In a bold step towards combating the growing threat of antimicrobial resistance (AMR), the Federal Government of Nigeria has launched the Second National Action Plan on Antimicrobial Resistance (AMR 2.0).

This milestone  aligns with the political declaration endorsed in the 79th session of the United Nations General Assembly High-Level Meeting (UNGA-HLM), President Bola Ahmed Tinubu’s health sector renewal initiative, and Nigeria’s commitment to global health security.

Antimicrobial Resistance (AMR) occurs when infections become harder to treat as microorganisms like bacteria, viruses, fungi, and parasites evolve, becoming resistant to drugs and developing the ability to survive treatments that once killed or inhibited their growth.The World Health Organization (WHO) describes AMR as one of the top global public health threats facing humanity, with 4.95 million human deaths estimated to be associated with bacterial AMR worldwide in 2019. 

During the launch and ministerial briefing of the AMR action plan  in Abuja, the Coordinating Minister of Health and Social Welfare, Muhammad Pate, disclosed that a situation analysis on AMR found that it is not only among the country’s population but also among animals, crop-sourced food, and the environment.

The Minister described AMR as a threat that is growing at an alarming rate and endangering decades of medical progress. “AMR threatens the foundation of modern medicine, rendering routine procedures, surgeries, and treatments less effective, and at times, ineffective. AMR, unaddressed, can surpass cancer as a leading cause of mortality globally. The economic consequences are equally dire, with projections estimating global losses of over $100 trillion. 

The Second National Action Plan on AMR outlines strategies for improving antimicrobial stewardship, enhancing surveillance and detection capabilities, promoting research and development and strengthening healthcare systems,” he said. 

Addressing AMR with One Health principles: A Strategic Move
AMR is driven by the overuse and misuse of antimicrobial drugs in humans, animals, and agriculture.

The environment plays a pivotal role in the transmission of antimicrobial-resistant organisms. Wastewater from pharmaceutical companies, healthcare facilities, and agricultural activities, which often contain high levels of antibiotics, contributes to the spread of AMR in the environment. With this strategic plan, Nigeria aims to reduce these environmental factors and strengthen surveillance systems to detect and monitor AMR in environmental samples.

In his remarks, WHO Country Representative Dr Walter Kazadi Mulombo reiterated that the world has reached a critical milestone in understanding the environment’s impact on antimicrobial resistance.

Commending Nigeria Centre For Disease Control (NCDC)and partners and stakeholders on developing Nigeria’s National Action Plan on Antimicrobial Resistance (AMR), Dr Mulombo said, “AMR threatens our time, economy and development. It’s a moral imperative and a career-defining challenge. If left unchecked, antimicrobial resistance may claim millions of lives and wreak economic havoc.It is predicted to cause over 39 million deaths in the next 25 years, surpassing current mortality rates.

This alarming projection underscores the urgency for collective action.”

“AMR is multifaceted, requiring an integrated multi-dimensional approach. Critical factors include irrational antibiotic use, lack of access to clean water, sanitation and hygiene, inadequate healthcare infrastructure and the limited funding for research and development.”

He, therefore, noted that this achievement demonstrates leadership, ownership and drive to address this pressing issue.

WHO’s Role in Supporting AMR Efforts
WHO has been a key technical partner in developing this NAP-2.0 , providing guidance on global best practices and supporting the federal government in aligning its strategies with the Global Action Plan on AMR.

To improve the national effort to control the impact of AMR, the ministry launched the AMR NAP 2.0, which is a revision of the national action plan on AMR adopted in 2017.

With the expiration of the AMR NAP-1.0 (2017-2022), an assessment of its implementation revealed key gaps and challenges, with only a 44% completion rate. The assessment highlighted weak involvement from sectors such as environment, plant, food, aquaculture, agriculture, and relevant human health sectors in the implementation of priority activities. Additionally, NAP-1.0 was not costed and lacked specific milestones and targets.

In response, the Government of Nigeria, along with the Federal Ministry of Health and NCDC, requested WHO's support in developing NAP-2.0 (2024-2028) and providing strategic guidance for the AMR Coordination Committee to develop the plan based on the AMR Global Action Plan, WHO manual for NAP Development, WHO implementation handbook for NAPs on AMR, and the  People-cantered approach to addressing antimicrobial resistance in human health.

In 2023, the WHO Country Office, in collaboration with African Regional and Headquarters, developed a unified strategic approach to support NAP-2.0 development. This approach addressed the critical gaps in NAP-1.0 implementation, coordination challenges, and the roles of different sectors. The goal was to ensure that NAP-2.0 was developed within the context of a One Health approach, with the involvement of various sectors.

The event in Abuja brought together key stakeholders from the government, health, and environmental sectors and international partners, including the World Health Organization (WHO), which has been at the forefront of supporting Nigeria in addressing AMR. The new action plan  builds on Nigeria’s earlier efforts to reduce the overuse and misuse of antimicrobials in healthcare and animal, agriculture sectors, expanding its focus to the often overlooked but critical environmental dimension.

Funding from the KSA and Fleming Fund supported the development of the strategic document One Health AMR NAP-2.0.