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Major partnerships are essential to address antimicrobial resistance A global health partnership between countries is now an international priority. Infectious disease transcends borders, cultures, and demographics, leaving long-term devastating effects. Antimicrobial resistance is now widely recognised as a major threat to global health security. Infections caused by resistant bacteria can be endemic, or can occur as an epidemic. Bacteria that have evolved to become resistant to existing drugs can lead to life-threatening infections with few or no treatment options. They can spread rapidly around health-care facilities, move across borders, and jump continents. Although warnings about antimicrobial resistance were first raised more than 50 years ago, the problem has escalated into a global crisis. WHO and the Global Health Security Agenda (GHSA) have prioritised combating antibiotic resistant bacteria on a global level.1,2 A recent important development is the endorsement of a global action plan for antimicrobial resistance at the 69th World Health Assembly in May, 2015.2 Global surveillance is one of the core pillars of this action plan because without such surveillance we cannot even begin to understand the extent of the problem, its geographical reach, or the effect on our populations, health-care systems, and economies. The starting point is to address the huge gap in surveillance capabilities identified in 2014 by the WHO’s first global report on surveillance of antimicrobial resistance.3 To address this gap, WHO’s action plan is being implemented in phases from early 2016 onwards, gathering information from an initial set of countries with institutional capacities to implement the programme, assessing that information while enabling other countries to collect and analyse information, and making progress www.thelancet.com/lancetgh Vol 4 April 2016
with other phases of data analysis and developing policy responses at the global, regional, and national level. Full implementation will need a few years of collaborative effort. To achieve the best possible results, we need to understand the different conditions prevailing across developed and developing economies. The 2014 WHO global report showed that many countries do not have the capacity or systems to undertake surveillance of antimicrobial resistance, with data deficiencies in large parts of the world, existing systems remaining largely uncoordinated, and data being shared infrequently. Although some regional systems and global diseasespecific systems exist, no overall global system for surveillance of antimicrobial resistance exists to bridge the gaps, pool data from all sources, and do analyses to better understand the problem and drive effective solutions.4 The efforts at WHO also need to be supplemented by other initiatives that are already addressing some of these issues. In December, 2014, in Stockholm, Sweden, WHO, along with its member states and partner organisations, proposed an agreed set of standards for surveillance of antimicrobial resistance.5 These standards list the priority bacteria and diseases for surveillance; explain the metrics to be used to ascertain the incidence of resistance; and advise how the data should be collected, reported, and analysed. Recently the proposed standards were published as a manual: the Global Antimicrobial Resistance Surveillance System (GLASS) for all countries to collaborate in the surveillance of antimicrobial resistance. 6 GLASS should be coordinated with a national action plan on antimicrobial resistance prior to participation. The programme requires active participation and input of partners around the world—in local health-care facilities, national laboratories, ministries, and regional networks. It will even reach out beyond the health sector to capture
data about antimicrobial resistance wherever it is occurring. Both the UN Food and Agriculture Organization and the World Organisation for Animal Health are joining WHO to ensure the integration of data from the human and animal health sector and from the agriculture and food industries.2 WHO will invite countries to join the GLASS via an open call at their website. Effective implementation requires the needs of low-income and middleincome countries to be addressed, their workforces to be trained to do surveillance, and improvement of their access to the microbiology laboratory. Achievement of these targets needs time but is key to adequately deal with the disease burden of healthcare-associated infections and antimicrobial resistance. The benefits of addressing antimicrobial resistance are global. Therefore, developed nations must help developing countries to equip themselves for such an initiative and to identify steps that might be relevant for diverse conditions. An important relevant initiative was taken at a recent Asian Pacific Economic Coalition and Global Health Security Agenda meeting, which outlined several key components for establishing robust infection prevention and control infrastructure.7 One of them— promotion of hand hygiene using alcohol-based handrub at the point of patient care—has received much attention in both developed and developing countries because of the major infection prevention effect of this simple technique that can be costeffectively launched in low-income and middle-income countries.8 For greater reach and possibility of earlier implementation, the initiatives taken by governments can be combined with public–private partnerships. Additionally, new resistance in a pathogenic bacterium with no treatment options should be notifiable under International Health Regulations to relevant authorities and control measures must be implemented
For the GLASS website see http://www.who.int/ drugresistance/surveillance/en/
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without delay. 9 This approach will work only if the new systems developing across the world, both regionally and globally, are connected and share a common approach to build synergies and partnerships for robust and effective systems. I declare no competing interests. Copyright © Singh. Open Access article distributed under the terms of CC BY.
Nalini Singh
[email protected] Children’s National Health System, George Washington University, Washington, DC, 20010, USA 1
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United States Department of Health and Human Services. The global health security agenda. https://ghsagenda.org/packages.html (accessed March 3, 2016). WHO. Global action plan for antimicrobial resistance. http://www.who.int/ drugresistance/global_action_plan/en/ (accessed March 3, 2016). WHO. Antimicrobial resistance: global report on surveillance. 2014. http://www.who.int/ drugresistance/documents/surveillancereport/ en/ (accessed March 3, 2016). WHO. Additional global, regional, national strategies and plans for antimicrobial resistance. http://www.who.int/ drugresistance/global_action_plan/General_ and_national_plans_amr_Dec_2014.pdf (accessed March 3, 2016). Public Health Agency of Sweden. Surveillance for antimicrobial resistance for local and global action. http://www.folkhalsomyndigheten.se/ amr-stockholm-2014/ (accessed March 3, 2016). WHO. Global antimicrobial surveillance system. Manual for early implementation. http://apps.who.int/iris/bitstream/10665/ 188783/1/9789241549400_eng.pdf?ua=1 (accessed March 3, 2016). 2015 APEC Health and Economy Ministerial Meeting Joint statement. http://www.apec. org/Meeting-Papers/Sectoral-MinisterialMeetings/Health/2015_health_hlm.aspx (accessed March 3, 2016). WHO. Clean care is safer care. http://www.who. int/gpsc/en/ (accessed March 3, 2016). WHO. Strengthening health security by implementing international health regulations. 2005. http://www.who.int/ihr/en/ (accessed March 3, 2016).
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