Meeting the AMR challenge
Antimicrobial resistance (AMR) is today a serious political, social and economic problem. The 71st session of the UN General Assembly identified AMR as a dominant global health concern, placing it high on the agenda of national policy makers, international organizations and financial institutions in developed and developing countries. Accordingly, to combat this global threat, the Sixty-eighth World Health Assembly in May 2015 endorsed the Global Action Plan (GAP) on Antimicrobial Resistance.
What makes AMR such a big threat to the SEA Region
The WHO South East Asia (SEA) region that comprises of low and middle income countries is home to around 1.8 billion people who are at the highest risk globally for the emergence and spread of AMR. Although the region has made steady social and economic progress, a large proportion of the population continues to live in poverty. Inadequate housing and sanitation accelerates person-to-person and environmental spread of resistant pathogens and genes. Antibiotic stewardship programmes also remain underdeveloped.
High use of antibiotics in hospitals and transmission of resistant pathogens between patients and to health workers accelerates spread of resistance. System-wide monitoring of measures such as infection prevention and control and awareness of healthcare workers is inadequate, and regulation of production and sale of antibiotics is weak. Being readily available over-the-counter without prescription has resulted in indiscriminate use. The issue is further compounded with availability of counterfeit and substandard antibiotics by unscrupulous producers in the absence of credible drug regulations and law enforcement.
WHO’s support to AMR containment in the SEAR
The WHO SEA Region recognized AMR as a serious public health threat and since 2010 has adopted several Regional Committee resolutions on prevention and containment of AMR. In 2011, the Regional Office organized a meeting in Jaipur, India wherein all health ministers of the Region committed to take intensive action by adopting the Jaipur Declaration on Antimicrobial Resistance. In 2014, AMR was included as a Regional Flagship Priority by the Regional Director who called for building national capacities to combat AMR, with a focus on achieving clear deliverables at both the regional and country levels. At the 2015 regional committee meeting in Timor-Leste, member states passed a key resolution for steadfast political commitment and multisectoral coordination to tackle AMR. Next, a regional strategy to support development and implementation of AMR National Action Plans was finalized to guide member countries in strengthening their national AMR prevention and containment programmes.
HIM Unit’s efforts in AMR containment
Since 2016, the HIM unit has been supporting the Regional Director’s Flagship on AMR. This strategic support is driven by recognition of the fact that fact that the most effective way to combat the complex issue of AMR global rise is through a One Health (OH) approach, that helps “design and implement programmes, policies, legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes.”
The HIM unit collaborates with Tripratite members to coordinate OH response across human, animal and environment sectors to the threat of AMR; supporting monitoring and evaluation of AMR containment efforts and technical support to strengthen AMR surveillance in member states.
Towards this end, in September 2017, the HIM unit coordinated the analysis of the AMR situation in SEAR and published the findings in a special issue of the British Medical Journal[H1] . [H2] As work on AMR intensified, the unit led the development of a situation analysis tool that provided technical guidance for assessing the functionality of the measures and capacity to contain AMR in the Region and subsequently formed the basis of developing NAPs in member states.
As part of ongoing work, the HIM unit has initiated following AMR-related projects that aim to foster and advance intersectoral collaboration between the public health, animal and environment health sectors. These are:
- An integrated surveillance project on AMR that is being implemented in Indonesia and India and will soon be implemented in Nepal
- Biennial review of progress of implementation NAPs in member states.
- A tripartite coordination team based in FAO-RAP in Bangkok, initiated by HIM
These projects aim at initiating a common interest and platform that can strengthen the collaboration on AMR surveillance through aligning and understanding of the risks posed by AMR at the country level.