#HealthSystems, Prevention & Preparing for Epidemics – Part 3: Antimicrobial Resistance

by Aubrey Clark, MPH; Mohan P. Joshi, MBBS, MSc, MD

Strong health systems are necessary to help prevent and mitigate epidemics, including the oft-overlooked epidemic of antimicrobial resistance. This post originally appeared on MSH’s Global Health Impact Blog as part of a new series on improving the health of the poorest and most vulnerable women, girls, families, and communities by prioritizing prevention and preparing health systems for epidemics. Join the conversation online with hashtag #HealthSystems.

The Epidemic We Can See Coming: A Call to Act on Antimicrobial Resistance

In February, at a high-level meeting of European Union ministers, Dr. Margaret Chan, Director General of the World Health Organization (WHO), warned that the world was facing a crisis. Dr. Chan was not referring to the Zika and Ebola epidemics which have captured global attention recently. Instead, she was referring to antimicrobial resistance, a “cross-border slow moving tsunami.”

Dr. Chan’s warnings are as urgent and dire as those issued for any epidemic in recent history:

This is a crisis, and it is global. Resistant pathogens travel well internationally in people, animals, and food. They can also spread directly from one person to another.

The cause for alarm is well-founded and supported by worrying signals from across the globe. In China, resistance to colistin, the last-resort antibiotic used to treat several life-threatening infections caused by Gram-negative bacteria, was observed during a routine surveillance project monitoring resistance in E. coli. In the Greater Mekong subregion in Asia, development and spread of resistance to artemisinin, a key first-line treatment for malaria, has been observed in five countries.

A UK-led review on antimicrobial resistance released in May further underscored the urgency with which the world must act. The review estimates that without concerted global action, approximately 10 million people will die annually due to drug-resistant infections by 2050. The situation is particularly serious for diseases like tuberculosis, for which multi-drug resistance is being detected in some countries in over a third of newly diagnosed patients and causing nearly 200,000 deaths each year.

While it differs in many ways, the lessons learned from Ebola and other epidemics can help mitigate the spread of antimicrobial resistance before the slow-moving tsunami  is upon us. Although emergency responses are critical in fighting epidemics, strong health systems help to prevent them from happening in the first place.

The USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program, implemented by Management Sciences for Health, is helping to address the challenge of antimicrobial resistance in low- and middle-income countries by working in partnership with country governments and local stakeholders to strengthen pharmaceutical systems which not only help to increase access to medicines, but also help to ensure that those medicines are safe, of assured quality, and are used appropriately and responsibly.

In May, SIAPS joined the Ecumenical Pharmaceutical Network (EPN) and other partners at EPN’s Forum 2016 in issuing a call to action against antimicrobial resistance. The call emphasized coordinated action by a wide range of stakeholders across the pharmaceutical system, highlighting four actions to address antimicrobial resistance: 1) build advocacy, awareness, and political will; 2) strengthen capacity of health systems; 3) ensure effective coordination between stakeholders; and, 4) strengthen monitoring and surveillance systems.

In the Forum’s plenary event, SIAPS also highlighted the burgeoning obstacle that antimicrobial resistance presents for countries working to achieve universal health coverage.

SIAPS is also working with local and national governments to follow a key WHO recommendation to develop antimicrobial resistance action plans. Provincial-level plans have been developed in South Africa; and, in Swaziland, SIAPS helped to establish and is providing technical assistance to the National Antimicrobial Resistance Containment Committee which is developing the nation’s action plan and strategy for antimicrobial resistance.

Slowing the spread of antimicrobial resistance can only be achieved by addressing its multifaceted and multidimensional drivers with stronger health and pharmaceutical systems. Implementing cross-cutting interventions, including antimicrobial stewardship and infection control programs, conducting medicine use evaluations, supporting drug and therapeutics committees, and strengthening regulatory systems ensure that pharmaceutical systems are better equipped to address, respond to, and slow antimicrobial resistance.