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Policy  –  Elements of a plan

Awareness and understanding

Improved awareness and understanding among the general public, health professionals, educators, civil society organizations and governments is essential when addressing the antibiotic resistance problem.

This is also the first strategic objective of the Global Action Plan on Antimicrobial Resistance. Public awareness campaigns can be effective when sustained and properly adapted to local conditions, and can help people take an active role in their health and ownership for their actions. This is of extra importance in settings where antibiotics are sold over the counter without a prescription. For the non-human sector, education and awareness-raising have to reach both farmers, veterinarians, the food industry and consumers. Engaging media in awareness campaigns may further increase reach and impact.

Example activities for action

  • Development of an external and internal communications strategy on antibiotic resistance can be helpful to assist those in charge of implementing awareness initiatives within the government or for associated stakeholders. The strategy should specify the intended target groups and can outline overarching messages to be communicated.
  • Advertising by pharmaceutical companies or drug sellers is frequently the only source of easily available information on medicines. Unbiased consumer information should be made available publicly as a function of the government.
  • A key point from a policy perspective is the inclusion of topics related to antibiotic use and antibiotic resistance in curricula for all human and animal health professionals, as well as for food industry and agriculture professionals.
  • Encourage and enable continuous professional education on resistance and related topics.
  • To achieve sustainable change and promote better understanding and awareness among the general public, it is also advisable to include aspects of infection prevention, antibiotic use and resistance in school curricula from a young age.
  • Arrange a public awareness campaign.

Getting started

A first initiative could be to prepare a campaign for World Antibiotic Awareness Day/Week, which is arranged all over the world in November each year. Materials can be prepared individually by participants or material available from for example WHO can be adapted to local settings. Read more in RAISE AWARENESS: Examples from the field – World Antibiotic Awareness Week.

Engage key stakeholders affected by the problem

As antibiotic resistance is a phenomenon across a whole range of diseases and not a disease in itself, there are very few patient organisations dedicated to the issue. As such, it is important to engage civil society/interest/patient groups in areas that will be affected by antibiotic resistance. Examples of these could be:

  • Cancer societies – Antibiotics are needed to keep infections in check when patients are on chemotherapy.
  • Maternal and child health groups – Antibiotics are life-saving commodities for sepsis and pneumonia in newborns, and needed to prevent or treat infections in for example caesarean sections.
  • Farming associations – Antibiotics are needed to maintain animal health and productivity, but are often used in excess.

These types of organisations can be vital not only to raise awareness of the problem but also help in implementing solutions to manage antibiotic resistance.

Empowering others

As stakeholders become aware of the issue, they can move from being informed towards taking action and influencing others. As an example, consumers are increasingly raising their concern for antibiotic use in the supply chain. The World Consumer Rights Day 2016 focused on pushing the world’s largest fast food companies to make global commitments to stop serving meat from animals routinely given antibiotics used in human medicine. Another example is the multi-stakeholder platform EPRUMA, which was formed to promote the responsible use of antibiotics in animals in the EU. Taking a holistic approach, the Antibiotic Resistance Coalition (ARC), launched an antibiotic resistance declaration in May 2014. The declaration contains 42 recommendations across human health, animal health and the environment that can be used to raise awareness about the many facets of the antibiotic resistance problem.

See also the UNDERSTAND and RAISE AWARENESS focus areas for background information on antibiotic resistance and information and tools for awareness raising campaigns and education.

