Convening Experts to Examine the Critical Underpinnings of Antimicrobial Resistance Strategies
Scenarios of a post-antibiotic society are dire and include massive, highly preventable loss of life, widening socio-economic disparities, and significant economic shortfalls. Estimates of the potential economic impact of antimicrobial resistance (AMR) could be as large as a global annual GDP shortfall of nearly $3.4 trillion by 2030 and $7 trillion by 2050.[i] Currently, 700,000 people die every year due to drug-resistant infections globally.[ii]
AMR is driven, in part, by pathogens being exposed to sub-therapeutic doses of medicines, which may be caused by several factors, including:
- Treatment errors by healthcare professionals
- Non-adherence by patients to appropriate prescriptions or treatment guidelines
- Poor-quality medicine
USP and many public health leaders from around the world recognize that quality-assured medicines play a critical role in helping to address AMR. Specifically, the strategies currently discussed to address AMR focus on investing in the development of new medicines, the appropriate use of existing medicines, and ensuring affordable access to antimicrobials. However, if medicines quality is not assured, these strategies could, at best, be less effective than hoped, and at worst, accelerate the emergence of resistance. USP has therefore been working with many stakeholders, including several country governments, to raise the level of awareness of the importance of the link between poor-quality medicines and AMR.
To advance this dialogue, USP, COFEPRIS (Mexico), FDA Ghana, and the Ministry of Health of the Republic of Indonesia cohosted an expert panel discussion on the sidelines of this year’s United Nations General Assembly (UNGA). The session, Quality Medicines: Critical Underpinnings of All AMR Strategies, explored this link with thought leaders from around the globe. The discussion was moderated by Dr. Ramanan Laxminarayan, Director and Senior Fellow at the Center for Disease Dynamics Economics & Policy, and I was joined on the panel by:
- Mrs. Delese Mimi Darko, CEO, FDA Ghana,
- Dr. Hajime Inoue, Senior Advisor to the Director-General and Representative for Antimicrobial Resistance, World Health Organization,
- Dr. Larry Kerr, Director, Pandemics and Emerging Threats Office, Office of Global Affairs, U.S. Department of Health and Human Services,
- Ms. Irene Koek, Acting Assistant Administrator, U.S. Agency for International Development,
- Mr. Mirfin Mpundu, Head, ReAct Africa,
- Mr. Jude Nwokike, Director, Promoting Quality of Medicines Program, USP, and
- Professor Akmal Taher, Special Advisor, Ministry of Health, Republic of Indonesia.
I was honored to be on a panel with such experts in the field and it was enriching to hear their insights on this issue. The audience spanned the global health sector, with representatives from country governments, multilateral organizations, academia, civil society, and the private sector, who contributed to a rich and thought provoking discussion.
Panelists and the audience highlighted the fact that medicines quality does not receive the attention it deserves, and that we lack evidence on the prevalence and causes of poor-quality medicines. Panelists also noted that we have been unable to quantify the relative contribution to AMR of the different drivers, however, medicines quality is one driver for which we have clear strategies. These strategies include setting public quality standards for antimicrobials, enhancing medicines quality monitoring and surveillance, securing supply chains and strengthening regulatory oversight. Addressing poor-quality antimicrobials has the potential to also support the medicine quality agenda more broadly, and contributes to access, a key component of the Sustainable Development Goals.
Although these examples are just a snapshot of the meaningful dialogue that took place, you can expect to hear much more from us on this topic. In fact, our newly created Quality Institute is in the process of recruiting research fellows to develop evidence that will help to support fact-based policy discussions on this topic. Also, we will publish a more detailed summary of the panel discussion.
[i] World Bank. 2016. “Drug-Resistant Infections: A Threat to Our Economic Future (Discussion Draft).” Washington, DC: World Bank. License: Creative Commons Attribution CC BY 3.0 IGO
[ii] The Review on Antimicrobial Resistance. 2016. “Tackling drug-resistant infections globally: final report and recommendations”. https://amr-review.org/sites/default/files/160518_Final%20paper_with%20cover.pdf (Accessed February, 2017)