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International Responses to the Emerging Threat of Antimicrobial Resistance

The problem of antimicrobial resistance (AMR) is not confined to a few countries but rather is a challenge that affects the entire world. The extent and pattern in which antimicrobials are utilised can, however, have a significant impact on the degree of urgency or severity of the condition. The problem has gradually but steadily extended to every single country in the globe, posing a threat to the safety of human, animal, and plant health as well as the security of food production. The consistent rise in the consumption of antibiotics in both the human and animal sectors raises serious concerns about a future in which not a single antibiotic will be available for the treatment of even the most prevalent bacterial diseases.

The drivers of AMR are present in human health, animal production, environment, and plant production sectors. Therefore, the problem requires joint and global efforts to address the challenge. In this pursuit, the first and foremost step is to measure the extent of the problem in different sectors. There is a coordinated effort underway to address this potential calamity including a wide range of international organisations. In response to the impending socioeconomic concerns of AMR, the World Health Organization (WHO) in its 68th World Health Assembly (WHA) adopted the Global Action Plan (GAP) on antimicrobial resistance, which was jointly developed by WHO, the Food and Agriculture Organization (FAO) and the World Organization of Animal Health (OIE).1 This action plan emphasizes the importance of a sustainable “one health” strategy for cooperation between multiple worldwide sectors and actors, including human and veterinary medicine, agriculture, the environment, finance, and informed consumers.

The global action plan on antibiotic resistance specifies the following five strategic goals:1

(1) To improve AMR awareness understanding among the general population

(2) To utilize effective surveillance for generating evidence

(3) To minimise the disease and infection events

(4) To regulate the usage of antimicrobial agents in the human and animal sector

(5) To invest in research and development to counter antimicrobial resistance

For as long as practicable, the action plan aims to maintain access to effective medicines for treating and preventing infectious diseases, with the availability and accessibility of safe and quality-assured drugs which are used responsibly by all those who require their usage.

All 194 WHO Member States are urged by the World Health Assembly decision to align their National Action Plan on Antimicrobial Resistance (NAP) with GAP-AMR. The United Nations General Assembly’s High-Level Meeting on AMR further reinforced the commitment of global leaders to address AMR.2 Many countries have operationalised NAP-AMR; however, a few underdeveloped nations are in the midst of developing effective and fully functionalised NAP.3

These international bodies have operationalised surveillance and monitoring of AMR and Antimicrobial usage (AMU) at regional and integrated information at global. WHO started the Global Antimicrobial Surveillance System (GLASS) in 2016 to collect official data on AMR and AMU.4 As of May 2021, 109 countries are enrolled in this surveillance system and sharing data, however, there are limited countries contributing data on AMU.5 Antibiotic usage is the major driver for AMR, therefore information on its extent of usage can provide valuable insight on its influence on the problem.

Another surveillance program was started in 2005 by WHO as the WHO-Global Salmonella Surveillance system which was later renamed as Global Foodborne Infections Network (GFN).6 Surveillance was committed to enhancing the capacities of countries to detect respond and prevent foodborne and other enteric infections from farm to table. The network work with countries to build national capacities for integrated surveillance and promote collaboration among various sectors. The network has also developed manuals and protocols for the detection of various pathogens, Antibiotic sensitivity testing (AST) protocol and molecular detection methods for the implementation of surveillance systems in and harmonised manner.7