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Toolbox  –  Policy

Global Policy

With the onset and fast pace of globalization, global governance helps address issues that affect all countries regardless of borders. Antibiotic resistance is one such threat to the security of people all over the world.

Global policies are often used in advocacy initiatives to remind countries of their global commitment to antimicrobial resistance and to hold governments accountable to track progress towards managing these commitments.

The Sustainable Development Goals (SDGs) are one set of global commitments that include 17 goals that affect all countries and for which global coordination and collaboration are necessary to achieve. It will be impossible to achieve these goals without addressing antimicrobial resistance.

Antimicrobial resistance and antibiotic resistance

Antimicrobial resistance is a wide term that includes resistance in different microorganisms to their respective treatment: Antibiotics for bacterial infections including TB, antivirals for viral infections, antifungals for fungal infections and antiparasitic agents for parasite infections. Global discussions on antimicrobial resistance today are in fact often about antibiotic resistance, as this is the most urgent global risk requiring increased attention and global coordination.

Circle-diagram of the information described in the text.

Antimicrobial resistance global governance timeline

Recent global efforts to address antimicrobial resistance began in 1994 with scientific working groups convened by the World Health Organization (WHO). The WHO released the first global strategy on antimicrobial resistance in 2001. Global uptake was slow and fifteen years later, the WHO released the Global Action Plan on Antimicrobial Resistance. Also released in 2015, were Global Action Plans from the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation of Animal Health (OIE). Together the three organizations are known as the Tripartite.

In 2016, Heads of States, during the United Nations General Assembly (UNGA), signed a political declaration on antimicrobial resistance committing to a broad multisectoral approach. That is, in agriculture, human and animal health – to strengthen regulation of antimicrobials, improve knowledge and awareness, promote best practices and to foster innovative approaches using new technologies in diagnostics and vaccines. This was only the fourth time in history that a health topic was discussed at the UNGA. Shortly thereafter, the UN Secretary General convened the Interagency Coordination Group (IACG) on Antimicrobial Resistance. The IACG submitted their recommendations to the UN Secretary General in April 2019.

IACG Recommendations

The IACG on Antimicrobial Resistance where tasked with outlining a blueprint of how to tackle resistance. The IACG included stakeholders across the UN, international organizations and individuals with expertise in human, animal and plant health, as well as the food, animal feed, trade, development and environment sectors. On 29 April 2019, the IACG completed its mandate upon submission of its report to the Secretary-General. The report included recommendations around five central themes outlined in the box below.

Themes and main recommendations of the IACG

  1. Accelerating progress in countries: Member states need to accelerate their progress on development and implementation of AMR National Action Plans
  2. Innovating to secure the future: Intensify efforts to support research into the development of new antimicrobials, diagnostics, vaccines, waste management tools, and safe and effective alternatives to antimicrobials across the One Health spectrum with sustained investment and the aim of equitable access.
  3. Collaborating for more effective action: Strengthen the systematic engagement of civil society and the private sector to optimize their contributions to the response to antimicrobial resistance, including working with national governments.
  4. Investing for a sustainable response: Develop innovative approaches to mainstream antimicrobial resistance-related activities and leverage resources from existing funding streams, as well as to mobilize new and additional funding including domestic financing commitments by national governments.
  5. Strengthening accountability and global governance: Create a platform that will raise the profile and urgency of addressing antimicrobial resistance; build and maintain political momentum and public support;enable more comprehensive monitoring of the science and evidence related to antimicrobial resistance;ensure accountability among all stakeholders; and recognize the central role of national governments.

