“This is the single greatest challenge in infectious diseases today,” said WHO Assistant Director-General for Health Security Dr. Keiji Fukuda. “All types of microbes—including many viruses and parasites—are becoming resistant to medicines. Of particularly urgent concern is the development of bacteria that are progressively less treatable by available antibiotics. This is happening in all parts of the world, so all countries must do their part to tackle this global threat.”
Issued a year after WHO’s first report on the extent of antimicrobial resistance globally, which warned of a "post-antibiotic era," the survey is the first to capture governments’ own assessments of their response to resistance to antimicrobial medicines used to treat conditions such as bloodstream infections, pneumonia, tuberculosis, malaria and HIV. It summarized current practices and structures aimed to address the issue, and shows there are significant areas for improvement.
“While there is a lot to be encouraged by, much more work needs to be done to combat one of the most serious global health threats of our time,” Fukuda said. “Scientists, medical practitioners and other authorities including WHO have been sounding the warning of the potentially catastrophic impact of ignoring antibiotic resistance. Today, we welcome what has been achieved so far, but much more needs to be done to avoid losing the ability to practise medicine and treat both common and serious illnesses.”
The report found monitoring is key to controlling antibiotic resistance, but it is infrequent. In many countries, poor laboratory capacity, infrastructure and data management are preventing effective surveillance, which can reveal patterns of resistance and identify trends and outbreaks.
Sales of antibiotics and other antimicrobial medicines without prescription remain widespread, with many countries lacking standard treatment guidelines, increasing the potential for overuse of antimicrobial medicines by the public and medical professionals. Public awareness of the issue is low in all regions, with many people still believing that antibiotics are effective against viral infections.
WHO says that the lack of programs to prevent and control hospital-acquired infections also remains a major problem in the fight against antimicrobial resistance.
Only three out of 35 countries in the WHO Americas region report having a national, multi-sector plan to address antimicrobial resistance. Few countries in this region have produced a report on surveillance of antimicrobial resistance in humans. Furthermore, antibiotics and other antimicrobial medicines are available over the counter in 18 countries in the Americas region.
The WHO European region fares better with 40 percent of the 53 countries reporting comprehensive plans and strategies in place to address antimicrobial resistance. About half of the countries have a national infection prevention and control program.
All EU countries undertake surveillance of resistance in bacteria through the European Antimicrobial Resistance Surveillance Network (EARS-Net), which is facilitated by the European Center for Disease Prevention and Control.
But more needs to be done at the public level inthis region. Public information campaigns are common, however, about half the population believe that antibiotics are effective against viruses.
WHO reports that awareness and monitoring is increasing in the South East Asia region, and that a high level of surveillance but low level of regulations enforcement was found in the Western Pacific region.
Of most concern are the regions of Africa – from which only eight of the 47 countries participated in the survey, and the Eastern Mediterranean. Inconclusive data from Africa due to the low number of respondents makes it difficult to draw any conclusions but the countries that responded reported poor quality medicines and resistance to malaria and tuberculosis as their biggest challenges.
The Eastern Mediterranean region, which includes Afghanistan, Egypt, Iran, Lebanon and Syria, reported several problems. None of the 13 countries that responded to the survey reported having a national action plan for antimicrobial resistance, and many gaps were found in addressing the issue – hardly surprising given the other emergencies in the region including natural disasters and conflict. In addition, public awareness is poor and antibiotics are available without prescription in nine ofthe region’s countries.
WHO, countries and partners have developed a draft Global Action Plan to combat antimicrobial resistance, including antibiotic resistance, which has been submitted to the sixty-eighth World Health Assembly, taking place in May 2015.
Governments will be asked to approve the plan and, in doing so, declare their commitment to address a problem that threatens global health as we know it. One essential step in implementing the Global Action Plan would be the development of comprehensive national plans in countries where they are now lacking and further develop and strengthen existing plans.