Sustaining action against antimicrobial resistance together

Antimicrobials play a central role in medicine, underpinning our ability to not only respond to infectious diseases but also to conduct a host of medical procedures, including life-enhancing surgeries, cancer chemotherapy, and organ transplantation. Alarmingly, however, many antimicrobials have lost their effectiveness due to antimicrobial resistance (AMR): the ability of microbes – bacteria, viruses, fungi, and parasites – to evolve in ways that protect them from the medications intended to eliminate them.

While AMR is a naturally occurring evolutionary process, human-led behaviors have rapidly increased its emergence and spread. The main drivers of AMR include:  the misuse and overuse of antimicrobials; lack of access to clean water and adequate sanitation for people and animals; poor infection prevention and control measures in healthcare facilities and farms; limited access to quality, affordable medicines, vaccines, and diagnostics; and lack of awareness and knowledge about AMR.

The impact has been drastic: Infections are harder to treat, and the risk of severe illness and death is rising. In 2019, almost 5 million deaths were associated with AMR, with the highest burden in western Sub-Saharan Africa at an estimated 27 deaths per 100,000 people. AMR is a critical development challenge and a global health security concern that left unchecked will disproportionately affect low- and middle- income countries, hampering progress towards the Sustainable Development Goals. 

Global and regional partnerships to tackle AMR

In recognition of the threat posed by AMR, countries around the world endorsed the World Health Organization’s (WHO) Global Action Plan on AMR at the 68th World Health Assembly in 2015, and committed to developing and implementing their own national action plans (NAPs) on AMR.

While countries are at various stages of progress, very few have fully implemented all the activities outlined in their NAPs, signaling a need for more comprehensive and coordinated support from partners at the national and global levels. This is partly due to the complex nature of AMR, which calls for a multisectoral or One Health approach, as well as financial constraints that hinder sustainable implementation of NAP activities.

To raise awareness of these issues, the theme for this year’s World Antimicrobial Awareness Week  is “Preventing Antimicrobial Resistance Together.” In line with this theme, WHO and the World Bank recognize the need to work together to better support countries as they strive to address the growing threat of AMR. The two organizations are united as technical and operational partners, ready to draw upon their comparative advantages to collectively provide countries with comprehensive support.

The World Bank is actively involved in supporting countries to address AMR through both AMR-sensitive initiatives – such as strengthening health, water, or agricultural systems – and AMR-specific initiatives. In West and Central Africa, the World Bank is supporting 16 countries through the Regional Disease Surveillance Systems Enhancement (REDISSE) Project, which aims to address systemic weaknesses within the animal and human health systems that hinder effective cross-sectoral and cross-border collaboration for disease surveillance and response. At the same time, the project supports countries to develop enhanced surveillance and information systems, strengthen laboratory capacity, advance the workforce capacity, and establish active and functional One Health national platforms.

Developing and implementing national action plans

In the joint WHO-World Bank report, Sustaining Action Against Antimicrobial Resistance: A Case Series of Country Experiences, we showcase recent country experiences in developing and implementing NAPs for AMR. The countries in the report – Sierra Leone, Burkina Faso, Jordan, and Malawi – provide examples of meaningful actions that can be taken to address AMR regardless of a country's technical capacity or stage of NAP implementation. These are some of the examples:

• Sierra Leone utilized the WHO Costing and Budgeting Tool for NAPs on AMR to develop a costed operational plan to help mobilize resources for sustainable implementation of prioritized AMR activities.
• Burkina Faso’s AMR Committee enacted several key actions to address AMR, including strengthening surveillance, ensuring safer antimicrobial prescribing practices, and improving water and sanitation, highlighting the important role of a dedicated governance structure to drive action on AMR.
• Malawi’s AMR National Coordinating Committee played a critical role in coordinating government ministries, implementation partners, and civil society organizations and was successful in raising public awareness, ensuring safer prescribing practices, and strengthening infection prevention and control measures in health facilities.
• In Jordan, AMR and antimicrobial consumption surveillance systems helped identify targeted actions for antimicrobial stewardship interventions, including guidance and regulations aimed at ensuring safer prescribing practices among healthcare workers.

The findings and recommendations of the report will be used in our work at the World Bank and help motivate greater action on AMR by showing countries entry points for action and by highlighting opportunities for resource mobilization for sustainable implementation of AMR action plans.  

You can download the full report here.