Selected Resources

Resource Description
WHO Competency Framework for Health Workers’ Education and Training on Antimicrobial Resistance Framework from WHO that outlines core and additional competencies for health workers in regards to antimicrobial resistance, and is a reference guide for academic institutions, educators, accreditation bodies, regulatory agencies and health policy- and decision-making authorities. The purpose is to guide the education and training of health workers.
Revising Preservice Curriculum to Incorporate Rational Medicine Use Topics: A Guide Guide. This SIAPS/USAID document guides stakeholders through the process of integrating rational use of medicines into the curricula for medical, nursing, pharmacy, and public health students. Includes sample documents from successful projects and templates that can be adapted for new initiatives.
Drug Promotion – What We Know, What We Have Yet to Learn – Reviews of Materials in the WHO/HAI Database on Drug Promotion – EDM Research Series No. 032  Report. This WHO document reviews interventions to control the promotion and marketing of drugs as well as methods to evaluate their effectiveness. The document offers a more theoretical framework and describes research into the effectiveness of interventions.
World Antibiotic Awareness Week Campaign. The WHO campaign web site provides a number of resources and campaign material to facilitate activities for world antibiotic awareness week, such as infographics, messages and “how to” guide.
How to improve antibiotic awareness campaigns: findings of a WHO global survey Journal article surveying antibiotic awareness campaigns around the world mainly targeting the general public. Presents information from 60 campaigns and discusses barriers and suggested improvements.
Antibiotic resistance: using a cultural contexts of health approach to address a global health challenge (PDF 1,1 MB) Policy brief that uses a cultural contexts of health approach to explore the effect of culture in the response to antibiotic resistance. The brief examines how the prescription and use of antibiotics, the transmission of resistance, and the regulation and funding of research are influenced by cultural, social and commercial, as well as biological and technological factors. It aims to show how culture can serve as an enabler of health and provide new options for change.
How to improve the use of medicines by consumers (PDF) Guideline from WHO that offers a detailed overview of methods to promote the rational use of essential medicines through public communication. It includes guidance on communication through different channels, such as mass media or local news networks and outlines how communication campaigns can be planned, implemented and evaluated.
Building Coalitions for Containing Antimicrobial Resistance: A Guide Guide from SIAPS/USAID on how to identify key stakeholders for addressing drug resistance, mobilize their support, formulate and implement a plan and subsequently evaluate outcomes. Also provides a number of templates and sample interview forms that can be adapted for different local contexts. An older version is available in Spanish and French.
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Ledingham K, Hinchliffe S, Jackson M, Thomas F, Tomson G. Antibiotic resistance: using a cultural contexts of health approach to address a global health challenge [Internet]. WHO Regional Office for Europe; 2019. Available from: http://www.euro.who.int/__data/assets/pdf_file/0004/394501/WHO_ABR-Policy_8th-Feb_Pages_HiRes.pdf?ua=1
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Huttner B, Saam M, Moja L, Mah K, Sprenger M, Harbarth S, et al. How to improve antibiotic awareness campaigns: findings of a WHO global survey. BMJ Global Health [Internet]. 2019 May 1 [cited 2019 Aug 14];4(3):e001239. Available from: https://gh.bmj.com/content/4/3/e001239
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World Health Organization - WHO. WHO Competency Framework for Health Workers’ Education and Training on Antimicrobial Resistance [Internet]. WHO. 2018 [cited 2018 Jun 30]. Available from: http://www.who.int/hrh/resources/WHO-HIS-HWF-AMR-2018.1/en/
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Chetley A, Hardon A, Hodgkin C, Haaland A, Fresle D. How to improve the use of medicines by consumers [Internet]. World Health Organization - WHO, University of Amsterdam, Royal Tropical Institute, editors. World Health Organization - WHO; 2007 [cited 2016 Mar 16]. Available from: http://www.who.int/drugresistance/Manual2_HowtoImprove.pdf
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Life Saving Commodities. Life Saving Commodities - Improving access, saving lives [Internet]. 2015 [cited 2016 Mar 14]. Available from: http://www.lifesavingcommodities.org/about/lifesaving-commodities/
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Smaill FM, Grivell RM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev [Internet]. 2014;10:CD007482. Available from: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0014480/
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Antibiotic Resistance Declaration. Antibiotic Resistance Coalition [Internet]. 2015 [cited 2016 Mar 14]. Available from: http://abrdeclaration.org/
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European Platform for the Responsible Use of Medicines in Animals - EPRUMA. EPRUMA [Internet]. Home. 2015 [cited 2016 Mar 14]. Available from: http://www.epruma.eu
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Consumers International. WCRD 2016: Antibiotic Resistance [Internet]. World Consumer Rights Day. 2016 [cited 2016 Mar 14]. Available from: http://www.consumersinternational.org/our-work/wcrd/wcrd-2016
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Teillant A, Gandra S, Barter D, Morgan DJ, Laxminarayan R. Potential burden of antibiotic resistance on surgery and cancer chemotherapy antibiotic prophylaxis in the USA: a literature review and modelling study. Lancet Infect Dis [Internet]. 2015 Dec;15(12):1429–37. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26482597
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World Health Organization - WHO. Global Action Plan on Antimicrobial Resistance [Internet]. Geneva, Switzerland: World Health Organization; 2015 [cited 2016 Jan 11]. Available from: http://apps.who.int/iris/bitstream/10665/193736/1/9789241509763_eng.pdf?ua=1
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World Health Organization - WHO. World Antibiotic Awareness Week [Internet]. WHO. [cited 2015 Nov 13]. Available from: http://www.who.int/mediacentre/events/2015/world-antibiotic-awareness-week/en/
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Organisation for Economic Co-operation and Development - OECD. Global Antimicrobial Use in the Livestock Sector [Internet]. Organisation for Economic Co-operation and Development - OECD; 2015 Feb. Available from: http://www.oecd.org/officialdocuments/publicdisplaydocumentpdf/?cote=TAD/CA/APM/WP(2014)34/FINAL&docLanguage=En
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World Health Organization - WHO, Harvard Medical School and Harvard Pilgrim Health. Using indicators to measure country pharmaceutical situations – Fact Book on WHO Level I and Level II monitoring indicators [Internet]. World Health Organization; 2006 [cited 2014 Aug 21]. Available from: http://www.who.int/medicines/publications/WHOTCM2006.2A.pdf
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Systems for Improved Access to Pharmaceuticals and Services. Revising Preservice Curriculum to Incorporate Rational Medicine Use Topics: A Guide [Internet]. Management Sciences for Health; 2013 [cited 2014 Aug 20]. Available from: http://siapsprogram.org/wp-content/uploads/2013/01/Preservice-Curriculum-Final.pdf