A Race Against Time: Antimicrobial Resistance Remains A Silent Killer Of Africa

By Jessica Ahedor

“Medicine is medicine whether you buy and don't finish taking it, someone else can also use it provided the person is suffering from the same condition as you were” says a 37-year-old driver David Tandoh, at Akweteyman a suburb of Accra. 

In the bustling cities and remote villages of most African countries, a silent killer is on the rise, threatening to undermine decades of medical progress. Although it is often overlooked by many antimicrobial resistance (AMR), is the ability of microorganisms to withstand the effects of drugs that once killed them. Experts say it is becoming a significant public health crisis on the continent.

Despite the dire consequences, the issue remains largely unnoticed by the public, often overshadowed by more visible health challenges like malaria and HIV/AIDS among others.

Antimicrobial resistance occurs when bacteria, viruses, fungi, and parasites evolve and become resistant to the drugs used to treat the infections they cause. This resistance develops primarily due to the overuse and misuse of antimicrobial medicines in humans, animals, and agriculture. In Africa, where healthcare systems are often under-resourced, the problem is particularly acute.

Like David Tandoh, buying antibiotics is generally unregulated in most parts of the continent. The sale of over-the-counter medications is normal without a prescription from a qualified physician. 

Dr Yaw Adu-Sarkodie, a leading infectious disease expert at the Kwame Nkrumah University of Science and Technology (KNUST) in Ghana, warns of the impending crisis: "Antimicrobial resistance is spreading rapidly across the continent, making infections that were once easily treatable with antibiotics increasingly difficult, and sometimes impossible, to cure. In Ghana, we are seeing more cases of drug-resistant infections, particularly in hospitals where the misuse of antibiotics is rampant."

According to the World Health Organization (WHO), Africa is expected to see some of the highest increases in antibiotic use globally, driven by population growth, increased access to healthcare, and unregulated sales of antibiotics. However, with this increased use comes the heightened risk of resistance.

AMR is already having a profound impact on public health in Africa, although the true extent of the problem is difficult to quantify due to limited surveillance and reporting systems. In Ghana, for instance, infections caused by drug-resistant bacteria lead to longer hospital stays, higher medical costs, and increased mortality.

Dr Raji Tajudeen Head, Division of Public Health Institutes and Research of the Africa CDC, explains, "AMR is an invisible epidemic. Unlike diseases that cause immediate symptoms, the effects of drug resistance can take time to manifest. Patients with resistant infections may not respond to standard treatments, leading to prolonged illness and a greater risk of death. The ripple effect on families and communities is devastating."

In many parts of Africa, including Ghana, the burden of AMR disproportionately affects vulnerable populations, such as children, the elderly, and those with weak immune systems. Infections acquired during childbirth, surgery, or through the use of medical devices are becoming harder to treat, putting millions of lives at risk.

Celestine Ativor, a mother of three went through a caesarean section to have the last two of her children laments “I am mostly in pain at the operated area so to ease the pain I take Amoxiclav, or Tramadol. I have been treated for the infection several times yet the pain is on and off, she asserts. 

Experts have attributed the rapid spread of AMR across Africa to several factors. The over-the-counter availability of antibiotics, often without a prescription, leads to widespread misuse. Many people self-medicate, often using incorrect dosages or taking antibiotics for viral infections like the flu, which do not respond to these drugs.

"In Ghana, antibiotics are readily available in pharmacies and even in local markets, often without the need for a prescription," says Dr. Bernice Dery, a public health expert in Ghana. "This easy access, combined with a lack of awareness about the dangers of AMR, means that people are using antibiotics when they don't need them or are not using them properly. This is one of the main drivers of resistance."

Agricultural practices also play a significant role in the spread of AMR. Antibiotics are commonly used in livestock farming to prevent disease and promote growth, leading to the development of resistant bacteria that can be transmitted to humans through the food chain.

Moreover, the lack of robust healthcare infrastructure in many African countries means that healthcare providers often prescribe antibiotics as a precaution, even when they are not necessary. Inadequate diagnostic facilities also contribute to the problem, as doctors may prescribe antibiotics without confirming the bacterial nature of an infection.

