Global Forum on Food Security and Nutrition (FSN Forum)

English translation below

Merci Dr Dolo.

Absolument, que cela soit en Afrique ou ailleurs, il n'y a pas que la résistance aux antibiotiques, mais aussi à d'autres antimicrobiens.

C’est la raison pour laquelle la 2 question du Forum est comment mettre aussi en exergue les autres types de résistance. Et j’ai répondu en anglais disant qu'il est très important maintenant de parler d'antimicrobiens et résistance aux antimicrobiens que de mettre souvent en exergue la résistance aux antibiotiques. Si l’on veut même considérer la définition originale d'un antibiotique (produit à partir d’un microorganisme contre un autre microorganisme, ex: la pénicilline), beaucoup de molécules considérer ajourd'hui comme antibiotiques parce qu’utiliser pour traiter des infections bactériennes ne sont pas vraiment des antibiotiques mais des antimicrobiens car synthétiques ou semi-synthétiques. Sans oublier qu'un petit nombre d’antibiotiques est efficaces contre certains parasites  microscopiques. Donc il est plus nécessaire de vraiment de parler d'antimicrobiens, surtout dans les campagnes de sensibilisation générales. Maintenant, pour la sensibilisation de personnels techniques et d’experts dans le domaine de la santé, la recherche scientifique et l’éducation, on peut faire la différentiation claire avec les termes techniques.

Thank you Dr Dolo.

Absolutely, whether in Africa or elsewhere, there is not only resistance to antibiotics, but also to other antimicrobials.

This is the reason why the 2nd question of the Forum is how to also highlight other types of resistance. And I replied in English saying that it is very important now to talk about antimicrobials and antimicrobial resistance rather than to only highlight antibiotic resistance. If we even want to consider the original definition of an antibiotic (produced from a microorganism against another microorganism, ex: penicillin), many molecules considered today as antibiotics because they are used to treat infections bacteria, are not really antibiotics but synthetic or semi-synthetic antimicrobials. Not to mention that a small number of antibiotics are effective against certain microscopic parasites. So, there is more need to really talk about antimicrobials, especially in general awareness campaigns. Now, for the sensitization of technical personnel and experts in the field of health, scientific research and education, we can make a clear differentiation with the technical terms.

Thanks, Irene and James.

With regards to the best approach of communicating resistance in other microbes, I do agree that the collective term "antimicrobials" should be used in all campaigns.  The emphasis has always been on antibiotics and bacteria and not much on the other bugs (except for scientists and researchers who are working specifically in these areas). The message should be clear that any medicine that is used for whatever type of infection or disease should be used only when absolutely needed in order to prevent bacteria from developing resistance to them.

One thing I also found interesting from my engagement with farmers is the use of the "cocktail" of drugs. Here, you have a sachet of medicine labeled "anti-stressor" or "multivitamin" but which in actual fact has a certain amount of antimicrobials incorporated into it. Some farmers would innocently use these without knowing the full content. The cocktails are often administered as growth promoters hence exposing bacteria to minute amounts of the antimicrobials that lead to resistance. 

As Irene said, feed producers should be included in the list of priority stakeholders. I do understand that in a bid to compete for the market, producers are somewhat under pressure to ensure that farmers get optimum productivity when they use their products and hence might be compelled to incorporate certain levels of antimicrobials in the feeds. This again is the reason we need serious engagement. The people need to understand the consequences of their actions and take responsibility for propagating and doing right when it comes to AMR stewardship. 

The message should also be very clear on AMU, "the intent is not to stop complete use of antimicrobials because they are essential and do save lives but to use them only when absolutely necessary so we do not run out of them".

Even though we need technocrats and people in other sectors to pass on the right message, from my experience of working with farmers, they are more likely to do the right thing when they understand the implications of their actions and when you present to them alternatives. For instance, if you say they shouldn't use antimicrobials, then one must be willing to invest in training them on good biosecurity and husbandry measures and other prevention strategies. As long as this new alternative results in increased profit, less cost and improved productivity, they will most likely go with it.

