This initiative is in line with the political declaration ratified during the 79th session of the United Nations General Assembly High-Level Meeting (UNGA-HLM), as well as President Bola Ahmed Tinubu’s health sector reform agenda and Nigeria’s dedication to enhancing global health security.
Antimicrobial Resistance (AMR) arises when infections become increasingly difficult to treat due to the evolution of microorganisms such as bacteria, viruses, fungi, and parasites, which develop resistance to medications and gain the ability to withstand treatments that previously eliminated or inhibited their growth. The World Health Organization (WHO) identifies AMR as one of the foremost global public health threats, with an estimated 4.95 million deaths linked to bacterial AMR worldwide in 2019.
At the launch and ministerial briefing of the AMR action plan in Abuja, the Coordinating Minister of Health and Social Welfare, Muhammad Pate, revealed that a situational analysis on AMR indicated its prevalence not only among the human population but also in animals, food crops, and the environment.
The Minister emphasized that AMR is a rapidly growing threat that jeopardizes decades of medical advancements. “AMR undermines the very foundation of modern medicine, making routine procedures, surgeries, and treatments less effective, and in some cases, ineffective. If left unaddressed, AMR could surpass cancer as a leading cause of death globally. The economic ramifications are equally severe, with estimates suggesting global losses exceeding $100 trillion. The Second National Action Plan on AMR delineates strategies for enhancing antimicrobial stewardship, improving surveillance and detection capabilities, fostering research and development, and fortifying healthcare systems,” he stated.
Addressing Antimicrobial Resistance through One Health Principles: A Strategic Initiative
Antimicrobial resistance (AMR) is primarily fueled by the excessive and improper use of antimicrobial medications across human health, animal husbandry, and agricultural practices. The environment significantly influences the spread of antimicrobial-resistant organisms. Contaminated wastewater from pharmaceutical industries, healthcare establishments, and agricultural operations, often laden with high concentrations of antibiotics, exacerbates the environmental dissemination of AMR. Through this strategic initiative, Nigeria seeks to mitigate these environmental contributors and enhance surveillance systems for the detection and monitoring of AMR in environmental contexts.
In his address, WHO Country Representative Dr. Walter Kazadi Mulombo emphasized that the global community has reached a pivotal point in recognizing the environmental factors influencing antimicrobial resistance.
Dr. Mulombo praised the Nigeria Centre for Disease Control (NCDC) and its partners for their efforts in formulating Nigeria’s National Action Plan on Antimicrobial Resistance (AMR). He stated, “AMR poses a significant threat to our time, economy, and development. It is both a moral obligation and a defining challenge for our careers. If not addressed, antimicrobial resistance could lead to millions of fatalities and severe economic disruption, with projections indicating over 39 million deaths in the next 25 years, exceeding current mortality figures.
This concerning forecast highlights the immediate need for collaborative efforts.”
“AMR is a complex issue that necessitates a comprehensive, multi-faceted approach. Key elements include the irrational use of antibiotics, insufficient access to clean water, sanitation and hygiene, inadequate healthcare infrastructure, and limited investment in research and development.”
He concluded by stating that this accomplishment reflects a commitment to leadership, ownership, and proactive measures in tackling this urgent challenge.
WHO's Contribution to AMR Initiatives
The World Health Organization (WHO) has played a pivotal role as a technical partner in the formulation of the National Action Plan 2.0 (NAP-2.0), offering insights on global best practices and assisting the federal government in aligning its strategies with the Global Action Plan on Antimicrobial Resistance (AMR).
To enhance the national response to AMR, the Ministry of Health introduced the AMR NAP 2.0, which revises the national action plan established in 2017.
Following the conclusion of AMR NAP-1.0 (2017-2022), an evaluation of its execution identified significant gaps and challenges, revealing a completion rate of only 44%. The evaluation pointed out insufficient engagement from sectors such as the environment, agriculture, food, aquaculture, and relevant human health areas in executing priority initiatives. Furthermore, NAP-1.0 lacked a budget and did not include specific milestones or targets.
In light of these findings, the Government of Nigeria, in collaboration with the Federal Ministry of Health and the Nigeria Centre for Disease Control (NCDC), sought WHO's assistance in crafting NAP-2.0 (2024-2028) and providing strategic direction for the AMR Coordination Committee. This development was guided by the AMR Global Action Plan, WHO's manual for NAP Development, the WHO implementation handbook for NAPs on AMR, and a people-centered approach to tackling antimicrobial resistance in human health.
In 2023, the WHO Country Office, in partnership with the African Regional Office and Headquarters, established a cohesive strategic framework to aid in the development of NAP-2.0. This framework aimed to address the critical shortcomings identified in the implementation of NAP-1.0, improve coordination, and clarify the roles of various sectors. The objective was to ensure that NAP-2.0 was formulated within a One Health framework, engaging multiple sectors in the process.
The gathering in Abuja convened essential stakeholders from government, health, and environmental sectors, along with international partners such as the World Health Organization (WHO), which has played a pivotal role in assisting Nigeria in tackling antimicrobial resistance (AMR). The newly developed action plan enhances Nigeria's previous initiatives aimed at curbing the overuse and improper use of antimicrobials in both healthcare and agriculture, while also broadening its scope to include the frequently neglected yet vital environmental aspect. Financial backing from the Kingdom of Saudi Arabia (KSA) and the Fleming Fund facilitated the creation of the strategic document titled One Health AMR NAP-2.0.