Rwanda’s Renewed Commitment Against Antimicrobial Resistance: A Call for Global Collaboration and Action

The Rwanda Biomedical Center (RBC), in collaboration with its esteemed stakeholders, on November 22, 2024, held the National Conference on Antimicrobial Resistance (AMR). The conference, themed “Educate. Advocate. Act Now,” brought together over 500 stakeholders, including policymakers, healthcare professionals, researchers, and civil society leaders, to tackle the growing issue of antimicrobial resistance and is part of the World Antimicrobial Awareness Week (November 18-24).

Antimicrobial Resistance (AMR) is a growing global health threat that arises when microorganisms like bacteria, viruses, fungi, and parasites stop responding to antimicrobial medicines. This resistance renders treatments ineffective, making infections harder to manage, increasing disease severity, and elevating the risk of death. AMR also leads to prolonged hospital stays and higher healthcare costs.

A significant concern is the link between human and animal health, as over 60% of human infections originate from animals. Misuse of antimicrobials in livestock can foster the development of resistant pathogens, which can then spread to humans. Addressing AMR is critical to safeguarding modern medicine and preventing the global spread of untreatable infections, according to WHO.

In his opening remarks, the Director General of RBC, Prof. Claude Mambo Muvunyi, emphasized the critical need for urgent action against AMR. Highlighting the theme “Educate, Advocate, Act Now,” he underscored AMR’s escalating threat to global health, projecting 39 million deaths annually by 2050 if left unchecked. Beyond health, AMR poses severe risks to livestock production, food security, and global economies, potentially costing trillions in GDP losses by 2030.

Rwanda, facing rising resistance to treatments for infections such as malaria, tuberculosis, and bloodstream infections, has responded proactively by launching its second National Action Plan for AMR. This plan adopts a holistic One Health approach, integrating human, animal, plant, and environmental health sectors to address AMR comprehensively. Key strategies include reducing misuse of antimicrobials, strengthening surveillance systems, and ensuring equitable access to quality diagnostics and medicines under universal healthcare coverage.

Prof. Muvunyi also highlighted the importance of global collaboration and evidence-based interventions. Rwanda actively contributes to the Global Antimicrobial Resistance and Use Surveillance System, leveraging robust data to guide policy. Public awareness and engagement remain pivotal, with efforts focused on educating communities about prudent antibiotic use.

“Antimicrobial resistance is projected to result 39 million deaths globally by 2050 if left unchecked. This is equivalent to three deaths every minute if no action is taken today. The impact is not only on human health but also on livestock production, particularly in low-income countries. A decline of 11% in livestock production is predicted if antimicrobial resistance continues. This threatens food security and the livelihoods of millions who depend on agriculture. Therefore, it is crucial for all to come together and fight against this issue,” he said.

Rwanda’s AMR response also aligns with international commitments, including recent ministerial discussions and political declarations on AMR. Prof. Muvunyi reiterated Rwanda’s dedication to fostering innovation, building resilience, and preserving the efficacy of life-saving antimicrobials for future generations. He called for coordinated efforts across sectors and borders, emphasizing that safeguarding health systems and populations is paramount in the fight against AMR.

“Rwanda will remain committed to its evidence-based and partnership-driven interventions, which I think is going also to be very important as we continue to strengthen our system to foster innovation but also build resilience as far as antimicrobial resistance interventions are concerned,” he added.

This collective action, he highlighted, is essential to secure a healthier and more sustainable future.

Moreover, while launching the second iteration of Antimicrobial Resistance (AMR) National Action Plan (NAP 2.0) as a strategic continuation of its commitment to combat AMR, Prof. Muvunyi emphasized Rwanda’s progress since its first AMR plan in 2020, which achieved 34% implementation despite challenges like the COVID-19 pandemic. He highlighted that strong political commitment and governance frameworks were pivotal to developing and sustaining these efforts.

“In 2002-2022, only 34 African countries had national action plans for implementation, with Rwanda being among them. The first national action plan was published in 2020 and expired this year, highlighting the need for continued awareness week and diverse actions,” he stated.

Key gaps identified in the first action plan included insufficient implementation of antimicrobial stewardship practices, limited access to diagnostics, and the lack of optimized antimicrobial prescriptions. Cultural behaviors and societal attitudes toward antibiotics usage emerged as critical hurdles. Rwanda’s new plan incorporates a robust Monitoring and Evaluation (M&E) framework, clearer activities, and costed interventions to address these challenges.

The AMR NAP 2.0 aligns with a One Health approach, emphasizing collaboration across sectors such as human, animal, plant, and environmental health. Notable areas of focus include enhancing diagnostic networks, ensuring antibiotic supply chain integrity, and fostering public engagement through education and behavior-change campaigns. The plan also prioritizes local production of antibiotics and capacity building in healthcare and veterinary systems.

Funding remains a key concern, with an estimated $6 billion RWF required for implementation in 2024 alone. Prof. Muvunyi called for increased domestic and international resource mobilization to ensure timely execution.

As Rwanda commits to action, the AMR NAP 2.0 serves as a model of multi-sectoral collaboration, aiming to address both technical and behavioral dimensions of antimicrobial resistance while ensuring sustainability and inclusivity. The government and partners aim to revisit progress during next year’s World Antimicrobial Awareness Week.

During his speech, Dr. Brian Chirombo, WHO’s Country Representative to Rwanda, highlighted the escalating global crisis posed by AMR, labeling it a “silent pandemic.” Addressing stakeholders, he commended Rwanda’s commitment through the launch of the Antimicrobial Resistance National Action Plan 2.0 and underscored the necessity of collective responsibility under the theme “Educate, Advocate, Act Now.”

He emphasized AMR’s pervasive impact, which claims an estimated 700,000 lives annually and is projected to cause up to 39 million deaths by 2050 without urgent action. He stressed the One Health approach, integrating human, animal, and environmental health, as pivotal to addressing AMR’s multifaceted challenges. Citing increasing resistance to antibiotics like those used for urinary tract infections and malaria treatments, and warned of potential reversals in Rwanda’s health progress.

He said, “I commend the government of Rwanda through the Minister of Health for their commitment to addressing AMR, and particularly putting in place the One Health system and approach to make sure that this becomes an entry point to addressing AMR using a multisectoral approach and the involvement of all the key stakeholders. However, we must advocate for more investments in the One Health approach. We need to do more research. We need to work more on surveillance.”

Education and advocacy are crucial for reducing antimicrobial resistance (AMR) misuse. Training healthcare providers, raising public awareness, and involving agriculture are essential. Political commitment, financial investment, and integration into national health policies are also required.

“We need a whole-of-society approach where we work together to be able to achieve these global targets for us to have the accountability to make sure that action on AMR is implemented and would yield the results that we need. Because AMR is already one of the silent pandemics. So, this year’s week is particularly crucial for ensuring that we keep momentum and continue to mobilize society and mobilize all stakeholders for action,” Dr. Chirombo said.

He urged immediate, evidence-based action to implement surveillance systems, promote responsible antibiotic use, and strengthen infection prevention measures. By scaling up Rwanda’s One Health surveillance efforts, he envisions the nation as a model for regional and global AMR responses. To conclude, he called for an inclusive, multi-sectoral approach to achieve sustainable progress in combating this pressing health crisis.