Between Quick Wins And Long Roads Ahead On Antimicrobial Resistance

Raising awareness, creating effective stewardship, national action plans on antimicrobial resistance, building trust and getting onto the agenda of the G20 are critical to fostering access and appropriate use of antibiotics, according to speakers at yesterday’s joint technical symposium on antimicrobial resistance (AMR).

The annual trilateral cooperation event between the World Health Organization, World Intellectual Property Organization and World Trade Organization was held on 25 October. The first panel of the symposium discussed the balance between fostering access to antibiotics whilst ensuring their appropriate use.

A Clinical Perspective on the Effect of AMR

Evelina Tacconelli, professor of medicine at the Universitätsklinikum Tübingen, Germany, has in the last years been working with patients with antimicrobial resistance and has carried out research to reduce the burden of disease. Tacconelli provided an overview of its effect, whilst also emphasising its ethical dimensions as every time an antibiotic is prescribed, it has “an impact on the community as a whole and on people who have not even been born.”

Tacconelli outlined the correlations between the rate of resistance and usage and the expense of antibiotics and mortality.

Patients with resistant infections also stay in the hospitals up to 10 days longer, which increases the risk of having further more problems, she said.

With regards to inappropriate therapy use, Tacconelli highlighted that the percentage of inappropriate therapy use ranged from 14 to 79 percent, and that a study last year found that one in every two prescriptions was a mistake.

Stewardship

Under her suggested roadmap, Tacconelli put forward that antimicrobial stewardship, in the form of guidelines and hospital measures for the reduction of antibiotic usage, is one of the main factors required to reduce the rate of infection. Another study recently found that guidelines in hospitals reduced mortality up to 35 percent, she added.

Furthermore, in relation to veterinary and husbandry practices, Rob Ahern, principal officer for Agricultural Health and Food Safety, Inter-American Institute for Cooperation in Agriculture (IICA), contended that it is important to consider that merely using terms such as “appropriate use” would not alleviate the challenge. Rather, guidelines and good practices need to be “customized to different stakeholders, needs and realities,” he said.

IICA is a specialised agency of the Inter-American System for agriculture and supports member states in agricultural development and rural well-being through international technical cooperation. In particular, IICA has supported efforts to encourage proper use of veterinary drugs and the implementation of surveillance programs.

When asked what could done on a global level with regards to stewardship by moderator Suzanne Hill, director of the Department of Essential Medicines and Health Products at the WHO, Tacconelli said there should be an agreement on control and implementing mandatory stewardship and regulation. There should also not only be a steering committee but an audit in place as well, to identify and define indicators, she said.

Ahern called for capacity to be built into veterinary services to improve stewardship and to achieve harmonisation in discussions on guidance in order for those on the ground have a clear idea what to do.

National and Global Action Plans

Eveline Wesangula, coordinator of the Global Antibiotic Resistance Partnership (GARP) in Kenya, shared her country’s experience to promote appropriate use and access to antibiotics.

Wesangula outlined that 50 percent of the causes of mortality in Kenya are infectious disease, and there are growing trends of AMR as well as widespread and inappropriate use of antibiotics in animals in addition to weak health and regulatory systems.

Wesangula recalled that the World Health Assembly last year, where the Global Action Plan (GAP) on AMR was adopted, recommended that all member states have their own national action plans on the prevention and containment of AMR.

“As much as AMR is a global problem, the solutions must be at a local level,” said Wesangula. Kenya is now in the process of creating its national action plan, with an emphasis on coherence and being practical, she explained.

Moreover, Wesangula said that Kenya would not implement the GAP nor the UK plan given that Kenya is at a different level of development. Through multisectoral approaches and cooperation with the ministries of health, agriculture, livestock and fisheries and the green economy, the objectives under the GAP are have tailored to suit Kenya’s local situations and to what is feasible within their economies, she said.

Next Steps: “Quick Wins”?

Upon being asked what each panellists’ “quick win” would be to try to improve access and use at the same time, Tacconelli replied that in her opinion the most important at the moment would be to reach a strong agreement between global partners at a more general level. The G7, the G20 and the WHO should place the issue on the table and state that it is no longer acceptable, she urged.

Wesangula responded by saying that her quick win would be the increase of awareness of AMR and appropriate use. This can directly affect the use of antibiotics by the general public to reduce demand, and get health workers to think twice about prescribing antibiotics. And also farmers should think twice about use in animals and gene transfer across populations and species she said.

Ahern referred to bringing the private sector and ministries of health together as a quick win as there is much trust to be built between the two players to firstly even measure the problems and share data.

To conclude the panel, Hill summarised, “This is a game for the long haul.”

Alexandra Nightingale is a researcher at Intellectual Property Watch. She completed her Bachelors in Law at the University of Sussex and holds an LLM degree in International Law from the School of Oriental and African Studies in London. During her Masters, she developed a strong interest in Intellectual Property, particularly patents and the aspects relating to global health. Her research interests now also include geographical indications and trademarks.

Image Credits: Alexandra Nightingale