AMR.
We stand committed in the fight against the threats of AMR, and the future needs stronger leadership, advocacy and accountability at all levels, and the time to act is now.
Dr Muhammed Radzi is the Director-General of Health Malaysia and Dr Rabindra Abeyasinghe is the World Health Organization Representative for Malaysia, Brunei Darussalam and Singapore.