Reducing overuse of antibiotics is key, but equally important is ensuring access to these essential medicines for those in need.
Access to antibiotics varies globally and is dependent on a number of factors, including medicine prices, a country’s regulatory framework and robustness of the health system. Lack of access to certain antibiotics is a global problem today.
Regulations to control the distribution and use of antibiotics can help to minimize the development of resistance and conserve the effectiveness of this non-renewable resource. However, limited access to effective treatment in many low- and middle-income countries compromises health, as well as animal welfare, health and productivity. This results in increased suffering, health care and societal costs.. While limiting the sale of antibiotics to prescriptions may seem like an easy solution and functions well in some countries, enforcing prescription-only laws may cut off access to antibiotics for parts of the population, particularly in rural areas and in resource-limited settings that lack access to healthcare and prescribers.
Monitoring access
An important factor in the availability of antibiotics is the price of medicines, both in the health and agriculture sector. In the former, survey methodology for measuring medicine prices, availability, affordability and price components has been developed and tested in over 50 countries.
Essential medicines lists
The WHO model list of essential medicines “presents a list of minimum medicine needs for a basic health-care system, listing the most efficacious, safe and cost–effective medicines for priority conditions. Priority conditions are selected on the basis of current and estimated future public health relevance, and potential for safe and cost-effective treatment”.
The WHO Model List of Essential Medicines provides guidance for the development of national and institutional essential medicine lists. The WHO list promotes health equity and aims to assure the availability of quality, affordable and effective medicines for treatment of widespread or high-priority diseases.
WHO Antibiotic Categorization – Access, Watch, Reserve (AWaRe)
WHO provides advise on which antibiotics to use to treat common bacterial infections, and which antibiotics to save for severe disease. It categorizes antibiotics into 3 groups based on the potential to induce and propagate resistance:
- ACCESS: Antibiotics that should be available at all times, at an affordable cost and of good quality. Example: amoxicillin, widely used to treat pneumonia.
- WATCH: Antibiotics that are recommended as first- or second-choice treatments for a limited set of infections. These are more prone to be a target of antibiotic resistance and thus prioritized as targets of stewardship programs and monitoring
- RESERVE: Antibiotics that should only be used as the last resort for highly selected patients. Should be closely monitored and prioritized as targets of stewardship programs to ensure their continued effectiveness.
Having an essential medicines list can result in higher quality of care, better management and use of medicines and more cost-effective use of resources. In countries where essential medicines policies have been implemented to coordinate long-term interventions at multiple levels of their health systems, a reduction in antibiotic use has been shown. Clear standard operating procedures on drug procurement and ensuring first line antibiotics are available and used correctly can improve public and private sectors.
Improving logistics and supply chain management
To secure access to medicines, a well-functioning supply system is required. Functional supply chains can promote public and animal health by increasing program impact, enhancing quality of care, improving cost effectiveness and efficiency. The supply chain of pharmaceutical products relies on several activities including product selection, quantification and procurement, and inventory management, storage and distribution. To ensure that these activities are performed in an effective and efficient manner, logistic management information systems, organization and staffing, budgeting, supervision and evaluation are all key components. Working with improvement of pharmaceutical management can ensure proper access to antibiotics, but it can also create the right preconditions for appropriate use of antibiotics and ensure quality of antibiotics in the market.
Selected Resources
Tools and methodology
| Resources | Description |
| WHO Model Lists of Essential Medicines | Guidelines. The WHO EML provides advise on which antibiotics should be available to treat bacterial infections. To assist rational use, it categorizes antibiotics into 3 groups: Access, Watch and Reserve. There are separate lists for adults and children. Also provides a database visualizing the essential medicines lists of different countries and their compatibility to WHO’s EML. |
| Policy and regulatory interventions to address antibiotic shortages in low and middle-income countries | Report. A stepwise approach to addressing antibiotic shortages is presented. This is based on a review of regulatory and policy measures by National regulatory authorities and other stakeholders like ministries of health and procurement agencies, to address antibiotic shortages. |
| MedMon – WHO Essential Medicines and Health Products Price and Availability Monitoring Mobile Application | Mobile app from the WHO. Enables measurements and monitoring of the price and availability of medicines. For both online and offline use. See also related publication Measuring medicine prices, availability, affordability and price components. Collecting data in this format facilitates national and international comparisons of medicine use. |
| Knowledge Portal on Innovation and Access to Medicines | Information portal. Open access knowledge hub from the Graduate Institute, with information, analysis and research synthesis on policies relating to innovation and access to pharmaceuticals. Presents materials under 3 overarching themes: Pricing, Intellectual Property and Innovation. |
| Procurement and Supply Management Toolbox | Information portal. WHO AIDS Medicines and Diagnostics Service (AMDS) set up an online platform to improve access to procurement and supply management (PSM) tools. It provides a searchable database of available PSM tools. |
| Access to medicines and health products | Information portal of the World Health Organization, with several resources for access issues. |