Highlight 33/2024 – Antimicrobial resistance, priorities and challenges at global and regional governance
Kinga Nadege Koulaouar, 17 September 2024
Almost half a century has passed since the discovery of life saving antimicrobials making surgeries, chemotherapy and other advanced treatments possible. But there is currently a prominent challenge as these medicines are becoming less and less effective. Antimicrobial resistance (AMR) is one of the world largest health and a development challenge with resistance harder to treat, causing death and debilitations of millions of people every year, especially in low and middle-income countries. This increase in drug resistance infections and the associated socio-economic impacts of these infections can turn back years of progress on key sustainable development goals for health, food, poverty alleviation and economic growth. UN sustainable goals will not be achieved if more is not done to reduce the impact of AMR on our health, food security and safety and on our environment.
An end of study project realized in the context of the Master of Advanced Studies in European and Regional Governance has examined AMR priorities and challenges in global and regional governance.
This research found that in global governance, AMR priorities are those indicated in the WHO AMR Global Action Plan (GAP). The GAP has five strategic objectives. GAP was approved by the World Health Assembly in 2015 and has been endorsed by the members of the quadripartite namely, WHO, WOAH, FAO and UNEP. The five strategic objectives includes, (Strategic objective 1) to improve awareness and understanding of antimicrobial resistance through effective communication, education and training, (Strategic objective 2) strengthen the knowledge and evidence base through surveillance and research, (Strategic objective 3) reduce the incidence of infection through sanitation, hygiene and infections prevention measures, (Strategic objective 4) Optimize the use of antimicrobial medicines in human and animal health and (Strategic objective 5) develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investments in new medicines, diagnostic tools, vaccines and other interventions.
The research also found that the GAP is diluted in the four AMR core priorities implemented by the members of the quadripartite namely, WHO, WOAH, FAO and UNEP. Moreover, the work of the quadripartite is complemented by that of the World Bank, UNAIDS and Codex Alimentarius. Which illustrates that AMR core priorities of international organizations involved are indeed crafted in implementation of the WHO GAP.
In regional governance, EU AMR priorities are those enshrined in the new European One Health Action Plan. These priorities take into consideration the objectives of the WHO GAP and those of national actions plans of member states. AMR priorities of the AU are set out in the African Union Framework for Antimicrobial resistance control for 2020-2025 and they do not contradict with the AMR priorities of the GAP as well. But AMR priorities of the EU have some specificities that they do not share with the GAP. The EU is considering the environmental dimension of AMR and develops strategic partnerships with developing countries to tackle the AMR challenge.
In terms of AMR challenges, in global governance previous studies found that the multiplicity of actors involved in the fight against AMR constitutes a challenge. This research reiterates this challenge because although the GAP promotes the adoption of a One Health approach to AMR, the multiplicity of actors constitutes a source of confusion as interventions and responsibilities overlap and resources get spoil. Furthermore, although the involved international organizations handle some important aspects of AMR, they remain generally restricted to one or few dimensions of AMR which is specific to their mandate or area of expertise. And it creates competition among them for accessing funds as well.
In regional governance, AMR challenges of the EU are different from those of the AU. Regarding the EU, one challenge the union is facing is how to handle shortages and ensure availability of antimicrobials, especially authorized and marketed medicine. To this end, the Commission has led down some key actions in the context of the EU pharmaceutical legislation reforms to manage critical shortages in short, medium and long term. Also, regarding the availability Veterinary Medical Products, there is currently no response at EU level. Moreover, raising awareness of the public on AMR challenge remains also a problem.
Concerning the AU, the African continent is facing many AMR specific challenges which includes weak medicines regulatory capacity and the circulation of counterfeit antimicrobials, weak laboratory capacity on AMR testing and reporting, lack of essential laboratory reagents and limited quality insurance and control protocol. Additionally, there is lack of regional framework for collaboration among surveillance of antibiotics resistance programs which hampers efforts to track emerging resistance problems, for instance to identify and contain new antibiotics threats.
Kinga Nadege Koulouar, Highlight 34/2024 – Antimicrobial resistance, priorities and challenges at global and regional governance, 17 September 2024, available www.meig.ch
The views expressed in the MEIG Highlights are personal to the authors and neither reflect the positions of the MEIG Programme nor those of the University of Geneva.