Dr Toby Leslie, global technical lead for health, shares his reasons for cautious optimism in World Antibiotic Awareness Week which runs from 13-19 November 2017.
We can expect plenty of hard-hitting headlines during World Antibiotic Awareness Week, which reflect the urgent need to slow down and reverse the fast-growing threat of antimicrobial resistance (AMR). However, I hope this week also provides some quieter moments for both the scientific community and policy makers to focus on the best collective response as we start out across unchartered and hazardous terrain.
After all, there are reasons for cautious optimism, not least that the whole world agrees there is a problem and that something must be done. It seems that time for talking is, at last, over and there is now a solid platform for action. Climate change and even the HIV epidemic don’t yet enjoy that level of global agreement and purpose – yet both have made notable progress in the face of a vast challenge. Of course, there’s much more to do. But they show what can happen when enough momentum pulls people in the same direction.
Another encouraging sign is that the process of decelerating AMR has already begun. Developed countries are starting to drop the amount of unnecessary antibiotic use in both human and animal health. As with climate change and HIV, however, it will be low and middle-income countries (LMICs) that feel the worst effects of AMR, including potentially devastating economic, health and environmental consequences if the direction of travel for AMR stays the same. It’s only right that western governments are funding initiatives to support the fight against AMR in Asia and Sub-Saharan Africa. Given the interconnectedness of today’s travel networks and food chain, any unchecked increase in antibiotic resistant infections there will directly impact the rest of the world.
More haste, less speed
Moving forward, a calm and measured response to AMR will gain longer-term rewards than short-term hype. Surveillance and capacity building don’t make for snappy headlines, but unless we have quality assured data to work with, we risk sleepwalking into disaster – especially in LMICs where AMR will hit hardest. For example, rapid phasing out of antibiotics for human medicine or intensive livestock production might cause more damage than it sets out to avoid.
A measured response starts with a better understanding of AMR, and how it spreads. At the moment, LMICs are poorly equipped to provide the data needed to generate their own effective response and inform global and local policy. There are simply too few trained microbiologists to conduct surveillance in human medicine, using One Health approaches. There are too few health facilities that routinely undertake bacterial culture – and still fewer who do routine antimicrobial drug sensitivity tests.
A big step forward will be the improvement of surveillance of bacterial infections and antibiotic use in agricultural systems, which are by far the highest users of antibiotics. As it stands, there is almost no systematic surveillance of antibiotic resistance so the understanding of the drivers of resistance is lacking – yet this is the critical intelligence gathering that is needed to break cycles of transmission.
Weak health systems in LMICs - which mean that many lack access to basic, quality healthcare - hamper reliable surveillance systems. There are also often significant logistical challenges for transporting samples and ensuring a quality assured supply chain for reagents and consumables. One Health structures and inter-sectoral collaboration need strengthening, with poorly defined standards for basic surveillance of pathogens and transmission patterns.
Improving the above deficiencies in surveillance are some of the major ambitions for the UK Government’s Fleming Fund. By supporting institutions and individuals in LMICs in Asia and Sub-Saharan Africa, we aim to increase vigilance and understanding on the frontline of AMR – sustainably, at local, national and regional levels. Once a more robust approach to AMR surveillance is in place, scientists and policymakers will gain the intelligence they need to make a more informed response to this threat.
AMR is a global problem that needs both global and local solutions. This week, amid the urgent calls for action, we should also take heart that many of those solutions are starting to take shape.