PATAM Director Tapiwa Kujinga Calls for Concrete Measures to tackle AMR

In this interview, Tapiwa Kujinga, Director of the Pan-African Treatment Access Movement (PATAM), offers valuable insights into the critical issue of antimicrobial resistance (AMR) and its impact on vulnerable populations in Africa. As a key supporter of the People to Leaders campaign's Call for Action on AMR, Kujinga highlights the urgent need for global leaders to address this silent pandemic at the upcoming UN General Assembly High-Level Meeting on September 26, 2023.

The campaign (and the Call) highlights how AMR disproportionately impacts vulnerable and marginalized populations. Based on your work, what are some examples you have seen of how AMR affects these communities? What specific actions should governments take to address these inequities?

In low and middle-income countries such as the majority of African countries, the impacts manifest in a number of ways. Firstly, there are communities with inadequate access to essential antimicrobials, and these are mainly rural communities which are not viewed as viable markets by marketers. Consequently, the community members will have to travel long distances to purchase antimicrobials when needed, and this exacerbates their poverty as these purchases are mostly out of pocket. Further, last-line antibiotics such as carbapenems are quite expensive and therefore out of financial reach to most of the population. I was made aware of a case where a child was in need of meropenem which cost around US$300, and this was after he was resistant to almost all the other antibiotics except for carbapenems. The stated amount is equivalent to the salary of most general workers, hence the parents could not afford it. It must be noted that most people who are dying from resistance in low and middle-income countries are unable to afford the antimicrobials to which they are sensitive, unlike in high-income countries where the mortality rate is low due to access issues.

Governments should therefore ensure access to essential antimicrobials in underserved communities through setting up of community pharmacies. In order to ensure access to last-line antibiotics, governments should consider subsidizing the cost and ensuring that they are available when needed. This entails that antimicrobial sensitivity testing (AST) should be routine whenever there is no clinical improvement after administration of standard of care antimicrobials.

Looking ahead to the UN General Assembly High-Level Meeting on AMR in 2024, what are your hopes and expectations for the political commitments and declaration that will emerge? Beyond high-level statements, what concrete actions and accountability measures would you like global leaders to adopt to turn the tide on this silent pandemic of AMR?

I have gone through the draft political declaration and noted the ambitious targets that are included there. This is a quantum leap from the 2016 declaration which also sought to address the global AMR pandemic. In my opinion, the political commitments and declaration will capture most of the demands of civil society and other stakeholders. The most important issue is whether governments will fulfill them or not. In Africa, in particular, governments have made numerous commitments which remain on paper, and this includes the 2016 political declaration and commitments on AMR which largely remain unfulfilled. Going forward, there is a need for leaders to create sustainable structures for the fulfillment of the 2024 commitments, and this includes monitoring progress and sharing surveillance data.

One of the key requests in the Call is for governments to ensure meaningful participation of civil society in AMR governance and policy making. Why do you think this inclusive approach is critical, and what mechanisms would you like to see established to facilitate this engagement?

Inclusion of civil society is critical, and this has been proved right by the HIV and subsequent pandemics. On the other hand, civil society has proved to be a game changer through its ability to analyze situations, create sustainable solutions and implement viable projects in response to pandemics. Going forward, it is important that governments include civil society in AMR programs, especially in the implementation of national action plans. Civil society is a great resource in community engagement as well as disseminating information to various communities.

The Call urges investment in public awareness, education and community engagement initiatives around AMR. Can you share some successful examples of how your organization has worked to educate and mobilize the public on this issue? What more needs to be done?

In the Zimbabwe AMR program, PATAM ran the education and awareness pillar, and we implemented a number of activities. These included running CME programs for doctors on AMR, engaging various communities through physical meetings, radio and television, publishing articles on AMR, running lectures on AMR with staff and faculty from the medical school and educating the media so that reporters are able to file accurate stories on AMR. At the moment, we are developing a community tool on AMR which we will use to scale up education and awareness among civil society organizations.

For more information on PATAM see:

Tapiwa Kujinga, Director of PATAM: In Zimbabwe civil society is involved in every aspect of the response to AMR