An Interview with Professor Mireille Dosso on the Fight Against Antimicrobial Resistance in Côte d’Ivoire
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Professor Mireille Dosso
Antimicrobial resistance (AMR) is a major threat in Côte d’Ivoire and requires rapid measures to contain it. For example, the average resistance to amoxicillin rose from 73.7% in 2012 to 87.3% in 2017 (Report of the Observatoire des résistances des microorganismes aux antiinfectieux en Côte d’Ivoire (Observatory on the resistance of microorganisms to anti-infectives in Côte d’Ivoire) for 2017). This shows that resistance to this commonly used antibiotic is very high and rising in the country. However, in recent years and following the World Health Organization (WHO) Joint External Evaluation in the country in 2016, Côte d’Ivoire has forged ahead with strategic measures to advance its fight against AMR. Professor Mireille Dosso, President of the Multisectoral Coordination Group for Antimicrobial Resistance and Director of the Institut Pasteur of Côte d’Ivoire, talks about the country’s efforts, challenges, and priorities to contain AMR.
How has Côte d’Ivoire fought against the threat of AMR, and what role does the Institut Pasteur play?
The Institut Pasteur of Côte d’Ivoire has been committed to fighting AMR for more than 20 years. It is hosting the ORMICI, an institution that serves as the executive unit to coordinate actions against AMR through six Multisectoral Technical Committees (MTCs) that correspond to the six strategic objectives of the National Plan to Combat AMR.
This multisectoral approach is a source of great pride for me as it enables strong collaboration among stakeholders. With MTCs unified under the leadership of ORMICI, we foster greater communications across all six committees. For example, when revising the national AMR plan, each committee has its own strategic objective to revise, but members of the other committees are invited to contribute to the work on all objectives so they can share challenges, lessons learned, and their overall experience on the implementation of activities.
I also would like to add that the collaboration with international partners has helped us make important achievements. The collaboration with the [US Agency for International Development] USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program has helped generate results to boost the fight against AMR. A number of documents have been developed that provide a framework for governance on the management of antimicrobials. Additionally, MTaPS’ support on infection prevention and control assessments and on the revision of the national AMR plan needs to be acknowledged.
Generally speaking, whether through USAID or the CDC, it is thanks to this funding that the renovation and functioning of the network of 11 laboratories specialized in AMR, as well as the provision of new equipment, was possible.
Pr. Dosso, Pr. Samba (Directorate General for Health), and Dr. Barouan (WHO) during the launch of National AMR Week in Côte d’Ivoire. Photo credit: Dr. Hérodias Ahimon/USAID MTaPS
Does the private sector have a role to play against AMR?
It can seem counterintuitive, but the private sector not only needs to be involved—it is often the sector asking for more regulations regarding multiresistant bacteria and antibiotic residues, especially stakeholders who operate in the health and agribusiness sectors. These sectors are affected by AMR because of the decrease in or loss of effectiveness of the products they sell.
These companies understand it is in their interest to have strict controls of the products that they sell, especially in the case of collective catering, as a way to defend themselves in court in the case of an accusation of food poisoning. Although the private sector wants stronger controls, the cost of those controls remains an issue. We need to find agreement between health authorities and the private sector so that strict controls can be accessible to the larger public.
The One Health approach seems especially relevant given the recent epidemics. What are the challenges for stronger collaboration among the different sectors (human, animal, and environmental health)?
The issue comes from the fact that these different sectors aren’t at the same level of progress. The human sector is more advanced—the Institut Pasteur started working in this area in the 1980s, and a number of scientists work on AMR throughout the country.
Regarding animal and environmental health, competencies and resources aren’t as strong since scientists started working on these areas much more recently.
I also want to indicate that the One Health concept is relatively new and we need to do a better job communicating its importance to different stakeholders. The current pandemic and climate change have more acutely demonstrated the need for a multisectoral approach to deal with them and this could accelerate the shift in the management of public health issues.
Awareness session provided to farmers on good usage of antimicrobials during National AMR Week in Yamoussoukro, November 2019. Photo credit: Dr. Bertin Guédé Kipré/Technical Working Group-AMR
COVID-19 has had a dramatic and global impact. Has this pandemic led to a change in Côte d’Ivoire’s approach to infection prevention and control?
Throughout the world, there is a stronger awareness from civil servants and health professionals of the importance of infection prevention and control. We shouldn’t forget the heavy toll that health professionals have paid due to the pandemic. In Côte d’Ivoire, health systems and IPC capacities have been strengthened during the pandemic, and we believe that a number of improvements will continue to take place as a result.
One of the biggest impacts of COVID-19 has been greater awareness within the political world on the need to pay attention to health facilities, labs, and the financing of the health sector to avoid social and economic consequences.
What should be prioritized to contain AMR efficiently in 2021?
My hope is to make people understand that antibiotics aren’t candy, and overconsumption of these products can have serious consequences. When the COVID-19 pandemic began to spread in Côte d’Ivoire, the first protocol against the virus included antibiotics, which encouraged mass consumption and a potential negative impact of these products. We need to continue to raise awareness that antibiotics have a specific purpose and protocol for their use.
I also believe that hygiene and prescribing practices should be prioritized. Hospital staff need to ensure the compliance of their facility to biosafety measures by ensuring that liquid and solid waste are taken care of appropriately. More training and equipment are needed to properly take care of this task.
Finally, it is important to note that Côte d’Ivoire faces a major challenge with medicines being sold without a prescription in legitimate businesses, as well as illegally in the streets, creating a market for fake, substandard, or expired medicines. Not only do patients not receive the care they need but this poses a serious health risk. Therefore, regulating use needs to be a public health objective and the fight against medicines trafficking a priority.
Site visit for an infection prevention and control assessment at the regional hospital center of Gagnoa. Photo credit: Dr. Ange-Fulgence Ouffoue/USAID MTaPS
The interview above has been edited for brevity. For more information on actions taken by Côte d’Ivoire to combat AMR, please watch Professor Dosso’s presentation “Multisectoral Coordination for the Fight against AMR: The Experience of Côte d’Ivoire” recorded during a side event of the 6th Global Health Security Agenda Ministerial Meeting in November 2020.