What and Why to Enhance Community Awareness on Antimicrobial Resistance

Dear Editor, SEAJPH[1] and Lancet[2] recently carried articles that paint a gloomy picture of the future if inaction to contain antimicrobial resistance (AMR) continues, especially among the developing countries. The political declaration of the UN General Assembly of 2024[3] on addressing the global challenge of AMR looks impressive, but is overwhelming. This declaration was preceded by several other global commitments including those made in recent meetings of UNGA-2016,[4] G20[5] and G7.[6] Unfortunately, awareness at the highest political level continues to coexist with little impactful action at the ground in most of the developing countries. Inadequate funding, low priority within the national health agenda, and weak intent to implement well-structured comprehensive plans seem to be the running theme across the developing Asian and African countries. Of 178 countries that have developed multisectoral national action plans (NAP) on AMR, only 52% have a functioning multisectoral coordinating mechanism and only 68% are implementing their NAPs.[3] Mere 11% of countries have dedicated funding to implement national plans.[3] Globally, the containment of AMR is influenced by technology-driven actions. These are primarily focused on discovery of new antimicrobial agents, diagnostic tools and innovations that promote prevention of infections in human health and animal care settings. While the importance of these initiatives is undeniable, two critical areas that have not been explored are “what” and “why” of AMR for community awareness. Addressing these two questions is mandatory for eliciting appropriate public health action and an affirmative behavioral change in the communities to reduce their persistent irrational use of antimicrobials. The AMR phenomenon needs simplification for a clear understanding by the public. The common man does not understand the generation and severe implications of AMR. Actionable messages on AMR are yet to reach him that help him in protecting his animals and obtaining optimal economic returns. All-out efforts are needed to engage communities including in rural areas using locally relevant communication means, leading to a change in behavior toward antimicrobials usage. Demystifying AMR needs to be entrusted to communication experts. These experts may be tasked to convert concepts, implications, and solutions of AMR into the simplest possible and easy-to-understand communication material for inducing behavioral change across all demographics. The messages must be both accurate and relevant for their intended audiences. The use of community-friendly material for better comprehension has the potential to lead to well-informed change in behavior. The NAP implementers must provide an enabling environment to make communication for behavioral change as an integral and priority component of their respective action plans.[7] There is an urgent need to generate socioeconomic factors that influence various paradigms of AMR. AMR policy needs to integrate socioeconomic drivers and their impacts into any communication strategy. This “why” of use of antimicrobials should be context specific, thus requiring tailor-made community-specific campaigns for action-oriented awareness.[8] Socioeconomic and sociocultural factors undoubtedly play a critical role in driving AMR. The emergence and spread of AMR relate to a mix of factors including social myths and misinformation, gender, living situations, educational level, healthcare access, regulatory enforcement, human mobility, conflict, climate change,[9] agriculture, and pollution. These key elements have to be built and embedded by the social scientists into the design of AMR communication strategy with a people-centered approach currently being advocated by the WHO,[10] to obtain maximum collaboration and participation from the antimicrobial users. A strong awareness among antimicrobial users through an evidence-based communication strategy that has social determinants and myths ingrained into it could lead to a voluntary reduction in the irrational use of antimicrobial agents by the community, thus significantly impacting AMR. It is obvious that technological advances cannot provide impactful solutions to the burgeoning global challenge AMR. Bringing about behavior change in the people toward rational antimicrobial use through evidence-based communication strategies that demystify AMR is critical for the success of any NAP. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.