A new global survey has found that more than 90% of the world's population now live in a country that has developed or is working on a national action plan to combat antimicrobial resistance (AMR).
The survey, conducted in November 2016 by the World Health Organization (WHO), the United Nations Food and Agriculture Organization (FAO), and the World Organization for Animal Health (OIE), also found that most countries that have implemented or are developing an AMR action plan are taking a One Health approach to the issue, addressing antibiotic use in both humans and animals.
The creation of national AMR action plans was an important element of the global action plan put forward by the WHO in 2015 to address the emerging AMR crisis. It called for individual countries to create multi-sectoral action plans to improve public awareness and understanding of AMR, increase surveillance of drug-resistant organisms, reduce the incidence of infection through improved sanitation and hygiene, promote antimicrobial stewardship in human and animal health, and increase investment in new antibiotics, vaccines, and diagnostics.
The United Nations General Assembly's political declaration on AMR in September 2016 called on countries to commit to accelerating the development and implementation of these plans. The survey is part of an effort by the WHO, FAO, and OIE to measure the progress that countries are making in meeting their commitments.
Some countries further along
The survey asked countries to assess progress in developing national AMR action plans, working with multiple sectors, and implementing key actions to address antimicrobial resistance. The self-assessment questionnaire also included questions on progress in human health, animal health, crop production, food safety, and the environment. The questionnaires were answered by 142 countries
While a majority of countries have at least begun the process of developing national AMR action plans, some are clearly farther ahead than others. Twenty-nine countries (20%)—including the United States, Australia, South Africa, Brazil, and several European Union nations—have either approved or implemented a multi-sectoral plan to address AMR that reflects the objectives of the WHO's global action plan and have an operational plan and monitoring arrangements in place. Only a handful of those countries, however, have identified funding sources to maintain those efforts.
More than one-third (34%) of the countries that responded to the survey have developed a national action plan that addresses human health, animal health, and other sectors, but have not yet established an operational plan or monitoring arrangements. Another 31% have a plan under development or a plan that involves only one sector. Twenty countries (14%) have no national action plan.
All of the countries without an action plan are low-income nations, the majority of them in Africa. That concerns Ren Wang, PhD, FAO assistant director-general for agriculture and consumer protection.
"Low- and middle-income countries are particularly vulnerable to the devastating effects of AMR, a complex problem that requires coordinated action on a number of fronts in diverse sectors, supported by solid laboratory and epidemiological and regulatory capacity," Wang said in an FAO news release.
In particular, many of these countries lack the resources to collect data on the extent of antibiotic use in animal agriculture and track the occurrence of drug-resistant pathogens in their food systems. The widespread use of antibiotics in animal agriculture is widely seen as contributing to the emergence of antibiotic-resistant pathogens that are transmitted to humans via food and the environment.
The FAO says it's working with governments in many low- and middle-income countries to improve their ability to monitor the use of antibiotics and the spread of AMR organisms in food and agriculture.
A lack of resources also affects the ability of countries to reign in human antibiotic use, the other major driver of drug-resistance. The survey shows that nearly a third of the responding nations—mainly low- and middle-income countries in Africa, Latin America, and Southeast Asia—have no system for monitoring antibiotic use in human health.
The FAO says that since the November 2016 survey, more countries have either finalized their AMR action plans or begun implementing them.
The Inter-Agency Coordination Group, a body formed to provide guidance to countries and ensure sustained global action on AMR, will report back to the UN on global progress in 2019.
Nov 17 FAO news release