Vaccines in the fight against antimicrobial resistance – perspectives from South Africa

Authors

  • A Brink Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, South Africa; National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
  • A Kgasi Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, South Africa
  • A Musyoki Department of Microbiological Pathology, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
  • B Kagina Vaccines for Africa and NITAGs Support Hub, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa
  • C Feldman Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • D Reddy Vaccines and Infectious Diseases Analytics Research Unit (Wits-VIDA), Johannesburg, South Africa; Division of Infectious Diseases, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • E du Toit One Health Trust, Washington DC, USA
  • E Kalanxhi One Health Trust, Washington DC, USA
  • J Meyer Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa; South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria, South Africa
  • I Impalli One Health Trust, Washington DC, USA
  • M Schönfeldt Child, Youth and School Health Directorate, National Department of Health, Pretoria, South Africa
  • M Sibanda Department of Clinical Pharmacy, School of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
  • N Schellack Department of Pharmacology, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
  • P Skosana Department of Pharmacology, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
  • S Essack Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
  • S Dlamini Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, South Africa
  • Y Ramsamy Division of Medical Microbiology, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

DOI:

https://doi.org/10.7196/

Keywords:

health care systems, drugs, antimicrobial

Abstract

Antimicrobial resistance (AMR), in which microbes adapt to and resist current therapies, is a well-recognised global problem that threatens to reverse gains made by modern medicine in the last decades. AMR is a complex issue; however, at its core, it is driven by the overuse and inappropriate use of antimicrobials. Socioeconomic factors have been identified as significant contributors to the emergence and exacerbation of AMR, especially in populations facing inadequate access to healthcare, poor sanitation services and high morbidity and mortality rates. Weak healthcare systems and water, sanitation and hygiene have been highlighted as fundamental risk factors for AMR emergence and transmission. Behavioural factors, such as purchasing antibiotics without a prescription from a registered healthcare professional, not completing the prescribed course or overly prolonged courses of antibiotics, using antibiotics to treat viral infections, lack of access to quality antibiotics, and the proliferation of substandard or falsified (SF) drugs, have also been identified as significant contributors to AMR. Low- and middle-income countries have a higher incidence of antibiotics being dispensed without a prescription than higher-income countries.

Author Biographies

  • A Brink, Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, South Africa; National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa; Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

    Dr Adrian Brink is Professor of the Division Medical Microbiology, National Health Laboratory Services, University of Cape Town. He studied Medicine at the University of Pretoria and specialized in Medical Microbiology at the same institution. Prior to moving to UCT in 2019, he was deployed in a large tertiary critical care hospital in Johannesburg, where he focused on innovative infection prevention and antibiotic stewardship research initiatives. Prof Brink was founding President of the Federation of Infectious Diseases Societies of Southern Africa and is the founder and current co-chair of the South African Antibiotic Stewardship Program (SAASP). Prof Brink serves on the South African Minister of Health’s Ministerial Advisory Committee (MAC) on Antimicrobial Resistance.

    Research Interests
    • The clinical and molecular epidemiology of antibiotic-resistant  infections
    • The mechanisms of antibiotic resistance as a confounder in antibiotic stewardship
    • The design and implementation of large-scale antibiotic stewardship and infection prevention and control interventions in low and middle-income countries. 
    • The protective, metabolic and immune functions of the gastro-intestinal and - vaginal biome, resistome and metabolome
  • A Kgasi, Department of Production Animal Studies, Faculty of Veterinary Science, University of Pretoria, South Africa

    Dr Alfred Kgasi has a Bachelor in Veterinary Medicine and Surgery degree from the Medical University of Southern Africa. He also has an MSc in Veterinary Science from the University of Pretoria. His other qualifications include an MBL (Master of Business Leadership) degree and also an LLB (Bachelor of Laws) degree, both from University of South Africa. He possesses strong technical and commercial skills in research, academia, veterinary pharmaceuticals and business strategy. Over the years he has occupied strategic key positions in the animal health and agricultural industry, both in public and private sectors. He also served as President of the South African Veterinary Council.

  • A Musyoki, Department of Microbiological Pathology, School of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa

    Deputy head of SAVIC and Senior lecturer , Dept. Microbiological Pathology, SMU

  • B Kagina, Vaccines for Africa and NITAGs Support Hub, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa
    Director and Principal Investigator: NISH

    Dr Benjamin Kagina (PhD in Clinical Sciences & Immunology, University of Cape Town (UCT), South Africa) is the Principal Investigator and Project Director of NISH.

    His research focuses on evidence-based practice in the field of vaccinology. The broader aim of Dr Kagina's research is to identify strategies that can improve vaccination programs in Africa and the rest of the world by extension. Several systematic review research projects are being conducted under Dr Kagina's leadership.

