WHO, the Food and Agriculture Organization and the World Organization for Animal Health have released findings from a recent survey assessing global progress in the fight against antimicrobial resistance, or AMR. The survey revealed that 100 countries have developed a national action plan for AMR, although substantial gaps in action remain.
The main challenge now, according to the report, is ensuring that national action plans are implemented, funded and supported by surveillance and evaluation systems. Only 10 countries surveyed reported having funding for all the actions in their national action plan.
“This report shows the global momentum to combat antimicrobial resistance,” Ranieri Guerra, MD, assistant director-general for antimicrobial resistance at WHO, said in a news release. “We call on governments to make sustained commitments across all sectors — human and animal health, plant health and the environment — otherwise we risk losing the use of these precious medicines.”
The self-assessment survey was completed by 154 of the 194 WHO Member States, representing 91.3% of the world’s population. It is the second survey of its kind to be released by WHO, the Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE). Results from the first survey, conducted in 2016 and 2017, were reported to the World Health Assembly and the OIE Work Assembly of Delegates in May 2017.
In 2015, all WHO Member States committed to a goal of developing a national action plan on AMR within 2 years. By May 2017, only 79 countries had a plan. Although the goal is still unmet, findings from the new survey, which includes data from 2017 and 2018, show that 93 countries reported having a plan in place. Health officials are aware of at least seven other countries with national action plans, raising the number to 100, according to the report. An additional 51 countries report having a plan under development.
WHO, FAO and OIE report that high-income countries have had greater success in developing and implementing plans than low-income countries. No country, however, has achieved sustained capacity at scale in all sectors.
Overall, 123 countries (79.9%) have policies to monitor the sale of antimicrobials. These policies are less common among low-income countries, less than half of which (52.6%) report having them in place.
Although 105 countries have a surveillance system to monitor antimicrobial consumption at the national level, only 61 countries are enrolled in the Global Antimicrobial Surveillance System (GLASS), which previously revealed high levels of antibiotic resistance to common bacterial infections in both high- and low-income countries. Further, the report states that only a proportion of countries enrolled in GLASS submit data on resistance and consumption to WHO.
Survey data further show that 102 countries (66.2%) have policies designed to optimize antimicrobial use. However, only seven of these countries systematically send prescribing data back to physicians — a practice that has been shown to reduce prescription rates, according to the report. In addition, only 26.6% of countries have guidelines for appropriate antimicrobial use in health care facilities.
Nine out of the top 10 chicken-, pork- and cattle-producing countries had a national action plan developed. Still, only 64 of countries limited the use of critically important antimicrobials for growth promotion. Among them, 39 were high-income countries. Matthew Stone, BVSc, MVS, deputy director general of OIE, said improving adherence to prudent antimicrobial use in animals is “an urgent priority.”
“Implementation of dedicated OIE international standards, appropriate national legislation and strengthening of veterinary services are essential steps to help all animal health stakeholders contribute to controlling the threat posed by antimicrobial resistance,” he said in the release.
Environment and plant sectors
According to the report, environment and plant sectors are underrepresented in many countries’ multisectoral working group, despite being “an emerging area of concern.” Only 10 countries have comprehensive systems to control waste management, such as regulations limiting the release of antimicrobial residues into the environment. WHO stated that current efforts to protect the environment from antimicrobial resistance are “insufficient.”
WHO. Global antimicrobial resistance surveillance system (GLASS) report. http://www.who.int/glass/resources/publications/early-implementation-report/en/. Accessed July 18, 2018.
WHO. Monitoring Global Progress on Addressing Antimicrobial Resistance. http://www.who.int/antimicrobial-resistance/publications/Analysis-report-of-AMR-country-se/en/. Accessed July 18, 2018.
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