September 15, 2015
The Question
How we can responsibly scale up access to antibiotics in low- and middle-income countries (LMICs) while minimizing the threat of resistance?
What we found
Solutions to maintaining ng effective antibiotic coverage over long term requires national and global policy actions and commitment. At the global level, 1) use of antibiotics can be curbed through accurate diagnosis of bacterial infection to avoid over prescription; 2) innovative antimicrobial drug financing initiative similar to AMFm where drug subsidy would ‘crowd-out’ inappropriate drugs and encourage appropriate drug use. On national level , they identified six characteristics necessary for successful engagement at the country level including, 1)awareness building to locally strengthen health policy capacity in LMICs 2) create a ‘working group’ of experts to act as a clearinghouse for antibiotic intelligence, 3) achieve national level trust for permanence and credibility, 4) on ground evidence based research 5)create avenues for public-private partnerships, 6) program implementation to raise the profile of working group members while providing direct benefit.
Why it matters
The effects of antibiotic resistance levels are local and global. Effective conservation measures benefit the local population directly while also contributing to the global benefit. Use of antibiotics is growing in LMICs, particularly in the BRICS (Brazil, Russia, India, China, and South Africa) countries. LMICs are likely to be the hardest hit by declining effectiveness of antibiotics because of their greater burden of infectious disease in both human and animal populations, the lack of access to affordable second- and third-line antibiotics, and because of suboptimal infection prevention measures in hospitals and communities.
In most countries, some clinicians and experts on the ground are acutely aware of antibiotic resistance; however, governments and policy makers have not yet recognized it as a priority and have not created a mechanism to address it. A mechanism for experts to gather around the issue is needed for antibiotic resistance to reach the national agenda. In South Africa, Kenya, and Vietnam, GARP recommendations have led directly to action plans developed in collaboration with the government. The authors also noted that antibiotic-awareness was only being realized at the national and subnational level and eluded that it is a global problem which governments and private sector actors can equally embrace. Achieving a cooperative, advisory, or internally incorporated relationship with ministries of health and agriculture will help lead to sustainable national impact.