    Research projects include:

    • Mass immunisation campaigns as strategies to improve vaccine coverage in low and middle-income countries
    • Interventions to improve vaccine-induced immunity among HIV-infected persons
    • Epidemiology of hepatitis A virus (HAV) in Africa
    • Understanding vaccine hesitancy in Africa
  • C Feldman, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Professor Charles Feldman was born and brought up in Johannesburg, South Africa. He obtained his MB BCh degree at the University of the Witwatersrand, in Johannesburg, in 1975 and served his internship at Johannesburg Hospital. He subsequently did his fellowship training in Internal Medicine at Johannesburg Hospital and received his FCP (SA) in 1981. He received his PhD in 1991 for a thesis entitled “Aspects of Community-acquired Pneumonia”. He was registered as a sub-specialist in Pulmonology in 1993 and was elected to the Fellowship of the Royal College of Physicians (FRCP) in 1997.

    From 1982 he worked as a consultant in the Division of Pulmonology/Critical Care in the Department of Medicine at Hillbrow Hospital in Johannesburg, and in 1986 became Director of the Intensive Care Unit and Pulmonology Unit of that Hospital. In May 1995 he was appointed as Professor of Pulmonology and Chief Physician, at Johannesburg Hospital and the University of the Witwatersrand, a position which he currently holds. 

    In 1988/89 he was a Research Fellow and Honorary Senior Visiting Colleague, in the Host Defence Unit, Department of Thoracic Medicine, National Heart and Lung Institute, and Royal Brompton Hospital, London, United Kingdom. 

    Professor Feldman’s research interest is in the field of community-acquired pneumonia, and in particular pneumococcal pneumonia. In addition to being part of large international clinical collaborations recruiting cases of community-acquired pneumonia he has also contributed to basic research studies, investigating the effects of various pneumococcal virulence factors on human ciliated epithelium as well as investigating the effects of antibiotics on pneumococcal growth and expression of virulence factors. He has a number of publications in books and book chapters, as well as more than 170 articles in indexed, peer reviewed journals.

  • D Reddy, Vaccines and Infectious Diseases Analytics Research Unit (Wits-VIDA), Johannesburg, South Africa; Division of Infectious Diseases, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    I am a specialist in Internal Medicine and Infectious Diseases, and currently a PhD fellow at Wits-VIDA, the Vaccines and Infectious Diseases Analytics research unit of the University of the Witwatersrand. My current research is focused on Klebsiella pneumoniae invasive disease (KpID) in adults.

    I previously worked at the largest tertiary hospital in the southern hemisphere, Chris Hani Baragwanath Academic Hospital (CHBAH) in Soweto, Johannesburg. My academic and clinical interests are broad and include:
    - public health infectious diseases, including vaccinology, vaccine rollouts, outbreak investigation, and infectious diseases representing global health security issues (including emerging diseases and AMR)
    - parasitology and tropical medicine
    - HIV-related infections and therapy
    - antimicrobial resistance and stewardship

    I was co-lead on the successful COVID-19 vaccine rollout for healthcare workers at CHBAH, which offered me a great learning opportunity in designing and implementing a mass vaccination campaign in a low resource setting. Our experience has been published in a peer-reviewed journal: https://doi.org/10.7196/SAMJ.2021.v111i7.15712

    I chaired the Gauteng Provincial Antimicrobial Stewardship (AMS) Committee (2020-2022), and was founding Chair of the CHBAH AMS committee (2018-2020) and spearheaded the implementation of several successful AMS initiatives at the hospital, including: AMS ward rounds; empiric antibiotic guidelines (and conversion to an app); and an online accredited AMS course.

    I am passionate about leadership, improving the functioning of health systems and optimising patient outcomes, and completed an MSc in Public Health through the London School of Hygiene and Tropical Medicine (2022).

  • E Kalanxhi, One Health Trust, Washington DC, USA

    Dr. Erta Kalanxhi is a Fellow and Director of Partnerships based in Abidjan, Ivory Coast.

    At the One Health Trust, Dr. Kalanxhi is involved in projects across several countries in Africa and Asia. She leads OHT’s efforts to advocate the value of vaccines as a critical tool for mitigating antimicrobial resistance in low- and middle-income countries and collaborates with the World Health Organization to develop policy briefs on the implementation of national strategies for antimicrobial resistance. Additionally, Dr. Kalanxhi contributes to the Mapping Antimicrobial Resistance and Antimicrobial Use Partnership project, which aims to close the knowledge gap on antimicrobial use and resistance in 14 African countries.

    As Director of Partnerships, Dr. Kalanxhi is involved in developing communication strategies at OHT and forging collaborations with other organizations committed to addressing pressing global health issues today.

    Dr. Kalanxhi received a Ph.D. in cancer research from the University of Oslo and an MSc in epidemiology from the London School of Hygiene and Tropical Medicine.

