Why does “ubuntu” matter to antimicrobial resistance in South Africa?
Date: 24 November 2020
Time: 19:00 SAST, CAT | 20:00 EAT | 17:00 BST | 13:00 EST | 18:00 CET
The Tripartite Executive Committee has decided to fix the World Antimicrobial Awareness Week dates to 18-24 November every year starting from 2020. The slogan for 2020 will be “Antimicrobials: handle with care” applicable to all sectors. The theme for the human health sector for WAAW 2020 is “United to preserve antimicrobials“. 
Join us for a 60-minute session with our panel experts. All stakeholders including medical professionals, healthcare workers, patients and the public, payers, policymakers, academics, entrepreneurs, veterinarians, environmental experts, farmers, etc. locally and globally are welcome. The public transcript will be recorded by Symplur.
T1: Why does working together matter to antimicrobial resistance?
T2: Who should be working together to tackle antimicrobial resistance?
T3: What barriers exist to tackle antimicrobial resistance locally, and globally?
T4: What can we do to promote collective action for antimicrobial resistance in South Africa?
CT: (Closing Thoughts): Is there anything you feel is important to add to this conversation?
HOW TO PARTICIPATE:
Start your answers with T1, T2, T3, T4 or CT for transcript purposes.
Answer only after the moderator prompts. Questions will be prompted every 10 minutes, but keep answers coming using the relevant T and number. Both panel experts and public attendees are encouraged to participate.
Use the #ProtectAntibioticsZA hashtag in all tweets so you are visible to others in the chat.
Everyone is welcome to join locally and globally. Our transcript will be recorded on www.symplur.com.
Ubuntu (Zulu pronunciation: [ùɓúntʼù]) is a Nguni Bantu term meaning “humanity.” It is often translated as “I am because we are,” or “humanity towards others,” or in Xhosa, “umntu ngumntu ngabantu” but is sometimes used in a more philosophical sense to mean “the belief in a universal bond of sharing that connects all humanity.” We humans may each be individuals but we’re only fully human when we embrace being part of each other. As Archbishop Desmond Tutu once described ubuntu, “There is no such thing as a solitary individual, we belong in a bundle of life.”  And so ubuntu’s definition of “I am because we are” means in a sense that if you aren’t seen by me or society as human or fully human then neither can I be fully human. Ubuntu was also at the very core of Nelson Mandela’s philosophy during our struggles after apartheid when he was released from Robin Island Prison in 1990.
In 2020, the idea of solidarity and ubuntu was reignited in South Africa when the first COVID-19 case was announced on the 5th of March.  To tackle this deadly global pandemic, everyone had to come together. If I didn’t wear a mask, self-isolate or wash my hands then I put you, your family and others in my community at risk. This fellow respect for each other’s wellbeing was one of the greatest lessons we all had to learn as South Africans. It became clear that our spirit of ubuntu and solidarity as one nation were imperative to tackling COVID-19.
In many ways, antimicrobial resistance requires the same type of collective action . Not only in human health but also in the animal, food production, plant and environmental sectors. Antimicrobial resistance needs a multisectoral approach, both locally and globally which is called “One Health”. Antimicrobial drugs are medicines that are used to treat infections caused by different microorganisms like viruses, bacteria, fungi and parasites. Antimicrobial medicines are grouped into categories according to the microorganisms they treat, for example, antibiotics kill bacteria and antivirals treat viruses. The frightening thing is that many of the same types of microorganisms that exist in different sectors like animal health exist in human health too and sometimes these germs can be passed on between us, like in the case of Staphylococcus aureus which is a common type of bacteria living on both animals and humans. It’s normally a harmless bacteria that live on our skin and mucosal areas like our nose unless it enters the body through an open wound or respiratory tract where it can cause an infection. Usually, antibiotics are used to treat it.
