Addressing antimicrobial resistance in developing countries: A balancing act
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The document addresses antimicrobial resistance (AMR) in developing countries, focusing on smallholder farmers and the informal agricultural sector, which face significant challenges due to low production yields, lack of resources, and insufficient regulation. It emphasizes the need for targeted interventions that reduce antimicrobial use (AMU) and transmission, support women's involvement in agriculture, and align with global health priorities. A call for urgent action and substantial investment in AMR research and development is made, highlighting the importance of localized approaches to effectively mitigate agricultural-associated AMR risks.
Addressing antimicrobial resistance in developing countries: A balancing act
- 1. Addressing AMR in developing countries: a balancing act Arshnee Moodley CGIAR AMR Hub leader Nairobi, Kenya Workshop on AMR of the Agricultural Chief Scientists of G20 01 September 2021
- 2. CGIAR AMR Hub mitigating agricultural associated AMR risks Launched in 2019 www.amr.cgiar.org 5 Pillars of the AMR Hub
- 3. Hub’s Approach & Activities Focus on small holder farmers largely neglected & informal sector
- 4. Why focus on Small holder farmers? Source: Options for the Livestock Sector in Developing and Emerging Economies to 2030 and Beyond. World Economic Forum White Paper January 2019 Market value of Africa’s animal-source foods will grow to ∼$151 billion by 2050 (from ∼$37bn in 2019) Most livestock products are sold locally and informally
- 5. Addressing AMR in the informal agricultural sector is a balancing act Impact on global livestock output: decline in livestock production 2.6-7.5% per year Impact on global poverty: Significant increase in extreme poverty- additional 28.3 million people (high- impact AMR scenario) Livelihoods Food & nutritional security Global health priorities Intensifying food systems Infrastructure deficiencies National health priorities
- 6. Fundamentals of reducing AMU and the spread of AMR Reduce use • AMU surveillance • Ban/restriction of specific antimicrobials • Education-Awareness compaigns • Evidence based treatment decisions • Treatment guidelines • Vaccines use • Limiting profit of prescribers Reduce transmission • AMR surveillance • Biosecurity • Hygiene/decontamination Challenges in both human and veterinary medicine in LMICs Role of the environment??
- 7. Further challenges in agriculture in LMICs Small holder farmers Small herd sizes Largely Informal Low production yields Poor animal husbandry Little biosecurity Poor quality inputs Low trust in authority Financial insecurity Poor vaccine uptake Dispersed farming system Lack of traceability Porous borders Informal drug sellers Complex value chains Devolved governance Local consumption Public + private importers Low knowledge & awareness “easier” to regulate intensive, large herd production systems motivation = profit
- 8. Approach to the informal agricultural sector in LMICs What is the incentive to change? Regulate, formalise or modernize vs. informal, dispersed, rural, untraceable & culture Consumer/market drive are unlikely to be a major driver Source: Options for the Livestock Sector in Developing and Emerging Economies to 2030 and Beyond. World Economic Forum White Paper January 2019
- 9. What about a gendered approach? • “farmer” = man in the field or with his livestock • 2/3 of 600 million poor mixed crop-livestock farmers are women • Between 5-10% of farms in NED, DK, DE are managed by females (Eurostat 2016) • Gender-blind intensification interventions can inadvertently cause women to lose their business AMR Interventions need to be effective AND empower rural women farmers
- 10. Sustainability of initiatives- we cannot eradicate AMR! • What are the indicators for M&E- global or country-level? • Attempts to align with the UN SDGs • agriculture is not well reflected • AMR specific indicators? • Targets to measure successful intervention? • Reduction % drug- resistant infections in humans and/or animals? • How much reduction? • Which drug-bug commbination? • Vaccination coverage? • How much and which target organism? • Reduction in agri. AMU • How much reduction? “Global leaders and experts today called for a significant and urgent reduction in the amounts of antimicrobial drugs, including antibiotics, used in food systems” 24th August 2021
- 11. Exists many important gaps in LMICs? LMICs Burden of AMR in humans and/or animals? Unknown Disaggregated AMU data? Unknown Interventions shown to reduce AMU at scale? No Interventions are feasible (access, distribution, uptake)? Maybe, maybe not Interventions are affordable for small-scale, semi intensive production farmers? Unknown Unintended negative consequences (e.g. livelihoods)? Maybe large
- 12. Investments in AMR R&D 2017-2025 All sectors Who provides funding? Domestic vs. international What has been the total investment? Where is the investments? Which sector? Number of project within timeframe
- 13. 2017-2025 All sectors Where is the investments? Which sector?
- 14. Implementation budget (over 5 years ): approx. 50M USD 2017-2025 All sectors Which sector?
- 15. MORE INVESTMENTS IN ALL ACTION AREAS LOCALLY RELEVANT INTERVENTIONS IMPACT AT SCALE CHANGE & COMMITMENT AT ALL LEVELS In LMICs, including the agricultural sector, there needs to be
- 16. Mitigating agricultural associated AMR risks together!
Editor's Notes
- #4: Small holder farmers Informal, small scale How to regulate the informal sector?? Incentives to changes for those actors who are financial insecure and low production outputs???
- #9: Regulation is needed but it’s not enough Majority of farmers rely on untrained animal health providers Informal sector fills a significant gap Limited resources to enforce regulations (corruption and low trust in government) Capacity building is useful IF incentives are in place Training not just about knowledge transfer - not enough To improve or change behaviour coupled with right incentives AND an enabling environment Willingness to pay: local consumers don’t have economic power AMU Policies may disproportionately reduce access in areas that may have the highest unmet needs Informal greatly outnumber formal geographical inequality- communities that are underserved by the formal providers, may be left without adequate physical access to antibiotics While such policies may reduce the inappropriate use of antibiotics, they could also disproportionately reduce access in areas that may have the highest unmet need for antibiotics
- #11: Biosecurity, animal AMU and food safety
- #16: Thinking about the gaps and incentives for motivations, What do we need? 1. Not just technological solutions but whatever solution it needs to context specific and we need to understand if those interventions have unintended consequences that could be devasting e.g. exclusion of women, access to care in rural communities