Miserly Cuts to the Foreign Aid Budget Will Promote the Spread of Antimicrobial Resistance

 If a viral infection can change society as radically as it has in 2020, you would assume protecting the country against future health crises would be a priority for any government. However, the recent 30% cuts to the foreign aid budget show that this government does not have its priorities in order regarding one of the greatest health crises of this century: antimicrobial resistance (AMR). 

AMR refers to microbes (viruses, fungi, parasites and bacteria) becoming resistant to the antimicrobial medicines designed to treat them, making infections much harder or impossible to treat. The trouble is that modern society depends on antimicrobials for much that we take for granted including disease treatment, surgeries and farming. If our medicines cease to be effective, routine practices become less safe. This will lead to people dying from small wounds, exposes us to food-borne infections and makes it harder to treat secondary infections – which contribute to many COVID-19 deaths. And like COVID-19, AMR spreads globally, so wherever resistant strains emerge, they will not stay in one place for long. Worldwide, AMR-linked infections currently cause 700,000 yearly deaths, a number predicted to increase to 10 million by 2050; for comparison, COVID-19 has so far caused 2.3 million deaths. 

Unfortunately, dealing with AMR is not as simple as finding new treatments; the rate at which microbes are becoming resistant to existing medicines outstrips the rate at which new ones are discovered. Therefore, avoiding a health crisis relies on slowing the rate at which resistant microbes emerge. 

 

In short, resistance develops when antimicrobials are used incorrectly or unnecessarily. Incorrect use refers to the day-to-day use of antimicrobial drugs, such as when patients fail to complete a course or the wrong type of antimicrobials are used e.g. antibiotics for a virus. These can generally be ascribed to limited resources or understanding among health workers and patients. Unnecessary use is more of a structural issue, and refers to when antimicrobials are used as a result of avoidable exposure to microbes, such as when people live in unsanitary environments, or the over dependence on antimicrobials in the agricultural industry*. Preventing incorrect and unnecessary use of antimicrobials requires dealing with medical, social, economic and environmental factors – a holistic approach adopted by the WHO referred to as the ‘One Health’ strategy, for which foreign aid is essential. 

Figure 1: An illustration of the One Health strategy utilised by The World Health Organisation to combat AMR on a global scale (Taken from Attwell et al., 2017)

Foreign aid provides the resources and education necessary so the right medicines are available and for people to complete their treatment course. It provides the sanitation infrastructure to prevent disease outbreaks in the first place; the frequency of cholera outbreaks reminds us how vulnerable many people still are. It improves agricultural standards to prevent over-dependence on antimicrobials in animal populations – a population that will grow as meat consumption increases globally. It also establishes reporting infrastructure to monitor disease outbreaks, which is essential for knowing how to direct resources. Every pound cut from the foreign aid budget undermines these efforts to slow the spread of AMR and brings the next world health crisis ever closer. 

 

Policy makers must treat AMR as the looming human tragedy that it is. It requires serious effort and thought, which were clearly missing before the decision to cut the foreign aid budget. A start would be adopting Antibiotics Research UK’s 5-point plan for tackling AMR, and to counteract factors contributing to AMR in the UK and abroad. Cuts to the foreign aid budget are among these factors, and will come back to haunt us unless we take action now. 

 

*This is done as a short-cut to meet health standards, and to promote animal growth. 

 

Useful Links & Reference Points: 

• ANTRUK 5-point plan: https://www.antibioticresearch.org.uk/antibiotic-research-uk-announces-five-point-action-plan-tackle-amr/ 
• WHO One Health Strategy: https://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial-resistance/policy/one-health 
• UK foreign aid spending 2018: https://fullfact.org/economy/uk-spending-foreign-aid/ 
• Attwell et al., 2017: https://www.researchgate.net/publication/316919784_Antimicrobial_Resistance_A_complex_multi-factorial_problem_requiring_orchestrated_interdisciplinary_response_From_the_Australian_Academy_of_Science_Report_An_Interdisciplinary_approach_to_living_in_a_

Author Information:

Conrad Fallon began his journey at University of Manchester in BSc Genetics, from which he is now studying MSc Developmental Biology. After graduating, he hopes to complete a PhD in Evolutionary Biology as he loves how relatively simple laws can be used to unify random variations and directional adaption in populations. He believes AMR is a great example of populations adapting to selective pressures through random variation and understanding how it occurs is extremely relevant to us all. Conrad has been a member of the University’s AMR society since September.