Dr Diane Ashiru-Oredope
Global AMR Lead, Commonwealth Pharmacists Association
Antimicrobial resistance (AMR) is a significant patient safety, public and global health threat. For that reason, it is important to take concerted efforts towards tackling AMR.
The World Health Organization (WHO) endorsed a global action plan on AMR in 2015 and in 2016 193 Heads of States committed for the first time to taking a coordinated approach to address the root causes of AMR across multiple sectors as well as the development and publication of national action plans based on the WHO Global Action Plan on AMR. This was only the fourth time a health issue has been taken up by the UN General Assembly (the others were HIV, non-communicable diseases, and Ebola).
Whilst governments, public health institutes and professional organisations have a key role, all healthcare workers and the public have a role in helping to tackle AMR. Multiple factors, including poor infection prevention and control measures, overuse of antimicrobials, lack of regulatory restrictions to antimicrobial access in the community and overuse and misuse of antimicrobials contribute to the development of AMR.
Applying a one-health approach to AMR
A cross-sectorial, one-health approach is important to tackle AMR as it recognises the interconnectedness of human health, animal health, agriculture and the environment. There is need for concerted effort among nations to mobilise the necessary tools to tackle the threat of AMR. This can be achieved through the development of regulations and guided by a global action plan to tackle AMR.
Having action plans and guidelines are an important first step in influencing clinical practice, as this impacts the direction of change in practice and context in which care is delivered. Although implementation of WHO-level action plans requires engagement of multiple stakeholders and changes at several levels before impact on practice is seen, the guidance set by WHO does have significant direct and indirect influence on care.
Commonwealth policy to tackle AMR
All 53 countries in the Commonwealth signed the UN declaration in 2016. Analysis of the WHO self-assessment survey highlighted progress made by 79% of WHO’s Member States for the period 2017-2018. Commonwealth countries’ progress with national action plans is similar to global progress when comparing the data; 51% of Commonwealth countries had a national action plan compared to 48% of countries globally; 25% of Commonwealth countries compared to 26% of all countries, had a national action plan currently under development; lastly 6% and 5% of Commonwealth countries and all countries had no action plan on AMR, respectively.
A health partnership approach
One way in which we can improve the awareness and understanding of AMR is through taking a health partnership approach. Developed by the UK Tropical Health Education Trust, this approach involves sharing skills and knowledge, bringing together multidisciplinary teams from the NHS and hospitals in four Commonwealth countries. It has a focus on antimicrobial stewardship – including surveillance – infection prevention control and antimicrobial pharmacy expertise and capacity.
The model is based around ideas of co-development between actors and institutions from different countries. The partnerships are long-term but not permanent, and are based on ideas of reciprocal learning and mutual benefits. There is hope that with a collaborative, multi-sectorial approach that brings together global communities we can all play our part in helping to curb AMR.
Ayodeji Matuluko, Chloe Tuck, Sarah Cavanagh, Victoria Rutter (Commonwealth Pharmacists Association (CPA))* Richard Skone-James, William Townsend, Beatrice Waddingham, Louise McGrath, Tropical Health Education Trust (THET); Lauren Sweeney (Fleming Fund), All members of the CwPAMS partnerships in the UK, Ghana, Uganda, Tanzania and Zambia.
*The CPA is a charity dedicated to enhancing the capacity of the pharmacy profession – particularly focused in low resource and disadvantaged settings – to provide safe effective medicines for all