New WHO report analyzes global response to antimicrobial resistance

A quarter of countries that responded to a WHO survey have national plans to preserve antimicrobial medicines like antibiotics, but many more countries must also step up. A new report, "Worldwide country situation analysis: Response to antimicrobial resistance", which outlines the survey findings, reveals that while much activity is underway and many governments are committed to addressing the problem, there are major gaps in actions needed across all 6 WHO regions to prevent the misuse of antibiotics and reduce spread of antimicrobial resistance.

"This is the single greatest challenge in infectious diseases today," says Dr Keiji Fukuda, WHO's Assistant Director-General for Health Security. "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."

"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."

Dr Keiji Fukuda, WHO's Assistant Director-General for Health Security

Issued a year after WHO's first report on the extent of antimicrobial resistance globally, which warned of a 'post-antibiotic era', this survey—which was completed by 133 countries in 2013 and 2014—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 (TB), malaria and HIV. It summarizes 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," says Dr Fukuda. "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."

Key findings of the report include:

• Few countries (34 out of 133 participating in the survey) have a comprehensive national plan to fight resistance to antibiotics and other antimicrobial medicines.
• Monitoring is key for 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.
• Lack of programmes to prevent and control hospital-acquired infections remains a major problem.

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.

Highlights of report by WHO region

WHO African Region

(8 out of 47 Member States in the region participated in the survey)

• The data in this region are incomplete due to lack of information, however the results suggest that antimicrobial resistance is a growing problem.
• All 8 countries in the region that responded state that resistance to treatments for malaria and TB are their greatest challenges.
• Poor-quality medicines are a general problem, further contributing to the challenge.

WHO Region of the Americas

(26 out of 35 Member States in the region participated in the survey)

• Only 3 countries in the region report having a national, multi-sector plan to address antimicrobial resistance.
• Few countries report having produced a report on surveillance of antimicrobial resistance in humans.
• Antibiotics and other antimicrobial medicines are available over the counter in 18 countries.
• Just 10 countries have standard treatment guidelines.

WHO Eastern Mediterranean Region

(13 out of 21 Member States in the region participated in the survey)

• None of the countries report having a national action plan for antimicrobial resistance.
• Many gaps were found in addressing the issue. This is not surprising, given the other emergencies in the region, including natural disasters and conflicts.
• There is poor awareness and understanding in all public sectors.
• 3 countries have conducted a public information campaign in the previous 2 years.
• Antibiotics and other antimicrobial medicines are available without a prescription in 9 countries.

WHO European Region

(49 out of 53 Member States in the region participated in the survey)

• 40% of countries report having comprehensive plans and strategies to address antimicrobial resistance.
• All EU countries undertake surveillance of resistance in bacteria through the European Antimicrobial Resistance Surveillance Network (EARS-Net), which is facilitated by the European Centre for Disease Prevention and Control.
• About half the countries have a national Infection Prevention and Control (IPC) programme.
• Public information campaigns are common, however about half the population believe that antibiotics are effective against viruses.

WHO South-East Asia Region

(All 11 Member States in the region participated in the survey)

• 5 of 11 countries have national plans to address antimicrobial resistance.
• Monitoring use of antibiotics and other antimicrobial medicines is limited, and these medicines are available without a prescription in more than half the countries.
• 9 of 11 countries have a national IPC programme and the same number have a national regulatory agency responsible for ensuring quality of medicines, but many countries report that health workers comply poorly with prescribing standards and guidelines.
• Public awareness in the region is growing - 5 countries report conducting awareness-raising activities in the previous 2 years.
• Health ministers of the region articulated their commitment to prevent and control antimicrobial resistance through the Jaipur Declaration in 2011.

WHO Western Pacific Region

(26 out of 27 Member States in the region participated in the survey)

• 4 of the reporting countries (17%) have a national action plan.
• Nearly 70% of countries report surveillance for antimicrobial resistance in bacteria; this proportion may increase following introduction of the Western Pacific Antimicrobial Resistance Surveillance system in the near future.
• Two-thirds of the countries report having an IPC programme.
• There is weak enforcement of regulations on the sale of antibiotics and other antimicrobial medicines without prescription and of quality standards.