Over the past few decades, since the first antibiotic (Penicillin) was discovered in 1928 by a scientist called Sir Alexander Flemming, bacteria like Staphylococcus aureus have been evolving to resist their effects. Although bacterial evolution is a survival mechanism used in nature, many of these microorganisms like bacteria have adapted much faster because of the additional pressure that is applied to them when antibiotics are overused and misused by humans. As a result, a Staphylococcus aureus bacteria that could no longer be treated with an antibiotic like Methicillin became known as a “Superbug” called Methicillin-resistant Staphylococcus aureus (MRSA). In the animal industry where the same evolution was taking place, it would be referred to as Livestock-Associated Methicillin-resistant Staphylococcus aureus (LA-MRSA) whereas, in hospitals, the MRSA superbug was known as Hospital-Acquired Methicillin-resistant Staphylococcus aureus (HA-MRSA) and in the community for example where the MRSA infection was acquired in a fitness facility, it was called Community-Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA). What was frightening was that if these new superbug bacteria got inside our body and caused an infection, this time they could resist those Methicillin antibiotics, sometimes meaning an amputation was necessary to stop the infection spreading to the rest of the body and when that was not possible, many patients would die.
Resistance doesn’t stop at Staphylococcus aureus bacteria either, it is impacting all other types of bacterial species including Salmonella which is a type of bacteria that can cause food poisoning and which depend on antibiotics to treat them if they cause an infection. Other antimicrobial medicines used for microorganisms like viruses and fungi are also becoming less effective. An example of antiviral resistance is lamivudine resistance in both HIV and the hepatitis B virus.  Candida Auris is further a fungal species that is particularly resistant to antifungal drugs and can spread in healthcare settings. 
So how do we stop antimicrobial resistance? It is as challenging a question as to how we stop COVID-19 because many of these superbugs can spread between us just as rapidly in certain circumstances. As in the case of the Coronavirus, hand hygiene is one of the most effective ways we can help to reduce the spread of bad germs, but so is taking the steps to use these medications more responsibly. For example, in the case of antibiotics, many of us use them for the flu or common cold when those types of infections are actually caused by viruses, so taking an antibiotic which was designed to treat bacteria won’t kill them.  This action contributes to overuse and misuse. In the animal sector, antibiotics are used when no disease is detected, but rather for growth promotion.  Policies around this need to change and consumers should be more informed about the types of antibiotics that are used in the food they eat.
Superbugs are not going to stop evolving resistance unless we do something drastic to change the situation. Human health relies on antimicrobials like antibiotics to work when we need them for almost every type of disease including cancer, HIV/AIDS, TB, disabilities like the loss of a limb, Rare Diseases like Cystic Fibrosis , heart disease, organ transplants or everyday surgery and dentistry. They are the cornerstone of modern-day medicine and without them being effective, treating these various types of diseases will be impossible. We should only use them for the right reasons and sparingly. The only way we can ever tackle antimicrobial resistance will be to work together, meaning not only health professionals or farmers working among themselves, but also as members of civil society who can make more informed choices through education and awareness, as well as through placing pressure on policymakers and sectors like the food industry because if this crisis continues, everyone will be impacted. Its a race between disease-causing microbes (pathogens) and humans which humanity is currently losing.
“If I don’t wash my hands, I put you at risk”, this is one lesson we learned about ubuntu and COVID-19. “If I don’t use antibiotics responsibly, I put you at risk”, one of many ubuntu lessons for antibiotic resistance and other antimicrobials which is yet to be learned.
“I am because we are.”  ubuntu
Join this Twitter chat during World Antimicrobial Awareness Week 2020 on the 24th of November at 19:00 CAT/SAST. Take the Antibiotic Guardian Pledge to help protect antibiotics for future generations at www.AntibioticGuardian.com/South-Africa.