One of the most concerning aspects of AMR is that it often goes unnoticed until it is too late. Unlike diseases that cause immediate outbreaks or epidemics, AMR creeps up silently, spreading through communities and healthcare settings. By the time its effects are fully realized, the damage is often irreversible.

"In many ways, AMR is a silent killer," says Dr Muyembe Tamfum, Director-General of the Institut National de Recherche Biomédicale in the Democratic Republic of the Congo. "It doesn't cause the dramatic outbreaks that we see with diseases like Ebola, but its impact on public health is just as deadly, if not more so. We need to act now to prevent a future where common infections become untreatable."

Combating AMR in Africa requires a coordinated and multi-faceted approach, involving governments, healthcare providers, the agricultural sector, and the public. The Africa CDC has been leading efforts to develop a continent-wide strategy to tackle AMR, focusing on surveillance, regulation, and public awareness.

"One of our top priorities is to strengthen surveillance systems so that we can better understand the spread of AMR across the continent," says Dr Ogwell Ouma. "We also need stronger regulations to control the sale and use of antibiotics, particularly in the agricultural sector. Public awareness campaigns are crucial to educate people about the dangers of misuse and the importance of completing prescribed courses of antibiotics."

In Ghana, initiatives like the National Action Plan on Antimicrobial Resistance have been launched to address the crisis. However, experts agree that more needs to be done. "We need to invest in healthcare infrastructure, particularly in rural areas, to ensure that antibiotics are used correctly and only when necessary," says Dr Adu-Sarkodie. "Education is key—both for healthcare providers and the public."

The fight against AMR in Africa is a race against time. If left unchecked, the silent killer could reverse decades of medical progress, leaving millions vulnerable to infections that were once easily treatable. The stakes could not be higher.

"We are at a critical juncture," says Dr. Muyembe Tamfum. "The decisions we make today will determine whether we can continue to rely on antibiotics to save lives, or whether we will face a future where even minor infections become deadly. The time to act is now."

As Africa continues to battle this growing crisis, it is clear that the continent's future health depends on the collective efforts of all stakeholders. By working together, Africa can overcome the threat of AMR and ensure that the silent killer does not claim more lives.

Africa CDC has been actively coordinating with various stakeholders, including the AU Member States, WHO, and other international partners, to bolster the continent's response to the outbreak. In his letter, Dr. Kaseya detailed the comprehensive efforts to enhance case detection, improve diagnostic capabilities, and mobilize resources for vaccine distribution. "A continental strategy for Mpox was developed which is used to mobilise resources to coordinate the outbreak response," he noted.

However, significant challenges remain. Only three African countries—Nigeria, South Africa, and the Democratic Republic of Congo—have approved the utilization of Mpox vaccines, and there is a growing concern about the continent's ability to secure enough vaccines to meet demand. Dr Kaseya warned that "the tension of the increasing demand of  vaccines by Western nations and the monopoly in the manufacturing of vaccines puts Africa at a disadvantage."

In light of these challenges, the Africa CDC has called on African leaders to unite in their response to the outbreak. "There is a serious risk that Africa will not be considered in the distribution of the vaccines and other medical countermeasures if African leaders don’t come together to make their voice on the fight against this disease," Dr Kaseya urged.

To support the affected countries, Africa CDC has activated its Emergency Operations Centre and deployed over 200 epidemiologists and logisticians to the hardest-hit regions. Additionally, the agency is working closely with AU Member States to implement intensive training programs for healthcare workers and enhance public awareness campaigns to educate communities about Mpox prevention.

As the continent grapples with this escalating health crisis, the importance of a unified and robust response cannot be overstated. Dr. Kaseya concluded his letter with a call to action: "The Africa CDC will remain at your disposal for any request that can help to address this health issue in our continent."

The situation remains fluid, with the Africa CDC continuing to monitor developments closely and adjust its strategies accordingly. The hope is that with sustained effort and international support, Africa can bring the Mpox outbreak under control and prevent further loss of life.