  • J Meyer, Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa; South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria, South Africa

    I am a pharmacist by profession, Head of the South African Vaccination and Immunisation Centre (SAVIC) and Programme Coordinator of the MPharm in Public Health Pharmacy and Management in the School of Pharmacy at Sefako Makgatho Health Sciences University. I specialise in vaccine safety, vaccination as an important pillar of antimicrobial stewardship, vaccine hesitancy and rational medicine use within the field of public health pharmacy. My research aims to strengthen healthcare services, improve public health, and contribute towards reaching the sustainable development goal of good health and well-being.

  • I Impalli , One Health Trust, Washington DC, USA

    Ms. Isabella Impalli is a Research Analyst based in New York, USA. 

    At the One Health Trust, Ms. Impalli serves as a researcher for projects on livestock vaccination, the value of information systems, and climate change.  

    Her research areas of interest include antimicrobial resistance (AMR), warning systems, the value of information, and climate change.  

    Ms. Impalli received a Bachelor of Science in Engineering (B.S.E.) in Civil & Environmental Engineering with a certificate in Humanistic Studies from Princeton University.  

  • M Schönfeldt, Child, Youth and School Health Directorate, National Department of Health, Pretoria, South Africa

    National cold chain manager at the National Department of Health. Responsible for ensuring and maintaining mechanisms to for constant/uninterrupted vaccine supplies at all levels, in order to facilitate optimal immunisation coverage. Facilitate safe storage, distribution and use of vaccines through effective vaccine management and cold chain distribution. Establish a process of flow of information regarding vaccine usage, wastage, quantities and distribution. Evaluate the management of vaccines and the impact of training programmes through provincial monitoring support visits and supervision. Liaise with pharmaceutical services, vaccine suppliers and monitor adverse drug reactions on vaccine related issues, such as Adverse Events Following Immunization (AEFI).

  • M Sibanda, Department of Clinical Pharmacy, School of Pharmacy, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa

    I am a public health pharmacist and currently employed as a lecturer and researcher in the Department of Public Health Pharmacy and Management at Sefako Makgatho Health Sciences University (SMU). I am also the Scientific Advisor on vaccines for the elderly at the South African Vaccination and Immunisation Centre (SAVIC) at SMU and a member of the One Health Trust and the Global Antibiotic Resistance Partnership (GARP) GARP-South Africa technical working group.

    My main interest is life-course vaccination, particularly vaccination of older adults and healthcare worker vaccination as well as rational antimicrobial use. I am a strong proponent of the use of vaccines as a strategy to mitigate antimicrobial resistance.

    Email: [email protected]


    Specialties: Pharmaceutical Public Health, Vaccinology, Antimicrobial stewardship, Hospital, Management

  • N Schellack, Department of Pharmacology, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa

    Acting Head:Division Clinical Pharmacy
     Assisting with lectures in the BPharm degree programme
     Assisting with lectures and Research in the Hospital Pharmacy Management Programme
     Supervising Master’s Degree and PhD student research Projects
     Assist with pharmacokinetic and pharmacodynamics research studies.
     Grant applications and research funding
     Assists with research statistical analysis

  • P Skosana , Department of Pharmacology, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa
    Disciplines
    • Infectious Diseases
    • Clinical Pharmacology
    • Clinical Immunology
    Skills and expertise
    • Antimicrobial Stewardship
    • Antimicrobial Resistance
    • Antimicrobials
    • Clinical Infectious Diseases
    • Antibiotic Resistance
    • Infection
    • Nosocomial Infection
    • Bacterial Antibiotic Resistance
    • Antibacterials
    • Bacterial Drug Resistance
    • Pathogenesis
    • Clinical Bacteriology
     