Selected Resources

Resource Description
UN Interagency Coordination Group (IACG) on Antimicrobial Resistance Information portal. Information about the work of the IACG and implementation of the IACG recommendations.
No Time to Wait: Securing the future from drug-resistant infections. Report to the Secretary-General of the United Nations Report. Final report from the IACG on Antimicrobial Resistance. Contains five groups of recommendations for global action on antimicrobial resistance. Summary of recommendations and key messages, as well as more detailed IACG discussion papers can be accessed on the same page.
Global Action Plan on Antimicrobial Resistance Global action plan adopted by the World Health Assembly in 2015. Outlines five objectives; improve awareness and understanding of antimicrobial resistance, strengthen the knowledge and evidence base, reduce the incidence of infection, optimize the use of antimicrobial medicines in human and animal health, and develop the economic case for sustainable investment.
When the Drugs Don’t Work – Antibiotic Resistance as a Global Development Problem (PDF) Report from ReAct that describes the negative impact of antibiotic resistance on global and national efforts to eradicate poverty, spur economic growth, reduce inequality, improve global public health, reduce hunger and protect the environment (Sustainable development goals 1, 2, 3, 5, 6, 8, 10, 12, 14 and 15).
Pulling Together to Beat Superbugs Knowledge And Implementation Gaps in Addressing Antimicrobial Resistance Report from the World Bank which highlights the need to re-frame antimicrobial resistance (AMR) as a global development issue. Chapter 3 (p.47) describes key knowledge and implementation gaps (table 1, p. 48) that may stand in the way for effective action. It also contains a framework – based on the expected level of risks (table 3, p. 56) for AMR emergence and spread – that aims to guide countries to suitable interventions (figure 5, p 58; table 4, p. 59).
Drug Resistant Infections: A Threat to Our Economic Future Report from the World Bank that estimates the potential burden of antimicrobial resistance by 2050. See also the infographic for a summary of the economic consequences.
Tackling Drug-Resistant Infections Globally: final report and recommendations Report. The final report from the Review on Antimicrobial Resistance, commissioned by the UK government, provides an overview of the antibiotic resistance problem and provides options for action within different sectors of relevance to resistance. A number of supporting documents and other publications from the Review can be found on the same page.
Briefing paper: Tackling Antibiotic Resistance for Greater Global Health Security (PDF) Policy brief for Chatham House provides an overview of the problem and how it relates to global health security, and also discusses current initiatives and options for action.
Antimicrobial Resistance in the Western Pacific Region: a Review of Surveillance and Health Systems Response Report by WHO (Western Pacific Regional Office) that provides in-depth situational reviews and technical discussions of surveillance, monitoring of use and the health systems response for addressing antimicrobial resistance in the region.
Policies to Address Antibiotic Resistance in Low- and Middle-Income Countries Review of antibiotic resistance policies in LMICs around the world, including a discussion of the specific challenges that these countries face.
Restricting the use of antibiotics in food-producing animals and its associations with antibiotic resistance in food-producing animals and human beings: a systematic review and meta-analysis Review on the effect of interventions restricting antibiotic use in food animal production. Provides evidence that restricting use lowered the presence of antibiotic resistant bacteria in the animals. The appendix lists all studies (2MB) included in the review and provides a quality assessment. (Open access)
Antibiotic resistance – the need for global solutions Journal article on the need for coordinated global initiatives, which must not only address the need for new drugs but also expand access to antibiotics. (Paywall)
Access to effective antimicrobials: a worldwide challenge Journal article that describes the importance of functioning antibiotics. It assesses the disease burden resulting both from antibiotic resistance and limited access to antibiotics, and discusses the potential effect of vaccines to decrease the need for antibiotics. (Register for access)
