Professor Chantal Morel
University of Bern, ESCMID AMR Action Subcommittee
Professor Holger Rohde
University Medical Center Hamburg Eppendorf, ESCMID AMR Action Subcommitte
Antimicrobial resistance (AMR) demands more than vertical responses. Learn why lasting solutions require health system strengthening, bold governance reform across health, agriculture and environment and sustained global action beyond isolated interventions.
As a global health community, we are confronted by numerous threats to human health and even human existence every decade. When these are particularly worrying, we tend to reshape our global health architecture to organise the response.
Funding, research and implementation of the response start to take on a vertical perspective; to galvanise attention, especially from donors; attempt to incentivise; tailor innovation; and organise swift emergency response and vaccine campaigns. Indeed, it allows us to work nimbly within what is otherwise often a slow and bureaucratic environment. This is crucial for tackling outbreaks and any health-related emergency.
Why AMR demands systemic action
Resistance to antimicrobials is one of the most alarming issues we face today, and our response over the past decade has been very much a vertical one. This has allowed for considerable basic research on antimicrobial resistance (AMR) and to improve awareness amongst global leaders (thanks in large part to the UK). We have also seen major global efforts such as the Global Action Plan on AMR and the completion of a National Action Plan on AMR by almost all countries.
However, given the slow pace of implementation of plans globally and, in particular, prevention of infection, access to even basic antimicrobials (which is essential for stewardship) and governance of use, one must ask whether our downward vertical response to AMR has not reached its limits, similar to what we previously experienced with HIV/AIDS and malaria. Indeed, like these two diseases, action on the ground requires a systemic response. Progress does not happen by parachuting in independent efforts and even resources.
These are efforts that require
long-term political support
and resource allocation.
Essential reform strategies against resistance
Further, since resistance comes about against all anti-infectives — and hence disrupts our treatment strategies across all infectious diseases — it does not lend itself to isolated, discreet solutions. Again, essential reforms like the banning of antimicrobials as growth promoters in agriculture, countering over-the-counter sales and building infrastructure to support good hygiene (eg. latrines, clean drinking water sources) and laboratory diagnosis are unlikely to be achieved in bursts of energy and funding. Rather, these are efforts that require long-term political support and resource allocation.
Strengthen systems, not silos
In sum, while crises such as AMR do require targeted research initiatives, tailored funding streams to develop urgently needed prevention and treatment technologies like vaccines, diagnostics and anti-infectives, our approach on the ground must not be led vertically. We must tackle these through robust health system strengthening and bold governance improvements.
