A Global Antimicrobial Conservation Fund for Low- and Middle-Income Countries

Abstract

On 21 st September 2016, for only the 4 th time in history, a health topic will take centre stage at a United Nations General Assembly (UNGA) high-level meeting where heads of state are present. A day-long session has been convened to discuss the global threat from the lack of access to antimicrobials and from increasing antimicrobial resistance (AMR). The main focus will be on antibiotic resistance. The involvement of the UN underlines the significance of this threat to public health, food security, global economic growth, and progress towards the 2030 Sustainable Development Goals. 1 Like climate change, AMR depends on effectively managing global public goods and common resources, in this case antimicrobials, whose use drives resistance, and thereby deprives others of their benefits. Such management requires interdependent action in three areas: conservation, access and innovation (figure 1).Akin to the reduction in use of fossil fuels to curb pollution levels that impact on climate, conserving antimicrobials to limit development of resistant microbes, thereby ensuring the continuation of their efficacy for all in need, is a critical strategic response. This must occur in parallel with existing efforts to promote greater, appropriate access to antimicrobials for the millions of people who currently, unfairly face disease without them. Simultaneously, reigniting a dormant antimicrobial research and development (R&D) pipeline to produce new classes of antimicrobials is equally important to renew this crucial man-made resource. The formation of DNDi/WHO's drug accelerator program, the Global Antibiotic Research and Development (GARD) Partnership 2 , as well as new funding streams like Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB-X) 3 and the nascent Global Antimicrobial Resistance Innovation Fund (GAMRIF) 4 are welcome and timely initiatives. However, if we are to ultimately reverse or indeed decelerate our new reality of the post-antibiotic era, then antibiotic conservation is going to need to take centre stage in an overarching strategy for AMR control, while we wait for new products to be developed, and even once we have them. This will be an ever-lasting battle, which will require strong conservation policies to be put in place permanently.Much of the global overuse of antimicrobials occurs in low-and middle-income countries (LMICs), topped by the BRICS nations (Brazil, Russia, India, China and South Africa) driving consumption in both animal and human sectors. 5 In general, an increased demand for animal protein accompanies the transition from low to higher incomes 6 and is currently met by more intensive farming

Global trends in antimicrobial resistance in animals in low- and middle-income countries

“…Second, our findings clearly indicate that the highest levels of AMR in animals are currently found in China and India where immediate actions could be taken to preserve antimicrobials that are essential in human medicine by restricting their use in animal production. Third, high-income countries, where antimicrobials have been used on farms since the 1950s, should support transition to sustainable animal production in LMICs-for example, through a global fund to subsidize improvement in farm-level biosafety and biosecurity (37). 9.…”

Human resources estimates and funding for antibiotic stewardship teams are urgently needed

“…The need for a global funding mechanism to address human resources for stewardship, infection prevention and other non-drug development measures has been highlighted [10], but remains elusive. Although more keenly felt in low-and middle-income countries, we believe that it is pertinent to all countries, as sustainable protected time for stewardship activities is often lacking.…”

Sociodemographic Aspects of Antibiotic Consumption Practices in Residents of Wah

“…Over prescription from clinicians, just to be 'on the safe side' and sometimes in response to patients' demand result in the development of the perception in the general public that antibiotics are necessary and safe for symptoms 23 of nonbacterial diseases. Furthermore, injudicious use of antibiotics in developing countries is the result of patients' past experiences, high cost of health care, non-regulatory sale, insufficient knowledge, demanding unneeded antibiotics, misperception 4,16,17,[24][25][26] and also self-medication. Sources of selfmedication may comprise taking leftover drugs from treatment courses prescribed earlier or using antibiotics given to friends family for similar 27 symptoms.…”

“…High connectivity between countries have resulted in the spread of resistant bacteria. Much of the overuse of antimicrobials, chiefly antibiotics, is reported in LMICs, especially in BRICS (Brazil, Russia, India, 17,18 China, & South Africa) nations.…”

“…Pakistan's close proximity with China and India makes it more vulnerable to this leading global health issue. Pakistan and other LMICs will be facing a massive challenge of the double burden of disease due to 17,19,20 antibiotic resistance.…”