After nearly a year since the first report released in January on Singapore’s National Strategic Action Plan on Antimicrobial Resistance (AMR), it is now officially launched as a national response.

Aligned with the World Health Organisation’s (WHO) Global Action Plan, it provides “a framework to strengthen and enhance activities to combat AMR, address identified gaps and prioritise future interventions,” according to the joint release by the agencies involved in the One Health Antimicrobial Resistance Workgroup.

The plan was developed by the inter-ministerial committee—comprised of the Ministry of Health (MOH), Agri-Food and Veterinary Authority (AVA), National Environment Agency (NEA) and Singapore’s National Water Agency PUB.

Crucial need to act against AMR

Senior Minister of State for Health, Dr Lam Pin Min emphasised the need to take serious action against the AMR problem, during the Public Health Thought Leadership Dialogue on AMR, at the National University of Singapore (NUS).

"It is only a matter of time after the discovery of an antimicrobial and its introduction to market that a micro-organism develops resistance to it, often fuelled by the overuse or abuse of these antimicrobials," he remarked.

The Public Dialogue on AMR was held on 1st November, focusing on addressing the global AMR problem. Photo credit: National University of Singapore
The Public Dialogue on AMR was held on 1st November, focusing on addressing the global AMR problem. Photo credit: National University of Singapore

Globally, about 480,000 people develop multi-drug resistant tuberculosis (TB) each year, and drug resistance is creating complications in tackling human immunodeficiency virus (HIV) and malaria, highlights WHO on its website.

Without effective antimicrobials for prevention and infection control, emerging new resistance mechanisms may disprove standard treatments for common infectious diseases, causing high risk to major medical procedures.

“The extreme scenario of antimicrobial resistance – of having no effective antibiotics to treat infections – will bring us to a post-antibiotic era where simple infections may kill. Even today, there exist infections that do not respond to many treatment options,” said Dr Lam.

National Strategic Action Plan boasts five core strategies to battle AMR

The National Strategic Action Plan prioritises on more work and research, with five core strategies to reduce the emergence and prevent the spread of drug-resistant microorganisms. These are education, surveillance and risk assessment, research, prevention and control of infection, and optimisation of antimicrobial use.

Dr Lam expressed that the group will work on public education on AMR, which can include “simple steps such as maintaining good hand and personal hygiene, to more in-depth understanding of antibiotics and how they work”. Campaigns for public education on the myths and bad practices of antibiotics use will be organised. Topics on AMR will also be extended to doctors’ undergraduate and postgraduate trainings.

Professor Teo Yik Ying, Vice-Dean of Research and Dean-Designate at the NUS Saw Swee Hock School of Public Health, also said that AMR education among doctors is essential as well. He urged authorities to “send a message” to GPs and polyclinics that they should not as prescribe antibiotics to patients solely on per request basis by the patients.

According to Professor Teo Yik Ying, AMR education among doctors is essential, as well. Photo credit: Youth.SG
According to Professor Teo Yik Ying, AMR education among doctors is essential, as well. Photo credit: Youth.SG

However, practising doctors would face challenges. In certain cases, it may not be easy to determine whether their patients get infection caused by bacteria or virus – antibiotics do not work for viral infections.

Patients also doctor-hop; therefore, accurate diagnosis based on doctors’ clinical judgement comes from experience and discussions with patients, noted Dr Philip Koh, from Healthway Tampines Clinic.

Surveillance of drug-resistant infections will include private hospitals and the community, besides public hospitals. The group will also develop guidelines on the appropriate use of antibiotics and other antimicrobial medicines, based on best practices, in primary care clinics and community settings.

Immunisation is also a preventive measure against preventable infections. Vaccinations as a “first-line defence” would greatly aid in the fight against AMR, said Professor Teo. Last month, the Ministry of Health (MOH) had introduced the National Adult Immunisation Schedule (NAIS) to encourage adult vaccine.

Future outlook: Three key longer-term efforts to tackle AMR

Dr Lam also identified three key elements as long-term efforts to fight against AMR.

The first involves integration of various agencies in coordinating efforts across sectors, such as surveillance activities and data sharing. “This is important to improve our understanding of how AMR develops and circulates between humans, animals, food and the environment,” noted Dr Lam.

Secondly, in-depth research is required to understand the complex factors influencing AMR, besides to develop innovative, evidence-based initiatives.

Finally, he called for national efforts in tackling AMR to be complementary to works done by international counterparts, as AMR is a global problem. MIMS

Read more:
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Antimicrobial resistance crisis: A long time coming
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