What you should know about antimicrobial resistance, an escalating global threat

Antimicrobial resistance (AMR) is threatening public health in Rwanda, where an estimated 2,400 deaths in 2019 were directly linked to drug-resistant infections and another 9,800 associated with them, according to the Institute for Health Metrics and Evaluation. ALSO READ: RBC warns against drug misuse amid rising antimicrobial resistance According to the World Health Organisation (WHO), antimicrobial resistance occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability and death. AMR is a natural process that happens over time through genetic changes in pathogens. Its emergence and spread is accelerated by human activity, mainly the misuse and overuse of antimicrobials - medicines used to prevent and treat infectious diseases in humans, animals and plants - to treat, prevent or control infections in humans, animals and plants. In Rwanda, despite national efforts, practices such as self-medication and the overuse of antibiotics continue to be prevalent, driving the emergence of infections that no longer respond to treatments. Health professionals warn that common antibiotics like amoxicillin are becoming ineffective in as many as 80 percent of cases due to misuse. The misuse includes taking antibiotics without a prescription, not completing full dosages, or using them to treat viral illnesses like common cold. ALSO READ: Young healthcare professionals: A frontline force against antimicrobial resistance Richard Bishumba, a pharmacist and the Board Chairperson of AMR Initiative Rwanda, noted that repeated use of antibiotics without proper medical advice leads to treatment failure and increases the risk of resistant infections. “This repeated exposure to pathogens may strain the immune system and contribute to developing resistant infections, which are harder to treat. Misuse of antibiotics can disrupt the body’s natural microbiota, potentially impacting immune responses,” he added. Microbiota refers to the ecosystem of microorganisms that reside within a host, such as the gastrointestinal tract in humans, and provide various benefits to the host's functions, including digestion and metabolism. Bishumba stressed the urgent need for public education, particularly among young people, who he believes can lead change through awareness campaigns and use of digital tools for AMR surveillance. Rwanda strengthened its national framework with the launch of the National Action Plan on Antimicrobial Resistance (2025–2029), on May 12, by the ministries of health, agriculture, and environment. The new plan builds on the previous 2020–2024 strategy and supports a One Health approach, which recognizes the interconnection of human, animal, and environmental health. The five-year plan focuses on six priority areas: raising awareness, strengthening surveillance of antimicrobial use and resistance, reducing infection through improved hygiene and sanitation, improving the responsible use of antimicrobials in all sectors, increasing laboratory capacity, and improving policy governance and investment. Dr. Leopold Bitunguhari, a medical researcher at the University Teaching Hospital of Kigali (CHUK), said the lack of adherence to medical prescriptions is still a barrier. “If patients are given drugs that don’t match their illness or they fail to follow dosage instructions, the treatment fails,” he explained. Medical professionals must take responsibility too, by improving prescription practices and refusing to dispense antibiotics without clear clinical justification, he added. “Pharmacists must also uphold ethical standards and avoid selling antibiotics without prescriptions,” he said. Improper use of antibiotics is not limited to humans. The agriculture sector contributes to the problem through the use of antibiotics in livestock and farming, which allows resistant bacteria to spread to humans through the food chain or the environment. Hospitals, too, can become AMR hot spots due to over prescription, inadequate infection control, and poor hygiene, he noted. “Promoting basic hygiene like hand washing in schools, markets, and health centers is essential. It’s one of the simplest ways to prevent infections and reduce the need for antibiotics, Dr. Bitunguhari added. According to Nadia Uwera, the Medicines Registration Specialist at Rwanda Food and Drugs Authority (Rwanda FDA), animal owners and farmers are central to the fight against antimicrobial resistance. “Their daily choices on antibiotic use in livestock can either help contain or worsen the spread of resistant pathogens,” Uwera said, explaining that responsible antibiotics use is often hindered by limited awareness of AMR’s long-term consequences, a shortage of veterinary professionals in rural areas, and the easy availability of antibiotics without a prescription, which leads many farmers to self-treat animals or rely on informal advice. “This can result in incorrect dosing, incomplete treatment, or using antibiotics when they are not needed. We need a coordinated response to change these practices through local education, stronger enforcement of prescription rules, and improving access to veterinary care through trained paraprofessionals and mobile outreach.” Uwera stated that when animals are well cared for with vaccines, good nutrition, and proper hygiene, there is less reliance on antibiotics. Involving farmers in AMR surveillance and community-based research can boost their understanding, making them essential partners in protecting the health of animals, people, and the environment through the One Health approach, she said. Globally, the threat of AMR has reached alarming levels. According to the World Health Organization, antimicrobial resistance is among the top 10 public health threats. In 2019, AMR was responsible for 1.27 million deaths worldwide and associated with nearly 5 million more. Children under five are disproportionately affected, accounting for one in five AMR-related deaths globally. Low- and middle-income countries, including Rwanda, bear the burden of the crisis due to limited access to diagnostics, poor healthcare infrastructure, and widespread poverty. WHO has repeatedly warned that AMR could reverse decades of progress in medicine. It makes common infections harder to treat and puts medical procedures such as surgeries, cancer treatment, and childbirth at greater risk. The world is also facing a crisis in the development and accessibility of new antibiotics. Few new drugs are being developed, and those that reach the market are often unavailable or unaffordable in resource-limited settings. WHO has called for increased investment in research and development, along with more equitable access to vaccines, diagnostics, and effective treatments. Economically, AMR is projected to cause immense damage. The World Bank estimates that the global healthcare system could face up to US$1 trillion in additional costs by 2050. Annual GDP losses could range between US$1 trillion and US$3.4 trillion by 2030. Rwanda’s response has included both national and international partnerships. Rwanda Biomedical Centre (RBC), in collaboration with the Infection Prevention and Control Rwanda Organisation (IPCR), Pfizer, and local hospitals, is leading several initiatives to combat AMR. According to Claude Mambo Muvunyi, the Director General of RBC, AMR has surpassed HIV/AIDS and malaria as one of the leading causes of death globally. “Every action we take today shapes the future of medicine. We must raise awareness and protect antibiotics for generations to come,” Muvunyi said. Rwanda participates in the annual World AMR Awareness Week (WAAW), celebrated from November 18 to 24. The campaign aims to increase understanding of AMR and encourage best practices across all sectors, including human, animal, and environmental.

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What you should know about antimicrobial resistance, an escalating global threat