Perspective

Global survey shows progress, gaps in antimicrobial resistance efforts

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.

Human sector

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.

Animal sector

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.”

References:

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.

Disclosures: Infectious Disease News was unable to confirm relevant financial disclosures at the time of publication.

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.

Human sector

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.

Animal sector

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.”

References:

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.

Disclosures: Infectious Disease News was unable to confirm relevant financial disclosures at the time of publication.

    Perspective
    Kim Faure

    Kim Faure

    It can be challenging for countries to respond to this survey as the questions are not 100% clear and a country’s achievements might fall between two categories. It is good to see that countries are making progress and moving forward in terms of AMR actions. It is also quite interesting that some countries have scored themselves high in the previous survey but rescored themselves lower in the current survey because they realize that more work needs to be done or they misinterpreted the questions and how they complied.

    Although it is great that a lot of countries have national action plans in place, I think the real work starts afterward with implementing the national action plan. That is when countries begin to understand the complexities of applying a One Health approach to things like awareness, surveillance and infection prevention and control. Some countries realize that they may have been overambitious in some of their goals.

    In low-income countries, implementing a national action plan is not a simple exercise of appropriate antibiotic prescribing among humans and animals, which is very much a behavior change issue in the developed world. This is quite a big piece of work that requires health system strengthening from all perspectives. Antibiotic access in low-income countries is as big an issue as overuse. Low-income countries still have to make sure antibiotics are actually getting to the patients in the first place. In addition, a lot of rural communities in many African and Asian countries have never had access to safe water, hygiene and sanitation facilities. Therefore, a massive amount of infrastructure has to be put in place to deal with this first, which is a long-term and budget-intensive exercise. Then there is the added complexity of having to integrate a national action plan into animal health. It is quite complex to agree on which national action plan activities are a priority and where the funding is going to come from for those activities. The report actually shows that it is probably easier for us to focus on the human health side first and get some of those activities up and running because there are still a lot of fundamentals to sort through in animal health until countries reach a point where they can start implementing those activities.

    • Kim Faure, MBBCh
    • Africa Head, Center for Disease Dynamics, Economics & Policy

    Disclosures: Faure reports no relevant financial disclosures.

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