Spotlight 22/01/18 | Conflict and AMR

A recent visit to the headquarters of the WHO Eastern Mediterranean Regional Office (EMRO) in Cairo highlighted the destabilising effect of conflict on the utility and distribution of antimicrobials. The Region, stretching from Morocco to Pakistan, and including Somalia, though excluding South Sudan, Turkey and Israel, is extraordinarily complex in political terms, and faces serious impediments to antimicrobial stewardship and policy making, which the Regional Office is committed to overcoming. Even in Regional states with a relatively strong commitment to primary health care provision, issues around sanitation, animal husbandry, population movement and growth, drug safety and distribution, and self-medication complicate the management of antimicrobials, and AMR National Action Plans are still in the drafting stage in most EMRO states.

The effects of civil and military conflict, currently most visible in Syria and Yemen, compound all of these problems, and upend the reach of policy making processes. A recent pilot campaign on antibiotic prescribing and population level misuse in Syria, with the support of the Syrian Pharmacists’ Association, sought to raise awareness around the risks in the Damascus area, identifying pharmacists as key gatekeepers, since antibiotics are largely accessed without prescriptions. Even in Damascus, which was relatively secure at the time of the programme, the campaign met many logistical hurdles. However, it seems that the feared reluctance of pharmacists to take on board the message of antibiotic stewardship and responsibility – under extreme economic stress – did not materialise. It is now planned to expand the scope of the publicity programme, alongside research into knowledge and attitudes around antibiotic resistance, to other cities in the country.

In Yemen, alongside huge logistical problems in distributing and accessing medical care, the epidemic of cholera has raised fears of potential for the emergence of resistant strains of the disease. As of last summer, there were as yet no reports of antibiotic resistance in cholera in Yemen. The potential for re-emergence of epidemic cholera in Spring 2018, and the persistent difficulties in organising humanitarian relief on the country present an ongoing quandary for AMR surveillance.