- Professor Natalie Schellack, Clinical Pharmacy and Paediatrics – @NSchellack
- Dr Esmita Charani, Postdoctoral Researcher and Pharmacist – @e_charani
- Dr Oluchi Mbamalu, Research Pharmacist, University of Cape Town – @oluch1_nm
- Professor Adrian Brink, Medical Microbiologist, University of Cape Town – @ABpreservation
- Dr Klaus Von Pressentin, Head of Family Medicine at University of Cape Town School of Public Health and Faculty of Health Sciences – @klausvon
- Dr Yogan Pillay, Country director of South Africa, Senior Global Director for Universal Health Coverage at the Clinton Health Access Initiative – @ygpillay
- Dr Ekwanzala, Water Microbiologist working in Antimicrobial Resistance, Tshwane University of Technology – @ekwanzala_md
- Dr Ali Halajian, Scientist, One Health, Zoonoses, Parasitology, Veterinarian and Science Communicator – @AliHalajian
- Pharmacist, The_SA – @PharmacistTheS1
- The Rural Health Advocacy Project (RHAP) advocates for access to quality and comprehensive rural health care in South Africa – @RHAPnews
- Ingrid Schoeman – Operational Manager, TB Survivor and Activist, TB Proof – @TBProof
- CANSA – Cancer Association of South Africa – @CANSA
- Professor Marc Mendelson, Professor of Infectious Diseases and Head of the Division of Infectious Diseases & HIV Medicine at Groote Schuur Hospital – @SouthAfricanASP
- Professor Renier Coetzee (PharmD), Associate Professor, University of the Western Cape – @reniercoetzee
- Dr Oliver Van Hecke, Family Physician (GP) and Clinical Lecturer, Nuffield Department of Primary Care Health Sciences, University of Oxford – @olivervanhecke
- Winnie Nambatya, @WinnieNambatya
- Dr Dena van den Bergh, Independent Consultant Health Systems Improvement & Honorary Lecturer Division of Infectious Diseases & HIV Medicine, UCT @Inspired2leadQH
- Dr Debbie Goff, Professor of Pharmacy Practice, Global Antibiotic Stewardship The Ohio State University USA, @idpharm
- Aoife Hendrick, National Clinical Pharmacy Fellow, Public Health England – @ AoifeJHendrick
- Dr Wilhelmina Strasheim, Medical Scientist, National Insitute of Communicable Diseases (NICD) – @WStrasheim
- National Institute of Communicable Diseases (NICD) – @NICD_sa
- Heidi Albert, Head of FIND South Africa – @FINDdx
- Cecilia Ferreyra, Head of AMR, FIND – @FINDdx
- Karishma Saran, Strategic Communications Officer, FIND – @FINDdx
- Campaigning For Cancer – A non-profit organisation who offer information, support and advocacy to cancer patients in South Africa – @Campaign4Cancer
- Kagiso Matiting, TB Survivor and Community Health Worker –
- Connie Walyaro, Executive Director – Leadership Council Member, International Society for Infectious Diseases (ISID), Africa, Asia Pacific, Americas at Talk ABR – @ConnieWalyaro
- Sonya Kolman, clinical pharmacist at Nelson Mandela Children Hospital in South Africa. Special interest in paediatric medicine and antimicrobial stewardship – @Sonya_kolman
- Professor Hannelie Meyer, Full Professor in the Division of Public Health Pharmacy and Management at the School of Pharmacy, Sefako Makgatho Health Sciences University (SMU) – @HannelieMeyer
- Prof Sue Goldstein, Public Health Specialist, Deputy Director SAMRC/ Wits Centre for Health Economics and Decision Science; PRICELESS SA – @DrSueGoldstein
- World Antimicrobial Awareness Week 2020 – https://www.who.int/news-room/events/detail/2020/11/18/default-calendar/world-antimicrobial-awareness-week-2020
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- Tutu, Desmond (2013). “Who we are: Human uniqueness and the African spirit of Ubuntu”
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- What is antifungal resistance, Centers for Disease Control and Prevention
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- Antibiotic Resistance Calls Future of Cancer Treatment Into Question, Technology Networks
- Chmiel JF, Aksamit TR, Chotirmall SH, et al. Antibiotic management of lung infections in cystic fibrosis. I. The microbiome, methicillin-resistant Staphylococcus aureus, gram-negative bacteria, and multiple infections. Ann Am Thorac Soc. 2014;11(7):1120-1129. doi:10.1513/AnnalsATS.201402-050AS
- South Africa’s spirit of ubuntu, Gilt Edge Africa
- World Health Organisation, Fact Sheet for Antimicrobial Resistance
- Africa CDC Framework for Antimicrobial Resistance in Africa 2018- 2023
- WHO Global Action Plan on Antimicrobial Resistance
- FAO Global Action Plan on Antimicrobial Resistance
- UNEP report – Antimicrobial Resistance: Investigating the Environmental Dimension
- The OIE Strategy on Antimicrobial Resistance and Prudent Use of Antimicrobials
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