TACKLING DRUG-RESISTANT INFECTIONS GLOBALLY FINAL REPORT AND RECOMMENDATIONS

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Intervention 4:
Improve global surveillance of drug resistance
and antimicrobial consumption in humans and animals
good surveillance, we cannot effectively
“Without
counter the threat that antimicrobial resistance
poses to health systems and people all over
the world. It is also vital that countries work
together to make sure old and new technologies
are rolled out in a way that supports better
global ”One Health” AMR surveillance
including animals and the environment.
”
Yasuhisa Shiozaki, Minister of Health,
Labour and Welfare for Japan
Why we need to act
Surveillance is the foundation of infectious disease management,
yet is often ignored or given less importance than treatment
in the fight against infectious diseases. In our report in March
201663, we showed that information from surveillance systems
would provide benefits at multiple levels. At the local level,
information would help improve patient health. At the national
level, surveillance data would help inform health policies and
responses to health emergencies. Finally, at the global level,
it would provide early warnings of emerging threats and help
identify long–term trends.
Surveillance for AMR should ideally include three strands of
data that need to be analysed in tandem to fully understand
the epidemiology of AMR. The first is monitoring data on
consumption of antibiotics in both humans and animals, which
would give us better information on the extent of antibiotic
use, in which areas, and which would help understand the link
between antimicrobial use and the development of resistance.
The second is data on resistance rates for various drug–bug
combinations and their impact on patients’ health. The third
is molecular biological data to explain the biological basis of
resistance, through characterisation of the types of resistant
bacteria and the genetic reasons for their resistance. This
information should be gathered within a ‘one health’ perspective,
covering animals and humans to provide a complete picture of
consumption and resistance rates as well as the environment,
to monitor base levels of antimicrobial resistance as well as the
impact of antimicrobial manufacturing. Although some of this
will take time, efforts should start urgently.
“At the local level, information would help
improve patient health. At the national level,
surveillance data would help inform health
policies and responses to health emergencies.
Finally, at the global level, it would provide early
warnings of emerging threats and help identify
long‐term trends.
”
What we need to do
We need to continue improving our monitoring and
understanding of infectious disease globally, and ensure that
the surveillance of drug-resistant infections is included in
these systems. To achieve this, action is needed in two ways.
First, the WHO, FAO and OIE, regional bodies and philanthropic
organisations need to continue playing a coordinating role in
developing a global surveillance network and governments
and national authorities need to increase funding to develop
and expand their current networks. Efforts are underway to
improve surveillance of infectious diseases in general and the
monitoring of drug resistance specifically, with important
work being led by the WHO through the Global Antimicrobial
Resistance Surveillance System (GLASS), the OIE through their
database on use of antimicrobials in animals with the support of
FAO and WHO, regional blocs, and philanthropic organisations
such as the Institut Pasteur and the Gates Foundation, with
wide international networks on the ground. Countries have
also increased funding in this area recently, in particular the US
government via the Global Health Security Agenda (GHSA), and
the UK Government with its announcement last year of the 265
million GBP (375 million USD) Fleming Fund – the latter being a
direct response to early recommendations made by this Review.
These initiatives, as well others, aim to increase international
cooperation, and support capacity-building in low-income
countries. But huge gaps need to be addressed if we are to have
comprehensive, reliable information on the development and
spread of drug resistance globally and how it is affecting patients.
Second, governments and globally-representative bodies need
to find ways to incentivise and remove barriers to safe, secure
and appropriate sharing of data of use to global surveillance
efforts. One particular challenge is to ensure that health systems,
doctors and researchers are able to make the most of the ‘big
63 Review on AMR, Infection prevention, control and surveillance: Tackling the development
and spread of resistance, 2016.