While the Political Declaration on AMR – and the commitments contained within it – provides a strong framework for action, numerous barriers exist at the global, regional, and national levels that hinder effective implementation. Delegates proposed a number of action areas to address barriers which are detailed below. Other organisations and individuals are encouraged to join these initiatives and actions:
Access and appropriate use:
Achieving the commitments and targets set for access and appropriate use requires understanding of local, national and regional environments and needs. Initiatives aimed at improving access to antimicrobials cannot be undertaken in isolation and must support access to all products which contribute to addressing AMR, including therapeutics, vaccines and diagnostics. Diagnostics are a critical part of the access and appropriate use discussion across both the human and animal health sector.
Barriers to equitable access and appropriate use exist around regulatory systems, capacity challenges, and challenges relating to having enough data gathered and analysed from surveillance across all sectors, with each sector having different challenges. Economics play a pivotal role in driving access and appropriate use of antimicrobials. Decision making in the animal health sector related to access and appropriate use of antimicrobials is largely based on cost of production of animals for food, whereas human health decision making is more complex and influenced by cultural norms that have developed around the use of antibiotics.
Therefore, specific actions for health systems strengthening must be considered for effective human health interventions. Any actions focused on access and appropriate use must necessarily also include prevention (e.g. WASH and Infection Prevention Control) including appropriate use of alternatives to prescription medications.
As a means of collaboratively identifying country priorities and where support is required for implementation the following actions and initiatives were proposed:
Action: Collaborative country engagement: Country driven, context specific approaches to address AMR at country and regional level are needed. Priority areas for action will vary in each country and becomes more complex when working across human and animal health and the environment. There was broad consensus that international actors need to improve coordination with each other and with countries to support the strengthening and financing of national action plans and to better understand how to support the implementation of technical commitments and targets. A group being coordinated by the AMR Industry Alliance aims to convene at the World Health Assembly in Geneva to identify country access needs in collaboration with countries to better understand how the global community can support action and progress.