English version below

Bonjour,

La problématique de la résistance aux antibiotiques occupe de plus en plus nos pensées compte tenu de la position assez préoccupante de la question dans nos pays africains.

Pour trouver un début de solution à ce problème, les efforts doivent être faits à plusieurs niveaux :

- strict respect des textes sur la commercialisation des médicaments vétérinaires.

Dans la plupart des pays africains, la vente du médicament n'est pas soumise à la présentation d'une ordonnance vétérinaire. Donc, la vente est libre. 

Les états doivent appliquer les textes afin de permettre aux seuls professionnels de s'approvisionner auprès des structures de vente 

- améliorer le niveau de formation et d'information des vétérinaires sur la question de la résistance aux antibiotiques.

Beaucoup de vétérinaires sur le terrain n'ont pas toutes les informations sur la question et cela constitue une grande insuffisance. 

- renforcer les services chargés du contrôle des denrées alimentaires : agences nationales de sécurité sanitaire des aliments ,etc .. 

- sensibilisation des éleveurs sur les méfaits de cette résistance.

En Afrique, il n'y a pas que la résistance aux antibiotiques. Il y'a de plus en plus une résistance aux acaricides qui se développe, surtout à l' amitraz. 

Meilleures salutations

Dr Dolo Yaya

Vétérinaire privé

Bamako, Mali

Hello,

The issue of antibiotic resistance is occupying our thoughts more and more given the rather worrying state of the issue in our African countries.

To find the beginning of a solution to this problem, efforts must be made on several levels:

- strict compliance with the legislation on the marketing of veterinary medicinal products.

In most African countries, the sale of the drug is not subject to the presentation of a veterinary prescription. So the sale is free.

States must apply the rules in order to allow only professionals to obtain supplies from sales structures

- improve the level of training and information for veterinarians on the issue of antibiotic resistance.

Many veterinarians in the field do not have all the information on the matter and this is a big shortcoming.

- strengthen the services responsible for controlling foodstuffs: national food safety agencies, etc.

- raising farmers' awareness of the harmful effects of this resistance.

In Africa, it's not just antibiotic resistance. There is more and more resistance to acaricides which is developing, especially to Amitraz.

Best regards

Dr Dolo Yaya

Private veterinarian

Bamako, Mali

Hello colleagues,

The biggest challenge related to AMR & inappropriate AMU in Africa is; in my own opinion countries in Africa share almost same style of practicing farming especially the small scale farmers market, 

The technocrats usually are not there to communicate to communities that ate in the farming groups so as to sensitize on the correct use of antibiotics instead untrained personnel are employed to serve the community on the use of antibiotics they don't advise on the proper usage of the drugs.

The other challenge is that most products are in languages that the locals may not be able to understand they will use it indiscriminately like the way oxytetracyclin is being used no one take time to go and monitor its use.

The other challenge antibiotics are sold on counter without prescription hence no professional takes it up to educate on the abuse of antibiotics.

Communication challenge in AMR & AMU in Africa is that since the marketing democracy every person understands the use of antibiotics in his or her own way. It has become difficult to communicate to the society on the prudence use of antibiotics.

Since this has a long term effect on human health, animal health as well as plant health people tend to ignore advises rendered on the danger of abuse of antibiotics.

Therefore one health approach needs to be adopted to overcome this communication challenge on AMR & AMU.

Regards 

James

(From Zambia)

2. Elaborating further what I mentioned in my previous post on the issue raised in question 2, the use of the word ANTIMICROBIAL should be consistent especially for big AMR campaigns.  For example it is more appropriate to refer to WAAW as World ANTIMICROBIAL Awareness Week than World ANTIBIOTIC Awareness Week. People will gradually get used to it. Thanks

Good morning to everyone and thanks to Chioma for the very elaborated and valuable contribution.

1. One challenge is the difficulty to translate technical words into simple statements that can be understood easily by people especially those who have "little" academic education. Explaining what a drug is, is easy, but explaining what a microorganism (microbe) or multi-resistant bacteria or superbug is, in a local language can be challenging. In this case, trying to differentiate technically between the different types of microorganisms (bacteria, viruses, etc.) would not be useful. One solution could be to discuss with local/ traditional therapist/healers to find adequate words to qualify disease-causing agents.

