Worldwide: WHO Urges Countries To Accelerate Efforts To Tackle Antimicrobial Resistance

On July 18, 2018, the Food and Agriculture Organization of the United Nations (FAO), the World Organization for Animal Health (OIE) and the World Health Organization (WHO) together released a survey report on "Monitoring Global Progress on Addressing Antimicrobial Resistance¹". The report says that countries are taking significant steps in tackling antimicrobial resistance (AMR), but serious gaps remain and require urgent action.

MONITORING GLOBAL PROGRESS ON ADDRESSING ANTIMICROBIAL RESISTANCE 2018

The global tripartite self-assessment survey of country progress in addressing antimicrobial resistance (AMR) is a component of a broader approach for monitoring and evaluation of the global action plan on AMR. This report analyses the results of the second tripartite self-assessment survey. It has been developed and run by the three organizations (FAO, OIE and WHO) and reflects progress in the human, animal (terrestrial and aquatic), plant, food safety and environmental sectors.

The 2018 round of the self-assessment survey received responses from 154 countries out of 194 WHO Member States – a response rate of 79.4%. All countries' responses from both years are published in an open-access database, offering scope for in-country review with civil society and other stakeholders².

ABOUT AMR

Antimicrobial resistance (AMR) is a grave threat to human health and economic development. The overuse and misuse of antimicrobials in humans, animals and plants have accelerated the natural evolutionary processes which makes microbes resistant to antimicrobial treatments. Today, some infections have even been rendered untreatable by existing antimicrobials. Projections suggest that AMR is likely to exacerbate global economic inequality, with the economic costs disproportionately affecting poorer countries.

REPORT HIGHLIGHTS

The report looks at surveillance, education, monitoring and regulating consumption and use of antimicrobials in human health, animal health and production, as well as plants and the environment – as recommended in the Global Action Plan (GAP) published in 2015.

The report charts progress in 154 countries and reveals wide discrepancies. Some countries, including many European states, have been working on AMR policies in human and animal sectors for more than 4 decades. Others have only recently started to take action to contain this growing threat. Progress in developing and implementing plans is greater in high-income as compared to low-income countries but overall all countries have scope for improvement. No country reports sustained capacity at scale in all areas. Promising findings include:

• 105 countries have a surveillance system in place for reporting drug-resistant infections in human health, and 68 countries have a system for tracking consumption of antimicrobials.
• 123 countries reported that they have policies to regulate the sale of antimicrobials, including the requirement of a prescription for human use – a key measure to tackle overuse and misuse of antimicrobials.

1. Progress towards the development of national action plans

When WHO endorsed the 2015 Global Action plan on AMR, all Member States committed to the ambitious target of developing a multisectoral national action plan within two years. By May 2017, 79 countries reported that they had a plan, and a further 50 countries having a plan under development. While the 2017 target is still unmet, the second tripartite self-assessment survey shows that progress has been sustained.

Now 93 countries (60.4%) have developed a national action plan on AMR. Among the 61 (39.6%) countries that have not yet developed a national action plan, 51 (33.1%) have a plan currently in development but 10 (6.5%) have reported no progress towards developing a national action plan. The ten respondent countries that have not yet taken any action to develop national action plans are predominantly a mix of small island states and fragile states across all regions.

2. Multi-sectoral approaches to addressing AMR

A need to establish a multi-sectoral working group was identified in the global action plan as an important facilitator of a One Health approach to addressing AMR. Where working groups have been established, they typically include representatives from human health, animal health, and food safety. Representatives from other sectors including food production, environment, and plant health are less frequently included.

The findings from this national self-assessment survey clearly show the importance of One Health approach and multi-sector working for progress in AMR. For future progress it will be important to ensure all sectors like the following, are playing their part:

Animal and food sectors

• Only 64 countries report that they follow FAO-OIE-WHO recommendations to limit the use of critically important antimicrobials for growth promotion in animal production. Of these, 39 are high-income countries, with the majority in WHO's European Region. By contrast, only 3 countries from WHO's African Region and 7 countries from the WHO Region of the Americas have taken this important step to reduce the emergence of antimicrobial resistance.
• A total of 67 countries report at least having legislation in place to control all aspects of production, licensing and distribution of antimicrobials for use in animals. But 56 either said that they had no national policy or legislation regarding the quality, safety and efficacy of antimicrobial products used in animal and plant health, and their distribution, sale or use, or that they were unable to report whether they have these policies in place.

Environment and plant sectors

• Although 78 countries have regulations in place to prevent environmental contamination generally, only 10 of them report having comprehensive systems to ensure regulatory compliance for all waste management, including regulations that limit the discharge of antimicrobial residues into the environment. This is insufficient to protect the environment from the hazards of antimicrobial production.

Human sector

• 105 countries report that they have a surveillance system in place and 68 have a system for tracking consumption of antimicrobials at national level. Whilst this is encouraging, only 61 countries have enrolled in the Global Antimicrobial Surveillance System (GLASS) with only a proportion of these submitting data to GLASS on resistance, or consumption data to WHO.

Much more progress around animal, plant and environmental surveillance is required, although steady progress is being achieved on data on antimicrobial usage in animals. Research and policy efforts to tackle AMR may be compromised without these data from both human and non-human sectors. Both axes of monitoring are needed to better understand and for informed AMR interventions and policies.

Note - As this is a self-assessment survey, it is possible that some countries reported progress in a very positive light. However, where joint external evaluations or JEEs have been held, scores have been compared and are broadly consistent with what has been reported in this survey. All countries' responses will be published in an open access database, offering scope for in-country review with civil society and other stakeholders.

Footnotes

1. http://apps.who.int/iris/bitstream/handle/10665/273128/9789241514422-eng.pdf

2. http://www.who.int/news-room/detail/18-07-2018-countries-step-up-to-tackle-antimicrobial-resistance

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