Due to COVID-19, pandemic preparedness and global health security have emerged as the dominating approach to addressing public health crises, of which antimicrobial resistance has been among the priority list. This piece highlights considerations for antimicrobial resistance to be addressed through the pandemic preparedness lens.
The lesson learned from the COVID-19 pandemic has been that the world was woefully under-prepared for effectively managing emerging public health threats. Antimicrobial resistance has been recognized as one of them – an ongoing, insidious pandemic that develops rapidly but more silently compared to COVID-19. Despite the recognition that access to effective antibiotics is a cornerstone of modern medicine, policies and actions must go beyond symbolic references. How to ensure sustainable access of antibiotics needs to be considered, and truly integrated into programs and policies when pandemic preparedness frameworks and capacities are revamped and expanded. This is a wake-up call for governments and should be a turning point for work on global health and international development.
Pandemic preparedness – increasing political momentum and partnerships
While the COVID-19 response and recovery efforts are ongoing, several initiatives and partnerships on pandemic preparedness and response have emerged over the past year, including the Access to COVID-19 Tools (ACT) Accelerator and its vaccines pillar COVAX. In the EU, the European Health Emergency Preparedness and Response Authority (HERA) was announced with the launch of preparatory actions that will focus on emerging biological threats to human health and antimicrobial resistance. The ASEAN Centre on Public Health Emergencies and Emerging Diseases was also launched at the ASEAN Summit meeting in November 2020.
Governments should not lose sight on antimicrobial resistance
While governments still need to focus on COVID-19 response and early recovery, they should not lose sight of the ongoing and longer-term serious threat of antimicrobial resistance. Even though antimicrobial resistance has been mentioned in discussions around pandemic preparedness, the political commitments and financial investments to tackle this growing crisis have so far fallen short. Decades of underinvestment in tackling the systems failures driving antibiotic resistance has left the world vulnerable to drug resistant infections and their detrimental consequences.
4 considerations for addressing antimicrobial resistance through pandemic preparedness
1, Public health driven research agenda needed
The COVID-19 pandemic has a major impact on the global economy and the enabling environment for addressing the ailing antibiotic pipeline. The lack of available treatments and vaccines at the outset of the pandemic has highlighted the need for a public health driven research agenda as part of global pandemic preparedness, as well as the need for more global coordination and solidarity in research efforts, funding and distribution of end-products. An estimated 93 billion USD was spent by governments in the last 11 months on vaccines and therapeutics development for COVID-19. This enormous amount should serve as a clear example that reluctance by governments to invest in preventing public health threats now, only means paying far more later.
2, Global rules-based governance needed to ensure sustainable access
Furthermore, vaccine nationalism that has been displayed in the pandemic response is an important lesson of why global rules-based governance to ensure equal, affordable and sustainable supply and access to antibiotics is needed. Beyond the fact that antibiotic R&D remains underfunded and the current pipeline is unable to respond to current resistance development, there are serious issues with global supply chains, availability, access and affordability of antibiotics, as well as their responsible management including through stewardship. Global rules cannot be left to times of crisis to be developed, where governments first and foremost are concerned with providing solutions for their own populations.
3, Continue efforts in diagnostics and preventative measures
The pandemic response has provided momentum for development of low-cost, rapid diagnostics and expansion of testing infrastructure and capacity – some of which can and should be repurposed for helping bring down the rates of unnecessary antibiotic prescriptions. The interest in vaccines and related R&D pipelines has increased significantly and if expanded beyond COVID-19, it can contribute to reduced disease burden due to infectious diseases and the overall lowering of antibiotic use. The report “Leveraging Vaccines to Reduce Antibiotic Use and Prevent Antimicrobial Resistance: a WHO Action Framework’’ lists strategies to expand the number of licensed vaccines and improve its coverage, to contain antimicrobial resistance. It also identifies priority disease areas for which vaccines are urgently required and maps the potential antimicrobial resistance related impact. Such analyses and sustained support to diagnostics and preventative measures for antimicrobial resistance containment need to be continued for evidence-based health systems strengthening, beyond pandemic response and preparedness.
4, Build core capacity through One Health Approach
Lessons from COVID-19 also reinforce the importance of building core capacity not only in human health systems. Reinforced infrastructure is required for addressing all sources of emerging infections as well as immunization, infection prevention and control, and WASH. It should not be neglected that in the near term, we will be entering a period of fiscal austerity and resources will need to be optimized. A narrow focus on health sector interventions has high risks of crashing the already fragile systems and exposing further vulnerability of affected populations especially in low- and middle- income countries. A One Health approach that addresses health, agricultural and environmental aspects of antimicrobial resistance should be adopted to prepare for and respond to pandemics. These are central elements that are already developed in National Action Plans on antimicrobial resistance. Investments that mitigate and address antimicrobial resistance, including the effective implementation of National Action Plans, are critical components in safeguarding and strengthening One Health systems and pandemic preparedness capacities.
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