Dr Mary R. Couper, Essential Drugs and Medicines Policy, WHO
Deaths from acute respiratory infections, diarrhoeal diseases, measles, AIDS, malaria and tuberculosis account for more than 85% of mortality from infection worldwide. Resistance to first-line drugs in the pathogens causing these diseases ranges from zero to almost 100%. In some instances resistance to second- and third-line agents is seriously compromising treatment outcome. In addition, there is a significant global burden of resistant hospital-acquired infections, emerging problems of antiviral resistance, and increasing problems of drug resistance in the neglected parasitic diseases of poor and marginalized populations.
Resistance is not a new phenomenon. However, the development of new families of antimicrobial drugs in the 1950s and 1960s and of modifications of these molecules through the 1970s and 1980s led many to believe that we could always remain ahead of the pathogens. By the turn of the century this complacency had evaporated. The pipeline of new drugs is running dry and the incentives to develop new antimicrobials to address the global problems of drug resistance are weak.
In 1998, a World Health Assembly resolution urged Member States to develop measures to encourage appropriate and cost-effective use of antimicrobials, to prohibit the dispensing of antimicrobials without a prescription from a qualified health care professional, to improve practices to prevent the spread of infection and thereby the spread of resistant pathogens, to strengthen legislation to prevent the manufacture, sale and distribution of counterfeit antimicrobials and the sale of antimicrobials on the informal market, and to reduce the use of antimicrobials in food-animal production. Countries were also encouraged to develop sustainable systems to detect resistant pathogens, and to monitor the volumes and patterns of use of antimicrobials as well as the impact of control measures.
Since then, many countries have expressed growing concern about the problem of antimicrobial resistance and some have developed national action plans to address it. Despite the mass of literature on antimicrobial resistance, there is little on the true costs of resistance and the effectiveness of interventions. Given this lack of data in the face of a growing realization that actions need to be taken now to avert future disaster, the challenge is what to do and how to do it.
The WHO Global Strategy for Containment of Antimicrobial Resistance takes up this challenge. It provides a framework of interventions to slow the emergence and reduce the spread of antimicrobial-resistant microorganisms through:
• reducing the disease burden and the spread of infection;
• improving access to appropriate antimicrobials;
• improving use of antimicrobials;
• strengthening health systems and their surveillance capabilities;
• enforcing regulations and legislation;
• encouraging the development of appropriate new drugs and vaccines.
The strategy highlights aspects of the containment of resistance and the need for further research directed towards filling the existing gaps in knowledge. The strategy is people-centred, with interventions directed towards those who are involved in the problem and need to be part of the solution, i.e. prescribers and dispensers, veterinarians, consumers, policy-makers in hospitals, public health and agriculture, professional societies and the pharmaceutical industry.
The strategy addresses antimicrobial resistance in general rather than through a disease-specific approach, but is particularly focused on resistance to antibacterial drugs. Much of the responsibility for implementation of the strategy will fall on individual countries.
Governments have a critical role to play by making the containment of antimicrobial resistance a national priority and by introducing regulations on the use of antimicrobials. Finally, international cooperation is essential and collaboration between governments, nongovernmental organizations, professional societies and international agencies, in acknowledging the importance of antimicrobial resistance and in implementing strategies to contain it, must be encouraged.