This meeting provided an opportunity for those responsible for human and animal health, primarily from countries in low and middle economic settings, to strengthen knowledge in approaching antimicrobial resistance (AMR) domestically, identify emerging good practice and ways to scale up action at country level.
Some of the key points to come out of the meeting were:
- The discourse is increasingly evolving to recognise the importance of the One Health concept in tackling AMR. For a truly sustainable response, action must be pursued at the human, animal and environmental level to acknowledge the ability of resistance to spread through ecosystems and into the food chain. Furthermore, it is also becoming increasingly apparent that the scope of the issue necessitates the inclusion of trade, finance and development institutions in the discussions.
- The relative lack of data regarding the level, spread and patterns of resistance in human, animal and agricultural contexts prevents many countries from recognising the true extent of the problem and also prevents the formulation of evidence-based intervention design and monitoring. Whilst there needs to be increased general data collection and strengthening of surveillance and monitoring systems this must be balanced with the urgency of the issue and the requirement in many situations to implement immediate interventions to tackle AMR.
- AMR needs to be capped at the source. Behaviour change interventions need to reflect the local context and be relevant to those being targeted. Bottom-up approaches at the individual and organisational levels are essential for modifying behaviour; top-down, policy-level approaches and social measures are also needed to sustain behaviour change.
- Antibiotics need to be used judiciously but this must be balanced with the principle that people need to have equitable access to effective antibiotics and, prudently used, antibiotics are necessary for animal health.
Choosing the right paradigms for sustainably stimulating research and development (R&D) requires new measures to align the financial incentives for drug and diagnostics development with public health needs. Understanding how the risks of drug development can be shared amongst the public and private sector will be important.
- There are inherent issues which present barriers to tackling AMR in LMICS, such as the fragile state of health systems, poor infrastructure, poor sanitation, weak leadership capacity and competing priorities.
- There is a need to ensure that the future growth of populations and intensification of livestock production due to an increased desire for protein-based foods are met with intelligently designed systems and a focus on improved biosecurity and better husbandry practices.
- The cross-cutting nature of AMR means as an issue it often suffers from a lack of leadership. In building effective advocacy and awareness the role of champions, civil society and forming multi-sector alliances and networks are all key elements to effective policy change.
The complexity and far-reaching drivers and impacts of AMR make action particularly challenging in countries with already stretched resources. Nations will benefit from developing a coherent set of priorities and actions based on what resources they do have, these can eventually be scaled up; capitalising on existing efforts where possible and forming regional alliances can help countries achieve their goals.
- Resistant microbes do not respect borders. The need to tackle the problem in a coordinated global way is key. Defining what a coordinated global response looks like is essential. Some of the key elements of a global response include raising the political profile of AMR, lesson learning from other countries, awareness raising at the national, regional and international level, sharing positive and negative experiences and establishing guidelines. Notwithstanding the importance of differing contexts, there are many similarities in the gaps and challenges countries face and in the possible responses.
Review on Antimicrobial Resistance, chaired by Jim O’Neill
UK Government: Progress report on the UK 5 year AMR strategy: 2014
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