In a study published in early 2022, an international team of researchers presented what remains the most comprehensive assessment to date of the consequences of antimicrobial resistance (AMR) on human health.
Using data from 204 countries, researchers estimated that 4.95 million deaths in 2019 were associated with AMR, including 1.27 million directly attributable to drug-resistant infection. These figures place AMR ahead of major deadly infectious diseases such as malaria and HIV.
Estimates of the future impact of AMR paint an even bleaker picture. A 2014 report by British economist Lord Jim O’Neill and the Wellcome Trust estimates that if AMR is left untreated, drug-resistant pathogens could cause around 10 million deaths per year by 2050.
Encouraging the medical community, world leaders and other stakeholders to do their part to avoid this bleak future is one of the goals of Global AMR Awareness Week, a global campaign by the World Health Organization (WHO) aimed at raising public awareness this week. and promote practices that help mitigate the threat posed by drug-resistant infections.
CIDRAP News recently submitted a series of questions to WHO officials on the themes of this year’s edition. Global AMR Awareness Week, their assessment of the progress made by countries in the fight against AMR and the challenges ahead. Responses were provided by Sarah Sheppard, WHO Communications Manager for Medicines, Health Products and AMR.
The conversation has been edited for length and clarity.
CIDRAP News: The theme for this year’s Global AMR Awareness Week is “Preventing Antimicrobial Resistance Together.” What is the message that the WHO wants to send?
Sarah Sheppard, WHO: Preventing AMR requires collective action from all sectors of society. Antimicrobial misuse and overuse are the primary cause of AMR, which occurs in many sectors. To effectively reduce AMR, all sectors must use antimicrobials cautiously and appropriately, and take preventive measures to reduce the incidence of infections.
We need a whole-of-society, multi-sectoral approach to effectively address this global problem. We also need each sector to have adequate resources so that they can effectively prioritize, cost and implement their priority actions in their specific sectors, and then monitor the impact.
CIDRAP News: A multi-sectoral approach is essential to the One Health concept, which recognizes the interconnection between people, animals, plants and their shared environment. Do you think countries are adopting the One Health concept in their efforts to combat AMR?
Sarah Sheppard, WHO: Countries are fully aware that tackling AMR will require a multi-sectoral “One Health” approach and have therefore developed multi-sectoral AMR coordination committees and multi-sectoral national AMR action plans. Around 171 countries now have multi-sectoral national AMR action plans.
However, most countries also identified multi-sectoral coordination, financing and governance as key challenges impacting their response to AMR. Furthermore, there needs to be greater awareness that the One Health approach does not exclude strong sector strategies and plans. Ultimately, the capacity of each sector must be strengthened to be able to generate evidence and then use the data collaboratively across sectors to develop both sector-specific and One Health policies and plans to mitigate the impact of RAM.
CIDRAP News: A global action plan to combat AMR was approved at the World Health Assembly in 2015, and the United Nations General Assembly (UNGA) followed in 2016 with a political declaration on the RAM. What progress has been made since then?
Sarah Sheppard, WHO: Progress in the implementation of the national multi-sectoral AMR action plans, which were developed based on the blueprint provided by the global action plan, has been monitored since 2016 through the annual AMR survey. country self-assessment on AMR monitoring (TrACSS).
Data received from countries shows that progress has been slow, ad hoc and that the interdependence of the different areas of work is not taken into account. Based on TrACSS 2022 data, only 24% of countries report effective implementation of their national action plans, only 10% report allocating dedicated funding, and 51% report that their multi-sector coordination mechanisms are not functional.
In the human health sector, the technical area that has seen the greatest progress has been the establishment of AMR surveillance systems. The WHO Global Monitoring System for Antimicrobial Resistance and Use (GLASS) report for 2022 shows that 126 countries, territories and areas are participating in GLASS. Some progress has also been made in monitoring antimicrobial consumption and establishing antimicrobial stewardship (AMS) programs. Finally, the complexity of AMR and its highly technical narrative has also impacted awareness, understanding and, therefore, the level of political engagement and support.
To further accelerate progress, WHO is currently developing a document on AMR strategic and operational priorities for the World Health Assembly in May 2024, which will then support the UNGA high-level meeting on RAM in September 2024.
CIDRAP News: What else would WHO like countries to do to combat AMR?
Sarah Sheppard, WHO: WHO launches a people-centered approach to combating AMR in human healthas well as a set of core interventions to help countries develop a programmatic approach to effectively implement the human health components of their national AMR action plans.
This approach relies on addressing the barriers and needs faced by people as well as critical gaps in health systems. It is guided by the principles of equity, access and leaving no one behind. It aims to make AMR as a health topic more accessible to policymakers by highlighting its impact on people, and it links AMR mitigation efforts to efforts to strengthen health systems and preparedness strategies and response to pandemics.
As part of their national AMR action plans, WHO wants countries to focus on six critical areas:
- Strengthen AMR governance and accountability, including by allocating adequate funding and supporting awareness and education.
- Generate strategic insights through AMR surveillance and monitoring of antimicrobial consumption and use to guide patient care and action against AMR, as well as through research and innovation.
- Improve access to prevention measures, including WASH (water, sanitation and hygiene), IPC (infection prevention and control) and vaccination.
- Improve access to essential health services, including affordable AMR diagnostic and health services and uninterrupted supply of quality-assured antimicrobials and essential health products.
- Improve access to timely and accurate information diagnostic and ensure bacteriological and mycological tests.
- Improve access to appropriate, quality-assured treatment through evidence-based treatment guidelines, AMS programs and restrictions on the sale of antimicrobials without a prescription.
To support the implementation of 13 high-level core interventions, WHO will provide detailed guidance to different levels of country health systems as well as relevant technical assistance.
CIDRAP News: There are many concerns about the impact of AMR in low- and middle-income countries, as well as the capacity of these countries to implement, finance and monitor national action plans against AMR. RAM. What is WHO doing to help these countries?
Sarah Sheppard, WHO: To support the implementation of national AMR action plans in low- and middle-income countries, WHO has developed a WHO National AMR Action Plan Implementation Manual which provides step-by-step guidance to countries. Additionally, specific technical tools and e-learning modules have been developed to strengthen countries’ capacity to coordinate, plan, cost, implement and monitor their plans.
Some of these national action plan tools include leadership skills training for effective multi-sectoral coordination to improve AMR governance mechanisms, the AMR cost calculation and budgeting tool to help countries develop accurate budgets and resource mobilization plans, as well as guidance to facilitate monitoring and evaluation of national AMR action plans. One online WHO AMR Resource Pack has also been developed to provide all available technical guidance documents to assist countries in the implementation of their technical activities.
In 2023, more than 700 national employees in 41 countries have benefited from technical training and more than 9,000 people have registered for the corresponding e-learning modules. WHO has also created an online site AMR Community Exchange platform with over 1,000 members to support peer-to-peer learning among technical staff from various countries and in various technical work areas.
CIDRAP News: How concerned are you about the potential impact that climate change could have on AMR?
Sarah Sheppard, WHO: WHO has not yet developed a guidance note or technical document on AMR and climate change. This is currently being planned.
We recognize that climate change can exacerbate infections, including zoonotic diseases, impact water and sanitation, and food security and food safety. Health emergencies caused by natural disasters associated with climate change can also lead to the development and spread of AMR.