SYDNEY CONFERENCE BRINGS ATTENTION TO ACTION ON ANTIBIOTIC RESISTANCE

6 October 2012

More than 230 participants came together for the Asia Pacific Conference on National Medicines Policies (APCNMP) in Sydney in May 2012 to share progress in implementing National Medicines Policies in the Asia Pacific region. Throughout the planning for the conference, antimicrobial resistance (AMR) repeatedly came up as a priority concern, so a workshop was designed to identify the main barriers and enablers to integrating AMR into NMP implementation plans. The countries represented ranged from China and India to Tuvalu, the smallest country in the world (apart from the Vatican).

By Mary Murray, ReAct Global Network Coordinator

See full Report of the workshop for details

Proposals made in the workshop included:

Build partnerships, raise awareness and strengthen collaboration among all stakeholders to address the growing challenge of antibiotic resistance (ABR). Make resistance VISIBLE. Educate the public regarding resistance and the use of antibiotics through simple and easy programs usingvarious media in specific locations Tell stories that engage people emotionally..Encourage people to ask ‘Do I really need antibiotics?’
Strengthen the ethos that no physician is practising in isolation but that their practice influences others –physicians and patients alike.
Build networks to join people together. ReAct and other global networks are beginning to collaborate in regions. There was a strong feeling in the workshop that it is important to be part of a regional network.
Link research projects with research training in order to promote research in the field of ABR to generate the necessary evidence.
Review and revise all undergraduate health related education programs with the aim of increasing students' skills in rational prescribing and dispensing of antibiotics. Develop an ethos of independent continuing education amongst health professionals.
Institute government (MoH) regulation of the interactions between pharmaceutical industries, doctors and pharmacists.
Focus on the mechanism for action – the national policy platform – represented by the community of stakeholders. This can serve as a review panel, agreeing upon the monitoring and evaluation methodology, the time frame for measuring outcomes and impacts. It should also propose course corrections. Replicate at local/regional levels.
Policy needs to be linked into incentives and sanctions because education alone is not sufficient. .Surveillanceof resistance rates and antibiotic use needs to be linked in to practice incentive payments and sanctions (professional and financial where possible. Accredit, and audit pharmacists who sell antibiotics.


National Prescribing Service, Australia, is running a 5 year campaign on resistance encouraging every Australian to become a resistance fighter.	‘How can we get the pacific islands onto the networking map?’ asks Natane fromTuvalu after the workshop

These proposals for action on AMR sit firmly within the overall conference actions recommended to advance implementation of national medicines policies. The conference created a broad frame for stronger action to implement NMP, including AMR.

Some of the key principles were the need to embed medicines policies in health policies and health systems. Implementation is unlikely without strong political commitment to policy and processes as well as social mobilization and good data systems. Health as a human right should frame the ethical challenges resulting from limited resources, where both societal values and good evidence must be considered. Therefore health literacy and engagement of civil society are needed so that people understand the issues, through better knowledge and skills relating to use of medicinesincluding antibiotics.

This will also enable people to participate in the decision-making processesfor equitable access of needed health services and products by all in society. In this regard, sufficient resources to fulfill the functions embodied in NMPmust be allocated. Monitoring and appropriate use of data is also an important component.

Finally collaboration and relationship building, at national, regional and local levelswill help identify shared problems, shape agendas for concerted action and help overcome capacity restraints. Sharing of experience, challenges and successes will help implementation of NMP, including AMR activities. The ultimate indication of penetration of NMP is not from medicine to the health system, but from political commitment to social capital. This implies the deep involvement of people in all aspects of NMP including the best options for universal access to essential medicines.

A number of specific recommendations to strengthen implementation of national medicines policies were made and provide a good framework for integrating action on AMR into the medicines and health system that national medicines policies are driving towards. These include:

- capacity building and information sharing on issues such assurveillance of antibiotic resistance, medicines prices in both public and private sectors, results of quality assurance activities, successes and failures in rational use of medicines including best practices in health and treatment literacy;

- data collection and analysis for monitoring progress in NMP implementation including performance of regulation, supply systems, medicines affordability, availability and use, prices and use of generic medicines, prescribing of AB and consumer use of AB, medicines safety and indicators regarding regulation of advertising;

- legislation to ensure sustainability of NMPs is needed including scaling practical initiatives to build the capacity of regulatory agencies, medicines inspectors, police and lawyers in evidence-gathering to enforce regulations in low and middle income countries (LMIC);

- the role and responsibility of the pharmaceutical industry in NMP includes development of new antibiotics and medicines for neglected diseases. This will involve development of new business models that recognize the need to balance profits with affordable and universal access to medicines particularly in LMICs; and to improve policies and practices around promotion of medicines including antibiotics.