News and Opinions  –  2023

Strengthening Diagnostics Capacity: How can the newly adopted resolution help to contain the spread of antibiotic resistance?

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In May 2023, at the 76th World Health Assembly, member states voted to adopt the resolution “Strengthening diagnostics capacity” following a recommendation from the World Health Organization Executive Board in February. This is the first time that such a resolution focused solely on diagnostics has been adopted at a global stage. How can the resolution catalyze change?

Doctor performs a nasal swab test on an elderly patient. During the COVID-19 pandemic diagnostics was a key element of action. Photo: Shutterstock.

In May 2023, at the 76th World Health Assembly (WHA), member states voted to adopt the resolution “Strengthening diagnostics capacity” following a recommendation from the World Health Organization (WHO) Executive Board in February.

Diagnostics essential to address AMR

Diagnostics have long been acknowledged as playing an essential role in the global response to antimicrobial resistance (AMR) with reference made to them in both the 2016 United Nations political declaration on antimicrobial resistance and the 2019 Interagency Coordination Group on Antimicrobial Resistance (IACG) recommendations. However, this is the first time that such a resolution focused solely on diagnostics has been adopted at a global stage.

Historic milestone

This historic milestone, is a sign of recognition of the importance of the topic and will help to push the agenda of diagnostic access as an urgent priority. ReAct welcomes this important resolution and believes that strengthening diagnostic capacity is a fundamental aspect of addressing antibiotic resistance and improving health across the world.

The resolution:

“Recognizes the critical role of rapid and accurate diagnostics to combat antimicrobial resistance by guiding the correct management of infections, and the appropriate use of new and existing antimicrobials through improved antimicrobial stewardship and surveillance.”

Diagnostics for antibiotic resistance

A comprehensive approach to addressing antibiotic resistance cannot rely exclusively on access to effective antibiotics and must encompass other health technologies, such as vaccines and diagnostics. Diagnostics play several key roles in the response to antibiotic resistance.

Individual patient level

At the individual patient level, diagnostics help healthcare providers determine the cause of illness and identify the appropriate treatment. Thereby, reducing morbidity, mortality and the total quantity of antibiotics consumed, as well as supporting the use of narrow spectrum antibiotics to help preserve the effectiveness of new and existing antibiotics.

Public health level

At the public health level, diagnostics serve as a source of information for surveillance of disease and can be used to monitor patterns of disease and outbreaks. Furthermore, diagnostics support the development of local guidelines for antibiotic use including the creation anti-biograms to help choose which antibiotic is best to use in cases where antibiotic therapy needs to begin without diagnostic confirmation.

Challenges to diagnostic testing for antibiotic resistance in LMICs

The 2021 Lancet Commission on diagnostics estimated that almost half of the world’s population has little or no access to diagnostic testing. This is a major challenge for low- and middle-income countries (LMICs) where delays in diagnosis is an important cause of morbidity and mortality.

Diagnostic testing not standard practice

Diagnostic testing is not standard practice in many healthcare systems in low-and middle-income countries. Often tests are simply not available, and if they are, patients must pay for them out-of-pocket. However, with diagnostic testing often costing more than inexpensive generic antibiotics, when forced to choose, patients with limited resources often choose to go directly for the treatment.

When asked about the role of diagnostics in addressing antibiotic resistance, Kevin Outterson, Executive Director of CARB-X highlighted exactly this issue:

“Generic antibiotics cost less than a few Euros. If the goal is to guide antibacterial use, diagnostics must be much cheaper than the drug unless the health system is willing to pay more. That is a formidable challenge.”

Kevin Outterson, Executive Director CARB-X

Affordable, accessible diagnostics will help address antibiotic resistance

The dearth of new, affordable, and accessible diagnostics is a challenge for addressing antibiotic resistance. Inequitable and inadequate access to diagnostics can lead to delays in diagnosis or improperly diagnosed infections which are not only harmful to the patient but also more difficult and expensive in the long run. Equitable access to diagnostics and investment in better diagnostics is key to addressing antibiotic resistance and reducing the burden on patients and healthcare systems around the world.

How can the resolution catalyze change?

While diagnostics have been included as part of political declarations and recommendations to address antimicrobial resistance for several years, clearly we are still facing challenges to harnessing their full potential. The central and fundamental role of diagnostics in quality health care remains to be under-recognized, leading to a lack of funding and inadequate resources at all levels.

Key initiatives to unlock diagnostic challenges

We hope to see the adoption of the resolution followed with key initiatives that can unlock the diagnostic challenges faced today. The resolution will raise awareness on the importance of diagnostics to not only ministries of health but also healthcare workers, non-governmental organizations, academia, industry, and investors and give WHO the mandate to focus on this important area.

Resolution provides goals and actions

The resolution provides goals and actions for national governments including the encouragement of member states to develop a national diagnostics strategy. Furthermore, the resolution opens the opportunity to set targets and document progress, and tasks WHO to monitor progress and report back to a subsequent World Health Assembly.

Resolution open doors to collaborations and investments

This momentous achievement is also expected to open doors for future collaboration and investments in diagnostics technologies. The right pieces are now in place to advocate for the needed funding to transform access to diagnostics on a global scale.

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