A 12-year-old schoolboy from Southern California dies of pneumonia caused by a bacterial infection. A 25-year-old pharmacy worker from England nearly succumbs to sepsis as a result of a urinary tract infection. An Egyptian businessman beats leukemia only to be infected with a resistant type of E. coli. Each of these stories is a real life example of the devastating impact of one of the biggest threats to global health in our world today — antibiotic resistance.
Despite the concern of clinicians and scientists over decades, and some progress in recent years, antimicrobial resistance has become one of the most serious global health threats of modern times. Although awareness of antimicrobial resistance is moving beyond the medical and scientific world in many countries, the reality is still inadequate surveillance and information, poor public understanding and insufficient infection prevention and control.
Antibiotic resistance is rising to dangerously high levels in all parts of the world. But only about one-quarter of countries have national plans to tackle resistance to antimicrobial medicines like antibiotics. This is far too few.
Antibiotics have long been regarded as one of the most significant medical achievements of the 20th century. They have transformed the course of human health. By allowing many serious infections to be cured, these medicines have saved countless lives, including those with diseases such as cancer or diabetes and people undergoing surgery — all of whom are particularly vulnerable to infections. Antibiotics have become so widely used that they are taken for granted by doctors and patients alike. Often, they are used when they are not needed. Unfortunately, this has accelerated the development of resistance.
Bacteria and other bugs develop resistance naturally to the medicines used to treat them. The combined use and misuse of antibiotics has accelerated the development of antibiotic resistance, leading to the situation in which we find ourselves today, with record high levels.
In the European Union alone, the inability to treat some infections is responsible for 25,000 deaths annually, with related costs of over $1.5 billion in health care expenses and productivity losses. It is set to get a lot worse.
In the face of this situation, sustained global and national leadership; commitment from all stakeholders, including the public and those in health, agriculture, business and civil society; and coordination and collaboration across sectors — particularly between human and animal health and agriculture — are critical to ensure that actions are complementary rather than duplicative or conflicting. The need for sustained commitment and action cannot be overemphasized because this is not a one-time battle to be won, but a long-term challenge.
In 2014, at the request of the World Health Assembly, the World Health Organization initiated a process that brought together stakeholders to develop a global action plan to combat antimicrobial resistance. This action plan — which represents the collective work of countries and partners representing multiple sectors, including the U.N. Food and Agriculture Organization and the World Organization for Animal Health, and civil society — has just been adopted by governments at the World Health Assembly. It will provide a much-needed global “blueprint” in which each stakeholder can see where their contribution is needed.
To implement the plan, governments have committed to deliver across five key areas:
1. Improve awareness and understanding of antibiotic resistance among populations. 2. Improve surveillance and research. 3. Reduce the spread of infection through effective sanitation, hygiene and infection prevention measures. 4. Optimize the use of antibiotics in human and animal health. 5. Increase innovation and investment.
Each of these areas is critical. The goal is not to stop using antibiotics, but to catalyze the changes needed to make sure they are only used when necessary. At the same time, we need to get better at encouraging the development of new medicines, new vaccines, better bedside diagnostics and other technologies. It is time to shift to approaches where research and development risks and benefits are shared more broadly and governments increase their investment in R&D.
We also need to look at health systems, which are key for ensuring fair access to medicines. Lab workers must have the equipment needed to diagnose infections rapidly, health workers must get the training they need to treat infections in line with national guidelines, and antibiotics must be accessible to those who have a health need for them.
Attitude and behavior change are needed at every level of society and in every country. As individuals, we can make a difference by preventing the spread of infections, for example, by washing our hands frequently, by using antibiotics only when prescribed, and by not sharing antibiotics. Health workers can improve infection control in hospitals and clinics and can prescribe antibiotics only when necessary. Policymakers must enable change by regulating and promoting appropriate use of antibiotics, increasing awareness and rewarding innovation. The health care industry needs to ensure new antibiotics, vaccines and diagnostics are part of their investments.
There are no simple, quick-fix solutions. But with rising political attention and adoption of the global action plan, the opportunity to finally bring antibiotic resistance under control is within reach.
Keiji Fukuda is the assistant director-general for health security at the World Health Organization. Fukuda has extensive public health and research experience working on influenza. At WHO, he has helped shape the global approach to pandemic preparedness, helped manage the response to the influenza H1N1 pandemic, strengthened surveillance, and played an instrumental role in facilitating intergovernmental discussions over the sharing of influenza viruses and related benefits. He has participated in many field investigations including the earliest outbreaks of avian H5N1 influenza and the emergence of SARS.
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