Dr Marc Sprenger
WHO Director, Antimicrobial Resistance Secretariat
While the world has woken up to the threat of antimicrobial resistance and is starting to respond, many low-income countries are struggling to find capacity and need greater support. That is the headline finding of a groundbreaking global survey of how well countries think they are doing in fighting antimicrobial resistance, conducted by the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO), and the World Organisation for Animal Health (OIE).
Bacteria are rapidly developing resistance to antibiotics. Viruses, fungi and parasites are doing the same. This is because we have been overusing and misusing medicines for decades. It’s called antimicrobial resistance, and it is a major global threat.
This silent tsunami, in which we are losing our ability to protect against infections such as pneumonia, tuberculosis and malaria, has been neglected for far too long. For years, microbiologists have been warning—with increasing volume—that indiscriminate use of antibiotics and similar drugs in humans and animals is increasingly rendering them ineffective.
Now, antimicrobial resistance has finally come to the forefront in health and political circles, leading to the development in 2015 of a Global Action Plan, endorsed by Ministers of Health and Agriculture at the governing bodies of WHO, FAO and OIE, and Heads of State at a high-level meeting of the UN General Assembly last September. Since then, countries have been developing national action plans to put the globally-agreed policy changes into practice.
Our survey of country progress offers some good news. More than 90% of people in the world (6.5 billion) live in a country that has developed, or is developing, a national action plan on antimicrobial resistance. Some of the key areas in which countries report that they are doing well are: training doctors, nurses, and other health workers on how to reduce the spread of antimicrobial resistance; improving the prevention and control of infections; and strengthening systems to detect the extent of the problem. These are incredible achievements. National plans are multisectoral—which means that leaders in human health, animal health, and the environment, who often talk about joined-up approaches, are actually putting it into action.
When you drill down into the numbers, a slightly less rosy picture emerges. High-income countries that already have stronger health and agricultural systems are much better prepared to deal with antimicrobial resistance—more than 80% of these countries have a plan in place, or are developing one. By contrast, about 30% of low-income countries either have or are developing a plan. This is not surprising. Many low-income countries lack the expertise or capacity to develop a national plan, or they are overwhelmed by dealing with fragile health systems or outbreaks of infectious diseases.
Yet low-income countries are the ones that need to be the best prepared since they are likely to bear the brunt of resistance: infectious diseases are much more common, and their health systems are much weaker and less able to adapt as first-line antibiotics (which tend to be cheaper) become less effective. The burden of harder-to-treat infectious diseases and the impact of treatment failure in human lives and relative economic cost will be much higher than in richer countries.
The lack of preparedness in low-income countries should concern us all, no matter how rich a country we live in. Antibiotic resistance will not just affect the ability to treat diseases such as malaria or tuberculosis, which many might think occur in the poorest parts of the world. Resistant bacteria will challenge our ability to treat women in childbirth, people undergoing surgery, or those on cancer chemotherapy. And, in a globalized world, microbes don’t respect national borders. They spread with ease.”