BACKGROUND: Growing political attention to antimicrobial resistance (AMR) offers a rare opportunity for achieving meaningful action. Many governments have developed national AMR action plans, but most have not yet implemented policy interventions to
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reduce antimicrobial overuse. A systematic evidence map can support governments in making evidence-informed decisions about implementing programs to reduce AMR, by identifying, describing, and assessing the full range of evaluated government policy options to reduce antimicrobial use in humans.
METHODS AND FINDINGS: Seven databases were searched from inception to January 28, 2019, (MEDLINE, CINAHL, EMBASE, PAIS Index, Cochrane Central Register of Controlled Trials, Web of Science, and PubMed). We identified studies that (1) clearly described a government policy intervention aimed at reducing human antimicrobial use, and (2) applied a quantitative design to measure the impact. We found 69 unique evaluations of government policy interventions carried out across 4 of the 6 WHO regions. These evaluations included randomized controlled trials (n = 4), non-randomized controlled trials (n = 3), controlled before-and-after designs (n = 7), interrupted time series designs (n = 25), uncontrolled before-and-after designs (n = 18), descriptive designs (n = 10), and cohort designs (n = 2). From these we identified 17 unique policy options for governments to reduce the human use of antimicrobials. Many studies evaluated public awareness campaigns (n = 17) and antimicrobial guidelines (n = 13); however, others offered different policy options such as professional regulation, restricted reimbursement, pay for performance, and prescription requirements. Identifying these policies can inform the development of future policies and evaluations in different contexts and health systems. Limitations of our study include the possible omission of unpublished initiatives, and that policies not evaluated with respect to antimicrobial use have not been captured in this review.
CONCLUSIONS: To our knowledge this is the first study to provide policy makers with synthesized evidence on specific government policy interventions addressing AMR. In the future, governments should ensure that AMR policy interventions are evaluated using rigorous study designs and that study results are published.
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Together for One Health. Building on the momentum of increased collaboration, the WHO, FAO, OIE and UNEP have developed a Strategic Framework for collaboration on antimicrobial resistance (AMR). This Framework reflects the joint work of the four org
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anizations to advance a One Health response to AMR at the global, regional and country level. It broadly supports the implementation of the five pillars of the Global Action Plan on AMR, as well as strengthening global AMR governance.
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This document outlines the FAO Action Plan on Antimicrobial Resistance 2021–2025 which serves as a roadmap for focusing global efforts to address AMR in the food and agriculture sectors. The aim of this plan is to help accelerate progress in devel
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oping and implementing multi-sectoral National Action Plans to tackle AMR by calling attention to strategic priorities and areas of expertise for FAO support.
Available in English, Arabic, Russian, French, Spanish, Chinese
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This policy brief aims to provide a review of the current progress on implementing the Mali national action plan on AMR, identifies critical gaps, and highlights findings to accelerate further progress in the human health sector. The target audience includes all those concerned with implementing act
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ions to combat antimicrobial resistance in Mali.
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The Quadripartite organizations have developed the One Health Priority Research Agenda for AMR report, this is a joint initiative to assist in directing and catalysing scientific interest and financial investments for the priority research agenda across sectors for countries and funding bodies. The
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research agenda also serves as a guide to mitigate One Health AMR that will help policymakers, researchers, and a multidisciplinary scientific community work together on solutions to prevent and mitigate AMR within the One Health approach.
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This document outlines the concept and content of the WHO people-centred approach to addressing antimicrobial resistance (AMR) in the human health sector. The proposed approach recognizes and aims to address the challenges and health system barriers
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people face when accessing health services to prevent, diagnose and treat (drug-resistant) infections. It puts people and their needs at the centre of the AMR response and guides policy-makers in taking programmatic and comprehensive actions to mitigate AMR in line with a proposed package of core interventions. These interventions are based on a review of four pillars and two foundational steps that are critical to overcome barriers faced by people and health systems in addressing AMR.
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Curriculum reform efforts to enhance training on rational medicine use (RMU) and AMR should pay particular attention to ensuring that the right topics are integrated and the right teaching-learning methodologies are adopted.
The framework is to be used as a reference guide, applied according to local priorities and needs, and targeted at academic institutions, educators, accreditation bodies, regulatory agencies and other users. The ultimate aim is to ensure that all health workers are equipped with the requisite compet
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encies at pre-service education and in-service training levels to address AMR in policy and practice settings.
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The GAP articulates five objectives for tackling AMR, and sets out the tasks required to achieve them, highlighting
roles and responsibilities for country governments, the One Health Tripartite organizations (FAO, OIE and WHO) and other national and international partners. To ensure that all stakeh
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olders assume their roles and responsibilities, and to assess whether they are collectively effecting the necessary change in AMR, the implementation of the GAP needs to be routinely monitored and evaluated. To that end, the Tripartite organizations co-developed a monitoring and evaluation (M&E) framework for the GAP, as outlined in this document
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This guideline provides advice in regards to applications for Marketing Authorisations for antimicrobial veterinary medicinal products (VMPs) on the data required and the methodology to be used for performing an assessment of the risk to public heal
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th from antimicrobial resistance (AMR) due to use of the product. The scope of the guidance extends to VMPs intended for food producing species and to the transmission of AMR by the foodborne route or through direct contact with treated animals.
