Antimicrobial Resistance: From Global Agenda to National Strategic Plan, Thailand/Resistance Aux Antimicrobiens: De L'agenda Mondial Au Plan Strategique National-Thailande/Resistencia a Los Antimicrobianos: De Un Programa Mundial a Un Plan Estrategico Nacional, Tailandia

By Tangcharoensathien, Viroj; Sattayawutthipong, Wanchai et al. | Bulletin of the World Health Organization, August 2017 | Go to article overview

Antimicrobial Resistance: From Global Agenda to National Strategic Plan, Thailand/Resistance Aux Antimicrobiens: De L'agenda Mondial Au Plan Strategique National-Thailande/Resistencia a Los Antimicrobianos: De Un Programa Mundial a Un Plan Estrategico Nacional, Tailandia


Tangcharoensathien, Viroj, Sattayawutthipong, Wanchai, Kanjanapimai, Sukhum, Kanpravidth, Wantanee, Brown, Richard, Sommanustweechai, Angkana, Bulletin of the World Health Organization


Introduction

Antimicrobial resistance poses a serious security threat to global health. In Thailand alone, such resistance is estimated to have caused 38 000 deaths and an economic loss of 1.2 billion United States dollars (US$) in 2010. (1) Subsequent global attention and national concern pushed the Thai government to take action against antimicrobial resistance.

The increased prevalence and global spread of drugresistant microorganisms are alarming. (2) Antimicrobial resistance is recognized as a key security threat to global health. By 2050--if effective interventions against antimicrobial resistance are not made--10 million deaths and an economic loss of US$ 100 trillion may occur annually as the result of such resistance. (3) In 2015, the Sixty-eighth World Health Assembly adopted a Global action plan for antimicrobial resistance and called on each Member State to develop and implement a corresponding context-specific national plan. (4) Discussion of antimicrobial resistance at the United Nations General Assembly in September 2016 led to a political declaration that endorsed the implementation of the global action plan using a One Health approach. (5,6)

Thailand has previously addressed antimicrobial resistance with fragmented approaches. For example, antimicrobial resistance formed a small component of the National drug development strategy (2012-2016) and the National strategic plan on emerging infectious disease (2013-2016). Although several relevant working groups were established, no platform for coordination existed and only very limited policy guidance. None of the working groups established national indicators, systems for monitoring and evaluation or targets. Fragmentation and the lack of both coordination and concerted efforts hampered progress.

Local setting

In Thailand, although the widespread availability of antibiotics from private pharmacies leads to frequent self-medication in households, no systems exist either to monitor the human consumption of antibiotics or to assess the general public's knowledge and perceptions of--or attitudes towards--antibiotics and antimicrobial resistance. A national system for the surveillance of antimicrobial resistance in humans was initiated by the ministry of public health's department of medical sciences in 1998 (7) but this system covered only 92 (9%) of the country's 1027 hospitals by 2017. Furthermore, the use of the antimicrobial resistance profiles and prevalence determined at these 92 sentinel hospitals to guide clinical decision-making by pharmacists or physicians appears to be uncommon.

Thailand's department of livestock development and food and drug administration have conducted some smallscale monitoring of antimicrobial resistance in livestock, and some universities have undertaken some research on this topic. However, nobody has conducted a systematic evaluation of the emergence or prevalence of antimicrobial resistance in livestock.

The surveillance of antimicrobial resistance in--and consumption of antimicrobial drugs by--humans, livestock and pets is key to assessing consumption trends, evaluating the outcomes of interventions and creating national benchmarks for use in international comparisons. However, despite the high estimates of mean global antibiotic consumption in humans--e.g. more than 20 standard units per capita (8)--and in chickens and pigs--e.g. more than 250 kg per 10 [km.sup.2] of land used to rear such animals (9)--there are, as yet, no national policy decisions to support the development of a comprehensive surveillance system in Thailand.

Approach

In Thailand, the development of a National strategic plan on antimicrobial resistance at the end of 2015 was perhaps the most important step towards addressing the fragmentation in the investigation of antimicrobial resistance and the lack of associated systematic interventions. The many stakeholders involved in this development included those working in the agriculture, animal health and human health sectors, civil society organizations, the Food and Agricultural Organization of the United Nations (FAO) and the World Health Organization (WHO). …

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Antimicrobial Resistance: From Global Agenda to National Strategic Plan, Thailand/Resistance Aux Antimicrobiens: De L'agenda Mondial Au Plan Strategique National-Thailande/Resistencia a Los Antimicrobianos: De Un Programa Mundial a Un Plan Estrategico Nacional, Tailandia
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