Antimicrobial Resistance (AMR) is an urgent global public health threat. According to the Centers of Disease Control and Prevention (CDC), AMR is killing at least 1.27 million people worldwide and is associated with nearly 5 million deaths in 2019.
AMR occurs when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. According to health experts, resistant infections can be difficult, and sometimes impossible, to treat.
AMR is one of the priority public health targets of G20 countries, and it is being approached under the One Health concept, which promotes an integrated approach encompassing human health, animal health, and the environment.
Financial Express.com reached out to Dr. Malin Grape, world’s first AMR ambassador, and she talked about Sweden’s perspective on addressing AMR and implementing the One Health approach and partnership with India. Last month, Grape was in India and she addressed various events and workshops held at the Embassy, along with the EU Delegation to India, on ‘One Health Approach to Antimicrobial Resistance: environment and manufacturing industry.’
In 2022, Grape became was appointed as Sweden’s and the world’s first AMR Ambassador to further strengthen global efforts against antimicrobial resistance. Grape leads the Ministry of Health and Social Affairs’ work on AMR. She represents Sweden and contributes expertise in EU work and in international forums such as the WHO. It is noteworthy that Sweden has long worked on AMR – in the EU and internationally. Excerpts:
What is Antimicrobial resistance (AMR)? Why is it a major threat to global health security?
So, resistance means that the treatments that we use to treat our infections with are not working anymore. This means that the infections are untreatable…this is especially for antibiotics and bacterial infections but also in other infections. This I would say, is a threat to the global health security because we don’t only need these drugs to treat our infections like Pneumonia, UTIs or Sepsis which in themselves can be life-threatening if the treatment is not working but these drugs are also pre-requisite for the health systems and the health services. Unless you can prevent or treat infections that can come up later.
What is One Health Concept? How can this concept help in addressing the challenge of AMR?
The One-Health Concept describes how human health, animal health, food production and environmental health are interconnected. When it comes to resistance, it is very obvious that bacteria knows no border. Sometimes, we are used to say One World, One Health approach. So, resistance spreads between humans and animals, between environment and humans, and this is why we have to counter-act on resistance. We have to take on this approach and understand that we have to take responsibility for all these sectors. To avoid conflict of interest of course, but also to find synergies including all concerning sectors.
India was one of the first few countries to develop a comprehensive National Action Plan on AMR in 2017. As it is one of the priority public health targets of G20 countries, how can the commitment and attention towards it be enhanced?
I must say I very much appreciate that India has been taken up as a priority during the G20 presidency. I think it’s extremely important and India can really show global leadership in this issue. What we have to do is to work both nationally on the ground to improve the situation in all countries but what is needed is also global awareness and political commitment. So, countries need to come together, and commit more ambitious work against AMR. Obviously, India as a strong country in itself and especially having G20 Presidency have a very important role. Sweden is currently also the president of the EU council…we would also very much to work together with India to put this on the political agenda.
You are not just Sweden’s first AMR Ambassador but also world’s first AMR ambassador. According to you, how can the global effort against AMR be enhanced?
I think what we need is…the countries to come together, and commit to this…but that in itself is not enough…but some things need to happen on the ground. We need to monitor the progress globally…and we also need to make sure that much more is happening in this area. Each country should also assess their own situation, challenges and how to address them in the best way. But I think there is also a lot to learn on this from each other. What we need is to prevent the spread infection, prevent resistance through hygiene, through vaccines. We need to make sure that we use antibiotics responsibly. We need to have access to effective antibiotics. We need to balance the access and excess and we need to also make sure that new treatments, new antibiotics are developed. So, we need to stimulate the research and development and innovations.
Sweden has long worked on AMR not just in the EU but also globally. Could you please share some key milestones?
Sweden started very early…its work on AMR and with this…we are grateful for this as it means that we have done something and which means we have less severe situation in Sweden then in many other countries. So, we started nationally on ground in 1986 and banned antibiotics for both promotion and in animals…that was 20 years before we could get EU on board and take the same decision. Globally, its still being done in many countries. So, I think we understood early that it doesn’t matter how good we are but we live in a global world and we are all dependent on global progress. So, for example, in 2014, together with the UK…we took initiative to make sure we had the action plan on AMR developed by the WHO which was inducted by all member states. We also supported the development of the Global Anti-Microbial Resistance (AMR) and use surveillance system. So, we try to do as much as we can and we need to do that in partnership for example with India.
What is Sweden’s approach towards implementing One Health? How can this be implemented uniformly in a diverse and massive country like India?
It’s extremely challenging to work across sectors…it is always challenging and everybody agrees with this. Nevertheless, you still have to try. It’s very difficult to compare with India…it’s a huge country. But what I would say…one way that we can approach this…which I think will work…Swedish government has multi-sectoral strategy. Also, India has a National Action Plan on AMR. But we have built a system where the coordination across 25 different agencies, governmental agencies, authorities…they are coordinating the work among each other because sometimes I feel it is more difficult to have the Ministries talk with each other. But on the agency-level it becomes little more easier. It’s also closer to the implementation. So, I think they are the once that are operationalising this strategy. So, this is I think a bit more sustainable. Then we have a quite stable structure and this coordinating mechanism…we are really proud of this. So, this is something that has been very successful in Sweden.