Purpose, framework and innovative methods
Antimicrobial resistance (AMR) is known as one of the main challenges for public health in the 21st Century. Published in January 2023 in the Lancet, this new study was initiated by the acknowledgement of AMR’s serious consequences on populations and economies. Countries included in the study are all part of the WHO Tripartite Antimicrobial Resistance Country Self-Assessment Survey (TrACSS) 2020-21, which “provides an annual understanding of international efforts to monitor and evaluate progress on managing antimicrobial resistance internationally ».
Additionally, a Global Action Plan (GAP) against AMR, based on the One Health approach, was adopted at the 68th World Health Assembly in 2015. 194 WHO member states then committed to developing multisectoral National Action Plans (NAPs) to tackle the issue. The study was thus designed to « operationalise and apply a governance framework for a global characterisation of all publicly available antimicrobial resistance National Application Programs (NAPs) ».
Researchers used the WHO, the FDI World Dental Federation, the European Centre for Disease Prevention and Control, the Food and Agriculture Organization of the UN, and the Action on Antibiotic Resistance as reference organisms to access data. They also translated the 114 available national NAP texts in English to study their terms, and developed their own indicators for the assessment of each country’s level of activity against AMR. They finally created maps based on scores to illustrate their findings.
Mitigated results suggesting a long way ahead, in a state of urgency
Overall, when AMR policies were adopted, the lack of systematical monitoring of cost-effectiveness would leave little potential for strategic policy design and implementation. AMR NAPs were therefore held back by lack of evidence, implementation and substantial action. To this day, comprehensive NAPs on antimicrobial resistance remain less numerous than NAPs on other health issues in the literature, such as cancer.
In the absence of an international comprehensive system of evaluation for NAPs efficiency, assessments were made at the scale of countries or groups thereof, based on similar economic contexts, specific regions or thematic areas. The authors observed important disparities among the studied countries. While 148 countries reported having developed an AMR NAP in October 2021, the authors were only able to identify 115 NAPs. As a result, only 76% of the NAPs were considered finalised in 2020-21. Moreover, even when established, AMR NAPs achieved uneven results. National capacities indeed widely differed, and low-and middle-income countries had less financing possibilities, mainly depending on donations. Additionally, not all countries mobilized the same strategic policies design, nor furnished the same amount of efforts to implement their AMR NAP.
Ultimately, the study demonstrates that the lack of uniformisation in hindering progress in the fight against AMR. There are still too few measures of global progress in that area, despite it being an official strategic priority of the WHO. The authors argue that the global response has not been up to the task, stating that « the assertion that the global response to antimicrobial resistance is favourable because of the development of as many as 148 NAPs is ill-conceived and inappropriate ». The development of a much stronger international response is urgently needed, due to the potential serious repercussions of AMR on global health and economy. Without an adequate response, the cost of inaction would increasingly weight down on the global GDP year after year. In order to achieve a change, monitoring and evaluating are key, and the authors recommend a baseline assessment to enable the characterization of microbes on AMR in future studies, including new data such as those gathered during the Covid-19 pandemic.
Measuring the global response to antimicrobial resistance, 2020–21: a systematic governance analysis of 114 countries. Jay Patel, Anne Harant, PhD, Genevie Fernandes, PhD, Ambele Judith Mwamelo, MPH, Prof Wolfgang Hein, PhD, Denise Dekker, PhD, et al. the lancet.com, Infectious diseases. Published: January 16, 2023. DOI: https://doi.org/10.1016/S1473-3099(22)00796-4
Article rédigé par Marie-Laure Privat