New WHO report highlights collaborative action to reduce antimicrobial resistance

WHO has recently released a report which provides for a strategic framework to advance a One Health response to AMR at the global, regional and country levels.

• It is a joint effort by the:
  • World Health Organization (WHO)
  • Food and Agriculture Organisation (FAO)
  • World Organisation for Animal Health (OIE)
  • United Nations Environment Program (UNEP)

Goal of strategic framework:

• The goal of the strategic framework is to preserve antimicrobial efficacy and ensure sustainable and equitable access to antimicrobials for responsible and prudent use in human, animal and plant health, contributing to achieving the UN-mandated Sustainable Development Goals (SDGs).

Objectives of the framework are:

• Optimize the production and use of antimicrobials along the whole life cycle — from research and development to disposal.
• To decrease the incidence of infection in humans, animals and plants to reduce the development and spread of AMR. 
• The overall impact to which the four organisations aim to contribute through their collaboration is for countries to have the capacity to design and sustainably implement evidence-informed One Health responses to AMR. 

The report defined three outcomes countries should have in place:

1. Policy and law support effective country-owned One Health AMR responses: 

• Recognise AMR as a priority in the broader development agenda, acknowledging the need for capacity building to strengthen AMR-specific legislation, policy coherence and sector-specific research. 

2. Systems and structures, including institutional capacities, are in place to support effective implementation of country-owned One Health AMR responses: 

• National Action Plans on AMR and guidelines to be regularly updated including monitoring and surveillance of AMR and antimicrobial use (AMU).
• Access to good quality antimicrobials strengthened for all sectors. 

3. Increased, sustained resourcing is in place for country-owned One Health AMR responses: 

• Priority actions from national action plans on AMR mainstreamed into national plans and budgets 

Intermediate outcomes

• The report also focuses on two intermediate outcomes that it considers interim steps, necessary for the achievement of the longer-term outcomes described above.

• The first intermediate outcome relates to the support provided at country level
• The second is focused on the tripartite (WHO, OIE and FAO) and UNEP action at global and regional levels in support of countries’ efforts.

What is Antimicrobial Resistance (AMR)?

• Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death.
• Antimicrobial-resistant organisms are found in people, animals, food, plants and the environment (in water, soil and air).
• They can spread from person to person or between people and animals, including from food of animal origin.
• Multiple drug resistance (MDR) is antimicrobial resistance (AMR) shown by a species of microorganism to at least one antimicrobial drug in three or more antimicrobial categories.

Mains drivers of antimicrobial resistance

• The main drivers of antimicrobial resistance include the
  • misuse and overuse of antimicrobials
  • lack of access to clean water, sanitation and hygiene (WASH) for both humans and animals
  • poor infection and disease prevention and control in health-care facilities and farms
  • poor access to quality, affordable medicines, vaccines and diagnostics
  • lack of awareness and knowledge
  • lack of enforcement of legislation

Major factors causing AMR in India are:

• Inappropriate consumption of broad-spectrum (last resort) antibiotics is high because of changing prescription practice in the healthcare system due to the non-availability of a narrow spectrum of antibiotics.
• Inappropriate antibiotic use among the general public like Self-medication to avoid the financial burden.
• Large proportion of sewage is disposed of untreated into receiving water bodies, leading to gross contamination of rivers with antibiotic residues, antibiotic-resistant organisms.