Is the World Failing in Fight Against Antibiotic Resistance?

Antimicrobial resistance is a growing global concern, one that the World Health Organization (WHO) is asking countries to ramp up efforts to prepare for. While many countries have strategies to address the issue, there are still a large number that do not have clear plans to curb misuse and reduce the spread of antimicrobial resistance, according to a new WHO report titled, “Worldwide country situation analysis: Response to antimicrobial resistance.”

Only 34 out of 133 countries participating in the recent survey of countries in the six WHO regions have a comprehensive national plan to fight resistance to antibiotics and other antimicrobial medicines. In May, at the 86^th World Health Assembly, WHO will ask governments around the world to declare their commitment to address the growing problem of antimicrobial resistance by approving a global action plan drafted by the organization.

The action plan sets out the following five strategic objectives:

• Improve awareness and understanding of resistance
• Increase knowledge through tracking and research
• Reduce the incidence of infection
• Optimize the use of antimicrobial medicines
• Ensure sustainable investment in countering antimicrobial resistance

“This is the single greatest challenge in infectious diseases today,” Dr. Keiji Fukuda, WHO’s assistant director-general for Health Security, said in a news release. “All types of microbes—including many viruses and parasites—are becoming resistant to medicines. Of particularly urgent concern is the development of bacteria that are progressively less treatable by available antibiotics. This is happening in all parts of the world, so all countries must do their part to tackle this global threat.”

Here are some of the key points WHO outlined from the report:

• Infrequent monitoring. Many countries lack the capabilities to keep a close eye on patterns of resistance to identify trends – a component that is key in controlling outbreaks and spread.
• Low public awareness of the issue. Many still believe antibiotics are effective against viral infections
• The sale of medicines without a prescription is widespread and adds to potential for overuse
• Lack of programs to prevent and control hospital-acquired infections, such as MRSA, remains key problem

The survey focused on what WHO calls the “building blocks” that are needed to combat antimicrobial resistance: a comprehensive national plan, tracking and laboratory capacity, access to quality-assured antimicrobial medicines, control of the misuse of these medicines, public awareness, and infection prevention and control programs. In many countries the sale of antibiotics without a prescription, or the lack of quality assurance protocols, can contribute to the problem. Either overuse, or underuse of antimicrobials can drive development of resistance. In 2013 there were about 480,000 new cases of multidrug-resistant tuberculosis. Since 2012 there has been an increase in resistance to first-line drugs that treat HIV. According to WHO, there are high proportions of antibiotic resistance that cause common infections, such as pneumonia and urinary tract infections, in all regions of the world.

More highlights from the report:

• All eight of the countries from the WHO African region that participated in the survey said resistance to treatments for malaria and TB are their greatest challenges
• Antibiotics are available over the counter in 18 of 26 countries participating in the survey from the Americas region
• Only three out of 26 participating countries from the Americas region reported having a national multi-sector plan to address antimicrobial resistance (the United States did not participate in the survey)
• Zero out of 13 participating countries from the Eastern Mediterranean region reported having a national action plan for antimicrobial resistance
• 40 percent of participating countries from the European region have comprehensive plans and strategies, but half of the population believes antibiotics are effective against viruses, despite public information campaigns
• Five out of 11 countries in the South-East Asia region have a national plan to address resistance, while 9 have national Infection Prevention and Control programs
• In 2011 health ministers of the South-East Asia region cemented their commitment to prevent and control antimicrobial resistance through the Jaipur Declaration. Many countries reported that compliance with prescribing standards and guidelines is lacking
• Four of 26 participating countries from the Western Pacific have a national action plan, while nearly 70 percent report surveillance for antimicrobial resistance

“While there is a lot to be encouraged by, much more work needs to be done to combat one of the most serious global health threats of our time,” Dr. Fukuda said in a statement. “Scientists, medical practitioners and other authorities including WHO have been sounding the warning of the potentially catastrophic impact of ignoring antibiotic resistance. Today, we welcome what has been achieved so far, but much more needs to be done to avoid losing the ability to practice medicine and treat both common and serious illnesses.”