On Monday the 70th World Health Assembly (WHA) will start in Geneva. Country delegates will have a long list of agenda items lined up for discussion to get through. While much attention will be given to the election of a new Director General to replace Dr. Margaret Chan, the discussion on antimicrobial resistance also features on the agenda. This year, the focus will be on the three requests made in the UN General Assembly Political Declaration of the World Health Organization (WHO): country progress in developing their National Action Plans (NAPs) on antimicrobial resistance, progress on finalizing the Global Development and Stewardship Framework and finally the setup of the ad hoc UN Interagency Coordination Group.
When WHO Member States adopted the Global Action Plan during the 68th WHA in 2015 a two-year period was agreed on by which time all countries should have developed NAPs on antimicrobial resistance and reporting back on progress to the WHA should happen. At this point in time, the WHO estimates that roughly 2/3 of the WHO member countries have managed to either complete their NAPs or are in the process of developing them covering over 85% of the world’s population. The remaining countries that have not yet embarked on developing their NAPs are characterized by the WHO as countries that are generally small, fragile or affected by conflict. However, a number of African countries that do not fall in these categories are also found in the group of remaining countries.
“From our experience the reasons why some countries have not embarked on developing national action plans include lack of political will, technical capacity and financial resources. While some countries have benefited from financial support through the tripartite organizations WHO, FAO, OIE and the Fleming Fund, other countries have either not been eligible or did not know about such resources. With a more clear and transparent process it is possible that they could have met the timeline.”
Mirfin Mpundu, Head of ReAct Africa
Improved civil society engagement needed
Further political engagement and improved involvement of civil society is needed. Regional WHO meetings should be inclusive of stakeholders, such as civil society and professional medical societies, who can further provide resources and anchoring of National Action Plan development, implementation and monitoring. Moreover, a gap analysis to identify countries who require technical and financial assistance outside of those eligible for e.g. Fleming Fund or ODA assistance would be a helpful in order to improve support for remaining countries.
From plans to implementation
Looking towards the effective implementation of National Action Plans, financial and technical assistance needs to be ensured. The WHO should consider developing decision tools to help guide decisions around prioritization and resource allocation. These tools should allow for countries to identify which interventions are most urgently needed in the near-term based on the country’s context of disease burden and level of resources available. Systems to evaluate the adequacy of National Action Plans should also be established.
Innovation, access and stewardship together
The WHO in collaboration with the OIE and the FAO has recently released a draft roadmap on the development and stewardship framework ahead of this year’s WHA. The document has evolved significantly from the report prepared for the 69th WHA in 2016. In particular, the approach that stewardship and access cannot be dealt with separately from innovation is commendable. The WHO and Member States play a critical role in ensuring that the principles of affordability, accessibility, efficiency, and equity through approaches which delink the cost of investment from both the price and volume of sales are at the core of the discussion. Focus should be on ensuring sustainable access to effective antibiotics and other health technologies.
Improve transparency of the ad hoc Inter-Agency coordination Group
The Interagency Coordination Group (IACG) on AMR was launched earlier this year by the UN Secretary General’s office and the WHO and a first convening of the group took place in April. Some important agencies such as UNDP and UNESCO were unfortunately missing from the first composition of the group. Issues around how to improve the transparency of the workings of the IACG will hopefully also be raised during the discussions next week in Geneva.
ReAct will be present at the World Health Assembly with representatives from all but one of our regional nodes.