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This is the first NAP on the Prevention and Containment of AMR in Kenya. It has been developed based on the National Policy on Prevention and Containment of AMR and the recommendations of the situation analysis on AMR conducted in 2011 and updated in 2016. This strategy provides a regulatory and imp
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lementation framework to establish and strengthen systems to contain the emergence and spread of AMR. Implementation of this strategy will require substantial funding and high-level political commitment. Because AMR is a multidisciplinary and intersectoral issue, successful implementation of this strategy will require effective coordination and collaboration among different sectors.
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The second ECDC/EFSA/EMA joint report on the integrated analysis of antimicrobial consumption (AMC) and antimicrobial resistance (AMR) in bacteria from humans and food-producing animals addressed da
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ta obtained by the Agencies’ EU-wide surveillance networks for 2013–2015. AMC in both sectors, expressed in mg/kg of estimated biomass, were compared at country and European level. Substantial variations between countries were observed in both sectors. Estimated data on AMC for pigs and poultry were used for the first time. Univariate and multivariate analyses were applied to study associations between AMC and AMR. In 2014, the average AMC was higher in animals (152 mg/kg) than in humans (124 mg/kg), but the opposite applied to the median AMC (67 and 118 mg/kg, respectively). In 18 of 28 countries, AMC was lower in animals than in humans. Univariate analysis showed statistically-significant (p < 0.05) associations between AMC and AMR for fluoroquinolones and Escherichia coli in both sectors, for 3rd- and 4th-generation cephalosporins and E. coli in humans, and tetracyclines and polymyxins and E. coli in animals. In humans, there was a statistically-significant association between AMC and AMR for carbapenems and polymyxins in Klebsiella pneumoniae. Consumption of macrolides in animals was significantly associated with macrolide resistance in Campylobacter coli in animals and humans. Multivariate analyses provided a unique approach to assess the contributions of AMC in humans and animals and AMR in bacteria from animals to AMR in bacteria from humans. Multivariate analyses demonstrated that 3rd- and 4th-generation cephalosporin and fluoroquinolone resistance in E. coli from humans was associated with corresponding AMC in humans, whereas resistance to fluoroquinolones in Salmonella spp. and Campylobacter spp. from humans was related to consumption of fluoroquinolones in animals. These results suggest that from a ‘One-health’ perspective, there is potential in both sectors to further develop prudent use of antimicrobials and thereby reduce AMR.
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The ECDC, the EFSA and the EMA have for the first time jointly explored associations between consumption of antimicrobials in humans and food-producing animals, and antimicrobial resistance in bacteria from humans and food-producing animals, using 2
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011 and 2012 data currently available from their relevant five EU monitoring networks. Combined data on antimicrobial consumption and corresponding resistance in animals and humans for EU MSs and reporting countries were analysed using logistic regression models for selected combinations of bacteria and antimicrobials. A summary indicator of the proportion of resistant bacteria in the main food-producing animal species was calculated for the analysis, as consumption data in food-producing animals were not available at the species level
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An Action Framework and annexe to Immunization Agenda 2030 (Draft version)
27 January 2021
In 2015, to advance the global and national response to antimicrobial resistance (AMR), the World Health Assembly issued resolution WHA68.7 calling for all Member States to develop AMR national action plans that address the five objectives of the Wo
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rld Health Organization Global Action Plan (GAP) by May 2017. The WHO GAP provides a framework to support countries in developing their national action plans on AMR. To operationalize and accelerate implementation of national action plans on AMR, WHO has developed a costing and budgeting tool and accompanying user guide. The purpose is to support countries in costing prioritized activities of an operational plan linked to their AMR national action plan, and identify existing funding and funding gaps to promote resource mobilization and sustainable implementation. The target audience of the publication are national policy makers and designated costing coordinators for national action plans on AMR.
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Lancet Glob Health 2021 Published Online December 13, 2021 https://doi.org/10.1016/S2214-109X(21)00463-
The purpose of this publication is to to provide a practical, stepwise approach to the implementation of the national action plans on AMR within the human health sector; and to provide a process and collation of existing WHO tools to prioritize, cost, implement, monitor and evaluate national action
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plan activities. The target audience of the publication are national/subnational stakeholders working on AMR within the human health sector. This includes national health authorities, national multi-sectoral coordination groups, senior technical experts and policymakers involved in implementing AMR activities at all levels of the health system, and implementation partners to accelerate sustainable implementation and monitoring and evaluation of national action plans on AMR.
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The aim of this course is to introduce the WHO costing and budgeting tool for national action plans on antimicrobial resistance (AMR). The tool is designed to support operationalization and to accelerate implementation of national action plans on AM
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R.
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