  • S Essack , Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa

    Professor Sabiha Essack (B. Pharm., M. Pharm., PhD), Professor in the School of Pharmaceutical Sciences at the University of KwaZulu-Natal is a Wellcome Trust Research Fellow who completed research towards her PhD in Pharmaceutical Microbiology at St Bartholomew’s and the Royal London School of Medicine and Dentistry in the United Kingdom. She received several prestigious scholarships and bursaries from the Wellcome Trust, Medical Research Council, National Research Foundation and the University of Durban-Westville during the course of her Masters and PhD studies.  Her research has been published in several journals and has been presented at a number of national and international conferences.   Professor Essack began her professional career with the B. Pharm degree in 1988 and practiced as a hospital pharmacist for three years within the KwaZulu-Natal Department of Health before returning to the University of Durban-Westville in 1992 to pursue the M. Pharm degree.  She is a C-rated researcher by the NRF, has established the Antimicrobial Resistance Research Proto-Unit in the School of Pharmaceutical Sciences and has secured several research grants for Essential National Health Research, from the World Health Organization, the Wellcome Trust, the Medical Research Council and the National Research Foundation investigating strategies for the prevention and containment of antibiotic resistance.   Professor Essack is president of the South African Chapter of the Alliance for the Prudent Use of Antibiotics (APUA), co-founder and chair of the South African Committee of Health Sciences Deans and a Ministerial appointee on the National Health Research Ethics Council 2010-12..  She serves on the Programme Accreditation Panel of the Council for Higher Education, she is a member of the National Antibiotic Surveillance Forum, the Federation of Infectious Diseases Societies of South Africa, the Islamic Medical Association and she has served on the National Executive of the Pharmaceutical Society of South Africa.   Professor Essack was appointed coordinator to the Africa Higher Education Collaborative, a 4-country Ford Foundation-funded initiative run by the Centre for the International Exchange of Scholars in the US, her leadership of which secured a £100 000 grant from the Mobilizing Regional Capacity Initiative Programme of the Association of African Universities to undertake research on “Access, Retention and Success in African Higher Education”.   Professor Sabiha Essack (B. Pharm., M. Pharm., PhD), Professor in Pharmaceutical Sciences at the University of KwaZulu-Natal (UKZN) is the South African Research Chair in Antibiotic Resistance and One Health and a Wellcome Trust Research Fellow who completed research towards her PhD in Pharmaceutical Microbiology at St Bartholomew’s and the Royal London School of Medicine and Dentistry in the United Kingdom. She received several prestigious scholarships and bursaries from the Wellcome Trust, the Medical Research Council (MRC), the National Research Foundation (NRF) and the University of Durban-Westville during the course of her Masters and PhD studies.  Her research has been published in several journals and has been presented at a number of national and international conferences.   Professor Essack began her professional career with the B. Pharm degree in 1988 and practiced as a hospital pharmacist for three years in the KwaZulu-Natal Department of Health before returning to the University of Durban-Westville in 1992 to pursue the M. Pharm and PhD degrees. She is a C-rated researcher by the NRF, has established the Antimicrobial Research Unit at UKZN and has secured several research grants for Essential National Health Research, from the World Health Organization (WHO), the Norwegian Agency for Development Cooperation (NORAD), MRC and the NRF investigating strategies for the prevention and containment of antibiotic resistance.   Professor Essack is expert consultant on antimicrobial resistance to the WHO Africa Office, founder and co-chair of the South African Chapter of the Alliance for the Prudent Use of Antibiotics (APUA), country representative on the Global Respiratory Infections Partnership (GRIP),  serves on the South African Chapter  of the Global Antibiotic Resistance Partnership (GARP), the South African Antibiotic Stewardship Programme, WHO’s Technical Working Group on Health Workforce Education Assessment Tools,  and is co-founder of the South African Committee of Health Sciences Deans.  She is a Ministerial appointee on the Board of the Office of Health Standards Compliance, an elected member of the Academy of Sciences of South Africa (ASSAf), a peer-reviewed member of the Southern Africa FAIMER Regional Institute (SAFRI) community, member of the Bio-economy Heath Innovation Sector Coordination Committee of the Department of Science and Technology.  She previously served as Ministerial appointee on the National Health Research Ethics Council, as well as on the national Department of Health, on the National Executive of the Pharmaceutical Society of South Africa, the Professional Body Reference Group of the South African Qualifications Authority (SAQA) and the Programme Accreditation Panel and Standards Development Reference Group of the Council for Higher Education (CHE).   Professor Essack is Associate Editor of the South African Journal of Epidemiology and Infection, serves on the Editorial Board of the African Journal of Microbiology Research, frequently reviews papers for several international journals as well as research proposals and rating applications for the FP7 Programme, the MRC and the NRF and is a member of the Society for Clinical Microbiology and the Federation of Infectious Diseases Societies of South Africa

  • S Dlamini, Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, South Africa

    Sipho Dlamini is an associate professor in the division of Infectious Diseases & HIV Medicine, at Groote Schuur Hospital. His clinical and research interests include TB, HIV, adverse drug reactions in TB and HIV and the use of vaccines in adults living with HIV infection.

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Published

2024-09-02

Issue

SAMJ Vol. 114 No. 9

Section

Research

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Copyright (c) 2024 A Brink, A Kgasi, A Musyoki, B Kagina, C Feldman, D Reddy, E du Toit, E Kalanxhi, J Meyer, I Impalli , M Schönfeldt, M Sibanda, N Schellack, P Skosana , S Essack , S Dlamini, Y Ramsamy

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How to Cite

1.
Brink A, Kgasi A, Musyoki A, Kagina B, Feldman C, Reddy D, et al. Vaccines in the fight against antimicrobial resistance – perspectives from South Africa. S Afr Med J [Internet]. 2024 Sep. 2 [cited 2024 Sep. 14];114(9):e2111. Available from: https://samajournals.co.za/index.php/samj/article/view/2111

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