2. Keep the messages simple and just refer to ANTIMICROBIAL resistance. Most people including highly educated people but not in the field of e.g. microbiology, medicine (Vet, human, plant), public health, etc. do not differentiate between types of microorganisms and I doubt are interested in making a difference. When talking about ANTIBIOTICS, most people include everything. This is not appropriate indeed, but they cannot be not blamed if there are not in the field. Thus, an emphasis should be put on using consistently ANTIMICROBIAL and AMR as opposed to ANTIBIOTICS and ABR.

For the general public, one approach is to explain by difference in types of diseases that require different types of drugs for treatment. Also, emphasize that a drug for a specific disease may not be efficient in curing another type of disease because the causing agent is different, thus people should seek medical advice and not self-medicate.

For technical people, research, and academia, technical words for the different types of microorganisms should be used and awareness/ advocacy campaigns should be technical.

5. Adding on to what Chioma mentioned, feed producers should also be also priority targets as many feed products are formulated with antimicrobials.

I am pleased to be part of this forum and I look forward to discussing with you all and learning from your contributions. It is my first time here, so pardon me if I do not exactly follow the format, I will learn as time progresses.

Early this year, we organized a public engagement program with farmers in Nigeria and we had some good interaction. We conducted one-on-one interviews with farmers upon arrival. This was to enable us to gauge prior knowledge of AMR. About half of the farmers that attended the program said they had not heard about antimicrobial resistance while some who had previously heard of the term AMR but did not completely get the message. My take on the questions raised for this discussion are:

1. The message on AMR is often presented as an abstract term and gives the impression of an impending threat (e.g. 10 million people will die by the year 2050 from AMR infections).

There is a need to make communications on AMR relatable to the “ordinary person” in order to drive the message home and make it easier to understand. The threat of AMR needs to be strongly emphasized and communicated as a problem that is already with us.

In our previous programs, we noticed more engagement when real-life experiences of the impact that AMR has on human health, livestock productivity, and food safety were shared. We also noticed increased interest when we analyzed the economic cost of using antimicrobials versus increased productivity in relation to prevention strategies of infections, improved biosecurity measures, and sanitation. Farmers want to hear how they can save costs whilst improving productivity.

Key stakeholders in the fight against AMR such as farmers who directly use antimicrobials are somewhat ignored in communications regarding AMR and inappropriate AMU in Africa. It is not enough to place posters in strategic places and share pamphlets on AMR without appropriate engagement. We do not need to assume that people will assume what the posters say. Often times, passing a message on behavioral change does not directly translate to change in behavior. Other strategies like active engagement need to be put in place to enable people to understand the meaning behind the message. 

3. To get AMR into the news and list of hot topics, countries need to invest in recording and communicating the number of lives lost per year due to AMR, quantifying AMR in terms of economic losses and magnitude of the threat. Proactive key stakeholders involvement is important and it might be needful to have in-country ambassadors for AMR, these could be highly respected people in the society who will be committed to this cause.

4. Properly coordinated, clear and concise messages on AMR in various dialects can be passed through local radio and television networks as well as national stations. Grassroot engagements often in collaboration with various associations could also be useful. Disseminating this information across board will also prompt consumer awareness in demanding for antimicrobial-free (organic) products.

5. Farmers are critical stakeholders and should be given priority. They do need to understand the need for responsible AMU if there has to be behavior change in terms of administering antimicrobials only when needed, not putting pressure on Veterinarians or extension workers for antimicrobials, and taking ownership to ensure the health of the nation in terms of food safety. There is a need to also involve Veterinarians, Lab diagnosticians, government bodies and the media.

6. The National Communication Commissions, National CDCs, various ministries of Health, Agriculture, and Animal Health should be involved at national level while the African Union,  African CDC, AU-IBAR need to take a strong stand in leading continental advocacy activities and awareness on AMR and AMU. FAO and WHO regional offices are already doing excellent work in this area and should continue with this.

I look forward to an engaging discussion.