Countries are making significant steps in tackling antimicrobial resistance (AMR), but serious gaps remain and require urgent action, according to a report of various UN agencies.
The report charts progress in 154 countries and reveals wide discrepancies. Some, including many European countries, have been working on AMR policies in human and animal sectors for more than 4 decades. Others have only recently started to take action to contain this growing threat. Progress in developing and implementing plans is greater in high-income than low-income countries but all countries have scope for improvement. No country reports sustained capacity at scale in all areas.
The report looks at surveillance, education, monitoring and regulating consumption and use of antimicrobials in human health, animal health and production, as well as plants and the environment – as recommended in the Global Action Plan published in 2015.
Promising findings include 105 countries with a surveillance system in place for reporting drug-resistant infections in human health and 68 countries with a system for tracking consumption of antimicrobials. In addition, 123 countries reported that they have policies to regulate the sale of antimicrobials, including the requirement of a prescription for human use – a key measure to tackle overuse and misuse of antimicrobials.
But implementation of these policies varies and unregulated medicines are still available in places such as street markets, with no limits on how they are used. Medicines are very often sold over the counter and no prescription is requested. This puts human and animal health at risk, potentially contributing to the development of antimicrobial resistance.
The report highlights areas, particularly in the animal and food sectors, where there is an urgent need for more investment and action. For example, only 64 countries report that they follow FAO-OIE-WHO recommendations to limit the use of critically important antimicrobials for growth promotion in animal production. Of these, 39 are high-income countries, with the majority in WHO’s European Region. By contrast, only 3 countries from WHO’s African Region and 7 countries from the WHO Region of the Americas have taken this important step to reduce the emergence of antimicrobial resistance.
A total of 67 countries report at least having legislation in place to control all aspects of production, licensing and distribution of antimicrobials for use in animals. But 56 either said that they had no national policy or legislation regarding the quality, safety and efficacy of antimicrobial products used in animal and plant health, and their distribution, sale or use, or that they were unable to report whether they have these policies in place.
There is also a substantial lack of action and data in the environment and plant sectors. Although 78 countries have regulations in place to prevent environmental contamination generally, only 10 of them report having comprehensive systems to ensure regulatory compliance for all waste management, including regulations that limit the discharge of antimicrobial residues into the environment. This is insufficient to protect the environment from the hazards of antimicrobial production.