Antimicrobials are an extraordinary medical advancement that have treated people against deadly infections since the early 20^th century. However, an overdependence on them and widespread misuse have led to an urgent and growing global health crisis: antimicrobial resistance (AMR), when bacteria, viruses, fungi, and parasites no longer respond to antimicrobial medications.

In 2019, the World Health Organization declared AMR as one of the top-ten global health priorities, and it is crucial that interventions to slow the spread continue even during the COVID-19 pandemic.

There are actions that health workers and individuals can immediately take to help slow the spread of AMR, such as prescribing antibiotics with discretion and taking them as directed. At IVI, we and our partners are working directly with health institutions and governments to develop systemic solutions to tackle the root causes of AMR spread and emergence.

The challenge: low- and middle-income countries heavily rely on antimicrobials for medical, nutritional, and economic security

AMR poses a disproportionate threat in low- and middle-income countries (LMICs) due to a greater lack of clean water and sanitation infrastructure, and subsequently, a higher prevalence of disease transmission and treatment. Additionally, (mis)use of antibiotics in both healthcare and in food production, often to compensate for suboptimal animal-food farming practices, can further exacerbate the development of AMR.

Good policy needs good data

IVI and its consortium of partners are conducting multi-country efforts to identify gaps in data and evaluate and increase available data on AMR and antimicrobial use (AMU). Evaluating both historical and current data is crucial to inform prospective surveillance efforts because data informs effective policy.

Through three separate Fleming Fund Regional Grants, funding provided by the UK government, IVI and partners are working with LMICs across Asia and sub-Saharan Africa to identify, evaluate, and create a demand for quality data to advance effective policymaking . Why is this important? Reliable and timely data is needed to generate the evidence to convince policy makers to invest in sustainable solutions to AMR.

Expanding the volume of historical and current data on antimicrobial resistance and usage in Asia

The IVI-led CAPTURA consortium was awarded two out of four Fleming Fund Regional Grants to work with 12 countries in South and South East Asia to collect and analyze historical and current data on AMR and AMU in the human health sector in these countries:

Nepal: Expanding the AMR network

In Nepal, the CAPTURA team added 36 potential lab sites to develop a regional AMR network, including the private sector, with ongoing capacity and quality assessments. The next steps are data collection and analysis.

Papua New Guinea: Building capacity in data management and reporting

In Papua New Guinea, the CAPTURA team led trainings for data collection, and digitized and presented lab data from 2016-2019 for policy. The team is continuing to collect pharmacy data.

Sharing AMR data to inform and drive effective policymaking

IVI and its consortium of partners are also spearheading an effort to catalyze regional AMR data sharing and analysis to influence regional and global policies for sustained commitment to AMR control. The RADAAR project (Regional AMR Data Analysis for Advocacy, Response, and Policy) aims to conduct data analysis, visualization, and advocacy for regional sharing and use of data in policy, planning, and practice in the Fleming Fund priority countries across Asia and .

Using a One Health approach that involves both the human and animal health sectors, the project will engage with the intersecting issues of antimicrobial resistance (AMR), antimicrobial use (AMU), and antimicrobial consumption. Extensive and close engagement with country stakeholders is planned for 2021 through a series of regional data sharing and policy workshops.

Strengthening external quality assurance (EQA) programs across reference labs in Asia

The Technical University of Denmark’s National Food Institute is leading an effort with IVI to improve the quality of AMR surveillance in the Asia region. Through EQASIA (Strengthening External Quality Assurance for AMR in Asia), we mapped the coverage, availability and uptake of EQA programs across One Health sectors in Asia, and will continue to strengthen EQA services in National Reference Labs.

Why is EQA important?

Quality-assured data is essential for developing nuanced treatment guidelines and tailored strategies to prevent the emergence and spread of drug-resistant infections.

Hear from our experts:

Dr. Marianne Holm (MH, left), Project Lead of CAPTURA, and Satyajit Sarkar (SS, right), Policy and Advocacy Lead of RADAAR, weigh in on the challenges of containing the spread of AMR and what we must do to develop sustainable solutions.

Why is AMR considered a global health crisis?

MH: AMR is present in all parts of the world with the potential to affect anyone of any age. Due to AMR, an increasing number of bacterial infections, such as pneumonia and tuberculosis, are becoming harder to treat as the pathogens causing these infections become resistant to regular antibiotic treatment. This leads to longer hospital stays, higher medical costs, and more deaths. Unless we take urgent action, AMR could cause an estimated 10 million deaths every year by 2050, making it one of today’s major threats to global health as well as to food security and development.

Why is there so little data on the regional and global prevalence of AMR?

SS: Today, due to substantial investments in surveillance capacity-building by the Fleming Fund and others, large quantities of data are being generated on AMR across low- and middle-income countries. However, to meaningfully translate any of this AMR (or antimicrobial use and consumption) data into reliable estimates of: the prevalence of AMR, the mortality and morbidity attributable to AMR, the speed or rate of emergence and spread of AMR, and the effectiveness of policies and actions, all the data must be quality-assured, and this is what is in short supply.

Why is AMR a particular challenge in low- and middle-income countries?

MH: LMICs have a higher burden of infectious diseases, largely due to limitations in health and sanitation infrastructure, as well as a higher dependence on antibiotic use in agriculture and food production. With higher disease prevalence comes higher antibiotic use or misuse, which can lead to resistant bacteria—or, “superbugs.” At the same time, limited financial resources and technical capacity make it difficult to conduct AMR surveillance in these countries. So, in addition to tackling the spread of AMR, working on developing sustainable solutions to track and understand its impact is crucial.

What does AMR stewardship look like?

SS: Conserving the efficacy of the current set of available antimicrobials, till new drugs are developed, is a key policy option for responding to AMR. In the context of human health, antimicrobial stewardship (AMS) is a potentially powerful strategy, and generally best implemented in hospital settings. Hospital clinicians work in close consultation and collaboration with the microbiology lab team and a designated antimicrobial steward (usually a senior and experienced clinician). The overall goals of any AMS initiative are to:

• work with health care practitioners to help each patient receive the most appropriate antimicrobial with the correct dose and duration
• prevent antimicrobial overuse, misuse, and abuse
• minimize the development of resistance

How do vaccines help contain the spread of AMR?

MH: Vaccines reduce the use, and subsequently, mis-use, of antibiotics by preventing infection in the first place. As we have seen with the uptake of Haemophilus influenza B and Streptococcus pneumoniae vaccines, vaccination has been associated with decreased incidence of resistant bacterial strains. Preventing infection is always preferable to treating it, making vaccines a critical first line of defense to staying healthy and reducing the spread of AMR.