A survey conducted by the World Health Organization finds most countries do not yet have a comprehensive national plan to tackle drug resistance – a year after the organization warned that we are heading toward a “post-antibiotic era.”
In a new report released Wednesday, the World Health Organization (WHO) revealed that only 34 of 133 countries that participated in the survey have composed a plan to address the increasing problem of bacterial resistance to antibiotics and other drugs.
Drug resistance, also referred to as antimicrobial resistance, is when microorganisms – such as bacteria and viruses – evolve and develop the ability to prevent antimicrobial medications, such as antibiotics and antivirals, from killing them.
“This is the single greatest challenge in infectious diseases today,” says Dr. Keiji Fukuda, assistant director-general for health security at WHO. “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.”
Methicillin resistant Staphylococcus aureus (MRSA) is just one of the many bacteria that have developed drug resistance. Most commonly acquired in health care settings, MRSA is responsible for more than 80,000 infections and is related to more than 11,000 deaths a year in the US.
“This is happening in all parts of the world,” says Dr. Fukuda, “so all countries must do their part to tackle this global threat.”
In April last year, WHO released the first global report on antimicrobial resistance after assessing data from 114 countries. Based on their findings, the organization declared antimicrobial resistance as a “major threat to public health” and stated that we are headed toward a “post-antibiotic era” if no action is taken.
This latest report is the first to assess governments’ response to the issue of antimicrobial resistance through a survey involving 133 countries from all six WHO regions: the African Region, the Region of the Americas, the Eastern Mediterranean Region, the European Region, the Southeast Asia Region and the Western Pacific Region.
While the majority of countries have yet to construct a national plan for antibiotic resistance, the report reveals that the countries that have are in the more wealthier regions, such as Europe.
Of the 49 Member States in the WHO European Region that participated in the survey, 40% had put together an antibiotic resistance action plan, while none of the countries in the Eastern Mediterranean Region and African Region who participated had made an action plan, though data for these regions is incomplete.
“The findings from the survey indicate that progress in this area is needed in all regions,” say WHO “including in countries with strong health care systems.”
Talking to Medical News Today, Dr. Charles Penn, coordinator of antimicrobial resistance at WHO, said the fact that so few countries have put together a national action plan suggests that the effect drug resistance can have on public health is being underestimated.
“One of the challenges that we face with antibiotic resistance is that it is not a disease in its own right,” he told us. “When people have an infectious disease, it’s not always immediately obvious to people that it has flared up because the antibiotics are failing. If you look at surveillance data, you can clearly see what the failure of antibiotics leads to – there are much higher mortality rates and you can see this on a case-by-case basis.”
As such, Dr. Penn believes an important part of getting people to realize the seriousness of drug resistance is to present them with such data. “That is what we did last year with the global surveillance report,” he added, “to really draw attention to just how widespread this is and what it’s doing to health.”
The report also reveals that the majority of countries surveyed lack treatment guidelines for the sale and use of antibiotics, which may increase misuse and overuse of antibiotics – a primary driver of drug resistance.
“The sale of antimicrobial medicines without prescription was widespread, and many countries lacked standard treatment guidelines for health care workers,” notes the report. “Thus, overuse of antimicrobial medicines by the public and by the medical profession was a potential problem in all regions.”
What is more, public awareness of antibiotic resistance was found to be low across all six regions. WHO state that even in countries that had launched public awareness campaigns, there was widespread belief that antibiotics could be used for viral infections, such as colds.
“This situation is alarming,” state WHO, “particularly in countries where antimicrobial medicines are readily available without a prescription.”
Lack of awareness surrounding antibiotic resistance was also identified among health care professionals, politicians, the media and academics – though academics were most aware of the problem.
Commenting on this finding, WHO say:
“The general lack of awareness in these sectors would indicate that antimicrobial resistance is likely to spread further. Without sufficient awareness, the appropriate regulations and standards will not be legislated, and other sectors will lack the information needed to implement them effectively.”
The survey also found that few countries are surveilling antibiotic resistance effectively. While surveillance was found to be high in the European Region – where antibiotic resistance is monitored through the European Antimicrobial Resistance Surveillance Network (EARS-Net) – such monitoring was found to be low throughout most other regions.
WHO say effective monitoring of antibiotic resistance is key to identifying trends and outbreaks, but that in many countries, such monitoring is let down by poor laboratory capacity, infrastructure and data management.
Another problem the report highlights is the lack of programs to prevent and control hospital-acquired infections, such as MRSA. WHO note that while half the countries in the European, Southeast Asia and Western Pacific regions that responded to the survey had a national infection and control program, such programs had not been applied to all hospitals.
“Poor infection control in any setting can greatly increase the spread of drug-resistant infections, especially during outbreaks of disease,” states the report. “Infection prevention and control programs are thus essential to curb the movement of antimicrobial-resistant organisms, starting with good basic hygiene, which limits the spread of all infections, including those that are resistant to antimicrobial medicines.”
WHO say that overall, the results of the survey indicate that some countries have shown they are committed to addressing the problem of drug resistance, though the findings also show much more needs to be done.
“Scientists, medical practitioners and other authorities including WHO have been sounding the warning of the potentially catastrophic impact of ignoring antibiotic resistance,” says Dr. Fukuda. “Today, we welcome what has been achieved so far, but much more needs to be done to avoid losing the ability to practice medicine and treat both common and serious illnesses.”
Working with a number of partners, WHO have created a Global Action Plan to tackle drug resistance, which will be reviewed at the 68th World Health Assembly in May. Governments worldwide will be asked to approve the plan and commit to addressing the issue.
WHO say the plan sets out five strategic objectives for governments:
- To improve awareness and understanding of antimicrobial resistance
- To gain knowledge of antimicrobial resistance through surveillance and research
- To lower infection incidence
- To improve the use of antimicrobial drugs
- To ensure sustainable investment is made into combatting antimicrobial resistance.
Dr. Penn told MNT that he really believes the review of the Global Action Plan next month will encourage all countries to take action against antibiotic resistance.
“Although many countries do not yet have an action plan, all countries come to the health assembly,” he said. “At the health assembly last year, there was a resolution adopted asking us to develop a suitable action plan. That resolution wasn’t just adopted by member states, but something like a third of the countries that make up the health assembly actually started the resolution – a much stronger endorsement than expected.”
“I think that is a very strong indication that countries at a government level do see this as an important health problem and they are looking for a global effort and guidance and support to take this forward.”