Academic journal article Bulletin of the World Health Organization

Strategies for Achieving Global Collective Action on Antimicrobial resistance/Strategies Visant L'accomplissement D'une Action Collective Mondiale Sur la Resistance Aux antimicrobiens/Estrategias Para Lograr Una Accion Colectiva Global Frente a la Resistencia a Los Antimicrobianos

Academic journal article Bulletin of the World Health Organization

Strategies for Achieving Global Collective Action on Antimicrobial resistance/Strategies Visant L'accomplissement D'une Action Collective Mondiale Sur la Resistance Aux antimicrobiens/Estrategias Para Lograr Una Accion Colectiva Global Frente a la Resistencia a Los Antimicrobianos

Article excerpt

Introduction

Antimicrobial medicines now save millions of lives each year and many infectious diseases are far less deadly because of them. (1) However, bacteria, viruses, parasites and fungi develop resistance to existing medicines and few novel antimicrobial products are being produced. Antimicrobial resistance--i.e. resistance of microorganisms to an antimicrobial drug that was originally effective for treating the infection it causes--is both natural and inevitable. However, inappropriate antimicrobial use, falsified or substandard drugs and poor infection control accelerate the pace of evolutionary processes. (1)

Today, diminishing antimicrobial effectiveness represents one of the greatest threats to human health. (2-4) Annual deaths from drug-resistant infection are projected to increase from 700 000 to 10 million by 2050, at a cumulative cost of 100 trillion United States dollars (US$). (4,5) The world might face a scenario where infection once again takes a heavy toll on a scale and severity not seen in over 80 years. Universal access to antimicrobials, on the other hand, represents one of the greatest opportunities to save millions of lives each year and improve the lives of millions more. For example, 244 000 deaths in neonates could be averted annually with basic injectable antibiotics. (5)

Global action is needed to mitigate the threat of increased antimicrobial resistance. However, policies designed to improve access to antimicrobial medicines, to maintain their effectiveness and to increase the supply of new products have not been implemented. (1) We argue that this lack of action is due to failures in global governance and global markets, rather than insufficient awareness or political priority. National governments would all benefit from cooperation and coordination on antimicrobial access, conservation and innovation, but none want to incur their part of the associated costs. (6,7) Global markets, meanwhile, undersupply antimicrobials for those who cannot afford them, oversupply them in wealthier contexts where individual benefits are not weighed against total costs and underinvest in research and development for new antimicrobials. (8)

We examine ways of achieving global collective action to correct these governance and market failures. Overcoming these failures should make it possible to implement policies designed to improve access to antimicrobials, conserve those that are still effective and drive innovation in preventing and treating infections. We map the existing actors in this policy area, identify guiding institutional design principles and evaluate 10 options for achieving progress. Our goal is to bring the science of global strategy (9) to bear on the challenge of antimicrobial resistance.

Governance of antimicrobial use

Many institutions address the threat posed by antimicrobial resistance (Box 1), with numerous global strategies, political resolutions and regulatory standards generated from multilateral activities, industry initiatives and public-private partnerships. However, the mandates and objectives of these institutions are not all aligned. For example, antimicrobial growth-promoters can advance Food and Agriculture Organization (FAO) objectives by improving weight gain in farm animals, but can adversely affect human health, of concern for the World Health Organization (WHO). These institutions work through different policy fora which have different powers to influence state behaviour and are attended by different delegations with different priorities. Ministers of agriculture attend FAO meetings, while ministers of health are at WHO. There is no forum in which they meet to resolve issues of common concern--such as antimicrobial resistance--on the international level. Commitments made by ministers of health to address the issue have resulted in several World Health Assembly resolutions (e.g. WHA51.17, WHA54.11, WHA54.14 and WHA58. …

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