Antimicrobial resistance — when bacteria stop responding to and become resistant to antimicrobial medications — is a global public health emergency with a substantial economic impact. Resistant bacteria, sometimes called superbugs, already claim 700,000 lives annually worldwide. If left unchecked, the death toll could reach 10 million per year by 2050, according to a recent United Nations report. The World Bank estimates associated global health care costs could increase more than $1 trillion per year by 2050.
Antimicrobial resistance has increased rapidly in recent years, especially in countries where regulations that control antibiotic prescription and use in humans and animals are weak or nonexistent. The complexity of preventing and controlling antimicrobial resistance calls for multisectoral collaboration and a coordinated biological, behavioral and governance response.
Laboratory data are at the forefront of effective surveillance and evidence-informed responses for epidemic-prone diseases and antimicrobial resistance. These data help us identify the cause of an infection, the biological mechanism through which an infection becomes resistant to antimicrobials, and the susceptibility of an infection to those antimicrobials. Laboratory networks are rightfully a key component of global efforts like the Global Health Security Agenda (GHSA).
FHI 360 understands the critical value of laboratories and fosters a One Health approach across our projects. We collaborate with local partners and host governments to strengthen detection and surveillance of priority diseases within the laboratory network, as well as work to support accreditation, referral and supply chain networks, data analysis and reporting, and rapid response capabilities for emerging infectious disease outbreaks like Ebola, Chikungunya, Zika, and most recently, COVID-19.
Our antimicrobial resistance response work — through both the Infectious Diseases Detection and Surveillance (IDDS) project, funded by the U.S. Agency for International Development in Africa and Asia, and the Fleming Fund Country Grants in Nepal and Vietnam — has yielded positive results. For example, within a year of project implementation in Nepal, the number of laboratories able to report quality antimicrobial resistance data to the national system grew from one to six laboratories. Data reports increased sixfold and led to Nepal reporting data to the World Health Organization’s Global Antimicrobial Resistance Surveillance System (GLASS) for the first time.
Behavioral and governance responses
Defeating antimicrobial resistance requires more than a biological response. We must also foster sustained behavior change among consumers and prescribers of antibiotics for humans and animals using intervention approaches informed by research. Better stewardship efforts are needed to effectively control over-the-counter dispensation of antimicrobials like antibiotics. In addition, we must create adequate demand for diagnostic laboratory services and then empower laboratory professionals to deliver timely, reliable results that build consumer and prescriber confidence.
To ensure the sustainability of laboratory surveillance and behavior change efforts, it is equally important to promote country ownership and to strengthen local governance. Strong local leadership is needed to develop policies for integrated preventive strategies that include monitoring antibiotic use in livestock and agricultural industries as well as monitoring wastewater and other environmental contamination. Global organizations, like FHI 360, can and do play a key role in leveraging tools, technologies and innovations to map existing gaps and identify resources at regional and global levels to facilitate development and implementation of critical policies.
We can prevent and control antimicrobial resistance. To do so, we must work together to strengthen laboratory networks, to change how we prescribe and use antibiotics, and to develop policies that coordinate and drive a comprehensive response.