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Global response to antimicrobial resistance ‘insufficient’
Governments around the world must do more to tackle the growing threat of drug-resistant infections, new research suggests.
National action plans to tackle the threat from antimicrobial resistance (AMR), which occurs when bacteria, viruses, fungi and parasites stop responding to medicines designed to treat them, were developed by more than 100 countries.
The plans focus on designing policies to curb AMR and devising tools to implement the policies - but they do not adequately factor in monitoring and evaluation.
The new research, carried out by experts at the universities of Leeds, Edinburgh and Hamburg, is the first large-scale analysis of these plans. They were designed after encouragement from the World Health Organisation, which has declared AMR one of the top 10 public health threats facing humanity.
Lead author Jay Patel, undergraduate dental student in the University of Leeds’ School of Dentistry , said: “Our analysis showed that countries were highly focused on designing AMR policies, and thinking about what tools would be required to implement those, but they generally did not consider how they would monitor and evaluate the impact of those efforts.
“This suggests that the international response may be inadequate to meet the scale and severity of AMR. This is particularly concerning in low and middle-income countries, where action plan activities often lack sustainable funding – relying instead on funds from foreign donors and philanthropies.
“The available evidence also suggests that simply developing a national action plan may not necessarily mean a country is more prepared to respond to the threat of AMR.
“Our study shows that the global response to AMR, and preparedness for the predicted challenges of AMR, require improvement in all locations around the world.”
The research team says governments across the world must strengthen their responses to AMR.
What is antimicrobial resistance?
AMR refers to changes in microbes, particularly bacteria, that cause the drugs used to treat infections to become less effective. AMR has emerged as a defining challenge for global public health in the 21st century. In 2019 alone, AMR was a factor in 4.95 million deaths worldwide – more than half of deaths due to bacterial infections.
Without action, AMR could render many routine antibiotics ineffective, claiming tens of millions of lives annually.
In 2017, the World Health Organization encouraged member states to develop national action plans stipulating how countries would tackle AMR. More than 100 countries have produced action plans, with several being implemented - but there had been no global analysis of the contents of these plans.
Published in The Lancet Infectious Diseases , this new research is the first to comprehensively assess international AMR efforts and national action plans and generate comparable quantitative results across countries and regions.
The 114 action plans, which were created in 2020-21, were evaluated against 54 elements, such as education, stewardship, and accountability, and each awarded a score out of 100. A mean score out of 100 for each country’s plan was then taken from these results.
Countries and action plan scores are shown in the table below
Norway
85
Croatia
60
Indonesia
53
Rwanda
45
Paraguay
36
USA
84
Tanzania
59
Timor-Leste
52
Cyprus
44
Afghanistan
35
UK
83
Zimbabwe
Ethiopia
51
Egypt
Uruguay
34
Sweden
78
Canada
58
North Korea
South Africa
43
Costa Rica
Denmark
76
Ghana
57
India
Sudan
Mauritius
33
Germany
Portugal
Sri Lanka
Ecuador
Maldives
Japan
75
Saudi Arabia
Kenya
Nepal
Fiji
32
Australia
Slovenia
Laos
50
Turkey
Mongolia
31
Switzerland
Mozambique
Colombia
49
UAE
Libya
France
74
Iran
Slovakia
Bhutan
42
Turkmenistan
Malaysia
73
Finland
56
Madagascar
Papua NG
Ukraine
29
South Korea
Iceland
Serbia
48
Pakistan
41
Sierra Leone
Thailand
72
Uganda
Iraq
Argentina
40
Barbados
28
Netherlands
71
Estonia
Cuba
Eritrea
Micronesia
Philippines
Liberia
Lithuania
47
Cambodia
39
Spain
Bahrain
55
Eswatini
Tunisia
Austria
70
Mexico
Czech Republic
Bangladesh
Ireland
69
Malawi
Luxembourg
Oman
Singapore
66
Russia
North Macedonia
46
Malta
38
Greece
65
Nigeria
Chile
Cameroon
Italy
Morocco
54
Georgia
Montenegro
China
64
Burkina Faso
Brazil
Tajikistan
Belgium
63
Zambia
Namibia
Nicaragua
Latvia
Myanmar
Poland
Brunei
37
Peru
61
Jordan
Lebanon
Vietnam
The findings
The study found that across all plans, there was a greater focus on policy design and implementation tools, but efforts to monitor and evaluate activities are generally poorly-considered.
Of all areas evaluated, accountability and feedback mechanisms were the joint-lowest scoring, followed by education.
Training and professional education across human health, veterinary, and agricultural sectors were insufficient in many countries, with several lacking a sustainable workforce strategy to deliver antimicrobial stewardship policies.
Countries scored well on participation, demonstrating a shared awareness that AMR can only be successfully addressed through engagement with multiple sectors spanning human, animal and environmental health. Infection prevention and control was frequently recognised as a critical objective.
Norway’s response was the highest scoring with 85, followed by the USA with 84 and the UK with 83. The lowest scoring countries were Ukraine and Sierra Leone with 29 points each, and Barbados and Micronesia with 28 points.
Further information
Contact University of Leeds press officer Lauren Ballinger via l.ballinger@leeds.ac.uk with media enquiries.
“ Measuring the global response to antimicrobial resistance, 2020–21: a systematic governance analysis of 114 countries " is published in The Lancet Infectious Diseases.
The research was funded by the Wellcome Trust and the Leibniz Association. JP, GF and DS are funded by the Wellcome Trust (106635/Z/14/Z). AH, WH and DD are funded by the Leibniz Association (SAS-2021-1-FZB). AJM provides consultancy services to the WHO Regional Office for Africa.
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The Lancet Infectious Diseases
Measuring the global response to antimicrobial resistance, 2020–21: a systematic governance analysis of 114 countries