Series prioritises human cost, stressing infection prevention, affordable antibiotic access and attainable containment goals
The Lancet series underscored the importance of assessing how interventions and investments can apply to low- and middle-income countries, where the burden of AMR is greatest. Photo for representation: iStock The world’s leading medical journal The Lancet released a new series on antimicrobial resistance (AMR) on May 23, 2024. The series focused on interventions and investments that can guide decision-making to achieve sustainable access to effective antibiotics and accelerate progress in addressing AMR.
Authored by leading global experts on AMR from multiple institutions, the series comprised a collection of six papers: An executive summary, four research papers and a commentary.
The series reflected on key areas such as the human cost of AMR, prioritising infection prevention and control (IPC), access to effective and affordable antibiotics, and achievable targets to contain AMR — keeping in mind the differing priorities of the developed and developing worlds.
It underscored the importance of assessing how interventions and investments can apply to low- and middle-income countries (LMIC), where the burden of AMR is greatest. “The series argues that the overarching problem is the high overall burden of bacterial infection and that AMR is a symptom of global health inequities that are not addressable by an agenda focused on high-income countries,” said The Lancet in the editorial in the series.
The first of the four papers scoped out the challenge of AMR, which is a critical barrier to the achievement of the United Nations-mandated Sustainable Development Goals. It recognised that improving access to effective antibiotics and addressing AMR are critical to achieving global goals for child survival and healthy ageing.
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It further emphasised the need for robust and actionable data to support action, change and interventions to contain AMR.
The second paper presents a review of evidence and modelling analysis to show how the burden of bacterial AMR in LMICs can be averted using existing interventions such as improved water, sanitation and hygiene (WASH), vaccines and better infection, prevention and control strategies.
The modelling analysis provided estimates of preventable AMR-associated deaths in LMICs annually based on three classes of interventions — at least 337,000 deaths could be prevented if IPC programmes in healthcare settings of LMICs are improved, 247,800 deaths could be prevented by ensuring universal access to high quality WASH facilities and 181,500 deaths could be prevented by ensuring universal access to pediatric vaccines.
Overall, about 18 per cent of AMR-associated deaths in LMICs annually can be prevented across these three intervention classes. Interestingly, the analysis indicated that 10 per cent reduction in global AMR burden is possible by utilising these existing tools. “These interventions could prevent more than 750,000 deaths associated with bacterial AMR each year in LMICs, with additional health and societal benefits,” said the editorial.
The third paper recognised that tackling AMR requires investment in new antibiotics, vaccines and diagnostics, and that access to both new and existing antibiotics, vaccines, and diagnostics is crucial. It outlined that innovation should be focused on the needs of populations in LMICs.
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The paper reflected on three approaches in view of achieving sustainable access to affordable antibiotics — reducing the cost of antibiotic development, preserving antibiotic effectiveness and preventing infections. It discussed how these could be achieved while at the same time looking at the challenges and potential of scaling up these efforts.
In the fourth paper in the series, the authors argued for the importance of setting targets to elicit political commitment and accelerate progress in AMR mitigation. They proposed the 10-20-30 targets for 2030 against 2019 baseline, as mentioned below:
While these are global targets, national targets may vary depending on the local context, current situation and feasibility of reductions (in mortality or antibiotic consumption) in the human and animal sectors. It also called for the establishment of an independent panel on evidence and support of leaders from LMICs to ensure oversight and accountability.
In an additional profile section in the series, Ramanan Laxminarayan, founder and president of public health research organisation One Health Trust and one of the co-authors, was quoted as saying, “The main thing we're trying to do is reframe this issue as one of sustainable access to effective antibiotics.”
“It's about people having access to antibiotics that really work when they need them. And that requires thinking about resistance, access, stewardship, and how we use antibiotics. And it also involves thinking about ways in which we can prevent infection, so that we don't have to have antibiotics, and we don't have to worry about AMR in the first place,” he added.
Released ahead of the upcoming high-level meeting of the UN General Assembly scheduled in September 2024, the findings from the series is expected to provide crucial data, evidence, and policy recommendations that would serve as the cornerstone for a UN resolution addressing AMR.
The series will be presented at a side event at 2024 World Health Assembly in Geneva.
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