Antimicrobial policy interventions in food animal production in South East Asia Journal article that describes key policies for tackling antimicrobial resistance (in relation to food animal production) in the South East Asia Region. (Open access)
1.
UN Interagency Coordination Group (IACG) on Antimicrobial Resistance. No Time to Wait: Securing the future from drug-resistant infections [Internet]. 2019 [cited 2020 Jul 3]. Available from: http://www.who.int/antimicrobial-resistance/interagency-coordination-group/final-report/en/
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UN Interagency Coordination Group (IACG) on Antimicrobial Resistance [Internet]. WHO. [cited 2019 Oct 9]. Available from: http://www.who.int/antimicrobial-resistance/interagency-coordination-group/en/
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Berthe FCJ, Wadsworth J, Thiebaud A, Marquez PV, Baris E. Pulling Together to Beat Superbugs Knowledge and Implementation Gaps in Addressing Antimicrobial Resistance [Internet]. The World Bank; 2019 Oct [cited 2020 Jun 4] p. 1–95. Report No.: 142527. Available from: http://documents.worldbank.org/curated/en/430051570735014540/Pulling-Together-to-Beat-Superbugs-Knowledge-and-Implementation-Gaps-in-Addressing-Antimicrobial-Resistance
1.
Laxminarayan R, Matsoso P, Pant S, Brower C, Røttingen J-A, Klugman K, et al. Access to effective antimicrobials: a worldwide challenge. Lancet [Internet]. 2016 Jan 9;387(10014):168–75. Available from: https:/www.ncbi.nlm.nih.gov/pubmed/26603918
1.
World Bank. Drug-Resistant Infections: A Threat to Our Economic Future [Internet]. Washington (DC), U.S.A.; 2017. Available from: http://www.worldbank.org/en/topic/health/publication/drug-resistant-infections-a-threat-to-our-economic-future
1.
World Health Organization - WHO. Antimicrobial Resistance in the Western Pacific Region: a Review of Surveillance and Health Systems Response [Internet]. Geneva, Switzerland: World Health Organization; 2015 [cited 2015 Apr 20]. Available from: https://apps.who.int/iris/handle/10665/208222
1.
ReAct - Action on antibiotic resistance. When the Drugs Don’t Work - Antibiotic Resistance as a Global Development Problem [Internet]. 2019. Available from: https://www.reactgroup.org/wp-content/uploads/2019/02/When-the-Drugs-Don%E2%80%99t-Work-Antibiotic-Resistance-as-a-Global-Development-Problem-Feb-2019.pdf
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Goutard FL, Bordier M, Calba C, Erlacher-Vindel E, Góchez D, de Balogh K, et al. Antimicrobial policy interventions in food animal production in South East Asia. BMJ [Internet]. 2017 Sep 5 [cited 2018 Sep 5];j3544. Available from: http://www.bmj.com/lookup/doi/10.1136/bmj.j3544
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Boonyasiri A, Thamlikitkul V. Effectiveness of multifaceted interventions on rational use of antibiotics for patients with upper respiratory tract infections and acute diarrhea. J Med Assoc Thai. 2014 Mar;97 Suppl 3:S13-19.
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Tang KL, Caffrey NP, Nóbrega DB, Cork SC, Ronksley PE, Barkema HW, et al. Restricting the use of antibiotics in food-producing animals and its associations with antibiotic resistance in food-producing animals and human beings: a systematic review and meta-analysis. The Lancet Planetary Health [Internet]. 2017 Nov 1;1(8):e316–27. Available from: http://www.sciencedirect.com/science/article/pii/S2542519617301419
1.
The Review on Antimicrobial Resistance, chaired by Jim O’Neill. Tackling Drug-Resistant Infections Globally: final report and recommendations [Internet]. 2016. Available from: https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf
1.
Buckland Merrett GL. Briefing paper: Tackling Antibiotic Resistance for Greater Global Health Security [Internet]. Chatham House. 2013 [cited 2016 Jul 7]. Available from: https://www.chathamhouse.org/publications/papers/view/194381
1.
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
1.
Laxminarayan R, Duse A, Wattal C, Zaidi AKM, Wertheim HFL, Sumpradit N, et al. Antibiotic resistance—the need for global solutions. The Lancet Infectious Diseases [Internet]. 2013 [cited 2015 Apr 21];13(12):1057–98. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24252483
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Gelband H, Delahoy M. Policies to Address Antibiotic Resistance in Low- and Middle-Income Countries [Internet]. The Centre for Disease Dynamic, Economics & Policy; 2014 Sep. Available from: http://cddep.org/publications/policies_address_antibiotic_resistance_low_and_middle_income_countries