The rising threat of antimicrobial resistance: A discussion on what happens when diseases defeat medicines

On July 16, Management Sciences for Health (MSH), in conjunction with the office of Congressman Ami Bera (D-CA), hosted “The rising threat of antimicrobial resistance: What happens when diseases resist the drugs that we’ve designed to fight them?” to discuss antimicrobial resistance (AMR), its consequences, and the efforts needed to fight it. This event, the second in a series on global health security funded by the James M. and Cathleen D. Stone Foundation, brought together global health security experts, including members of the US Agency for International Development (USAID) and global health organizations.

To kick off the morning, MSH Senior Technical Director Jacob Hughes reminded the audience that AMR causes 2 million illnesses in the US and claims the lives of 700,000 people worldwide each year. Mr. Hughes highlighted the work of the USAID-funded Medicines, Technologies, and Pharmaceutical Services (MTaPS) program to help develop, implement, and monitor national action plans and disseminate best practices to combat AMR. MSH’s ongoing work in the fight against the spread of AMR also includes strengthening pharmacovigilance systems, improving capacity and availability of local experts, and instituting disease surveillance systems.

The keynote speaker, USAID Senior Infectious Disease Strategy Advisor Richard Greene, delved deeper into the complexities of AMR, explaining why it is such a significant global health security issue: “Antimicrobials can become ineffective, common medical procedures become high risk, the gains of disease-specific programs can be undermined. But AMR is not just a health issue. In many countries, the use of antimicrobials is largely uncontrolled and unmonitored, especially in the animal health sector. ” Mr. Greene indicated that combating AMR requires a holistic and multisectoral approach—a “One Health” approach—because of the interconnectedness of human health, animal health, and the environment.

A main thread during the conversation was the capacity to leverage progress across countries. Congressman Bera highlighted this point at the start of his remarks by indicating that historically, progress has always been achieved with the creation and enforcement of public health measures. Speaking about the recent measles epidemic in various countries, including Madagascar and the United States, he called for a better way to provide information domestically and globally. He added that global health security can’t be achieved through donations alone but by strengthening the capacity of countries to do the work themselves.Mr. Greene also noted the importance of facilitating progress by referencing the Global Health Security Agenda (GHSA) Action Packages, which are a way to facilitate global and regional collaboration toward specific GHSA objectives and targets.

Members of the panel discussion, moderated by Loyce Pace, President and Executive Director of the Global Health Council, presented the different faces of AMR. Chris Collins, President of the Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, indicated that AMR is dangerous in all forms, but TB alone accounts for more than one in four AMR-related deaths and poses a serious threat to global health and economic development. “Multidrug-resistant TB is more contagious than Ebola, with equally high mortality rates, and yet too many cases go undiagnosed and for those with access to treatment, adherence is a huge challenge.”

Building on his comments, Willo Brock, Senior Vice President, External Affairs, for the TB Alliance, emphasized some of the barriers that keep people from seeking help. “If many people in your environment suffer from TB and you start coughing, you should be advised to go to the doctor. But if you’re going to be put on treatment for 20 months, facing isolation, with chances of suffering from adverse drugs events and economic distress for your family, your survival instinct will tell you not to seek treatment.” Mr. Brock called for stronger investments in faster detection methods and treatments that will help save not only lives but also money and resources for health institutions and patients.

Closing the panel, MTaPS Technical Director Javier Guzman focused on essential points to combat AMR, including enforcing legislation, policies, and guidelines; building coalitions; and changing behaviors, and he reminded the audience that two-thirds of antimicrobials are given without prescriptions. He also mentioned the need for stronger accreditation standards for private drug shops. He finished his remarks by emphasizing the fundamental role of access to good information: “Countries need better health information, which includes quality data for better supply planning and patient management.”

From fostering the creation of public-private partnerships to improving livestock and agricultural practices, sustained action and awareness are critical to fighting the spread of AMR. As Mr. Collins said, “Whichever way we look at it, we need to be talking about health systems. The end game with infectious diseases requires a strong health system.”