Worldwide country situation analysis: response to antimicrobial resistance
April 2015
Worldwide country situation analysis: response to antimicrobial resistance
April 2015
WHO Library CataloguinginPublication Data
Worldwide country situation analysis: response to antimicrobial resistance.
1.AntiInfective Agents. 2.Drug Resistance, Microbial. 3.Infection Control. 4.Population Surveillance. I.World Health Organization.
ISBN 978 92 4 156494 6
© World Health Organization 2015
(NLM classification: QV 250)
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Design and layout:JeanClaude Fattier
Contents
Acronyms and abbreviations
1.
2.
3.
4.
5.
6.
7.
8.
Country strategies to control antimicrobial resistance
WHO African Region
WHO Region of the Americas
WHO Eastern Mediterranean Region
WHO European Region
WHO SouthEast Asia Region
WHO Western Pacific Region
Conclusions
Annex 1
v
1
13
17
21
25
29
33
37
41
iv
AMR ANTIMICROBIAL RESISTANCE
Acknowledgements
WHO woud îke o express îs graîude and apprecîaîon o a Member Saes (Annex 1.) a provîded înormaîon o e WHO survey on poîcîes and acîvîîes a e naîona eve în e area o anîmîcrobîa resîsance.
he conrîbuîon o saf în WHO Regîona and Counry OIces as been învauabe: în gaer-îng orîgîna daa and înormaîon rom Member Saes, în supporîng e process o aggregaîon o ese daa; and în revîewîng e regîona anaysîs o e indîngs a relec e counry sîua-îon a e poîn wen e survey was conduced. he suppor and commîmen o e members o e WHO Task Force on Anîmîcrobîa Resîsance, comprîsîng WHO saf rom Headquarers and Regîona OIces as, îs aso acknowedged.
WHO aso acknowedges e conrîbuîon o Bîoex, Ausraîa, în conrîbuîng o e ex în e capers on e regîona and goba indîngs and în deveopîng e grapîcs and abes based on e daa coeced and e conrîbuîon o Eîzabe Heseîne wo provîded edîorîa servîces.
he projec was managed by Mr Tejînder Cowdary o e Pandemîc and Epîdemîc Dîseases Deparmen, WHO Headquarers and overseen by Dr Carmem L. Pessoa da Sîva, Team Lead, and Dr Cares Penn, Coordînaor, Anîmîcrobîa Resîsance Unî, Pandemîc and Epîdemîc Dîs-eases Deparmen.
Fînancîa suppor was provîded by e Mînîsry o Hea and Weare, Repubîc o Korea.
WORLDWIDE COUNTRY SITUATION ANALYSIS: RESPONSE TO ANTIMICROBIAL RESISTANCE
Acronyms and abbreviations
AMR CAESAR
EARS-Ne ïPC MDR PAHO TB WePARS
anîmîcrobîa resîsance
Cenra Asîan and Easern European Surveîance o Anîmîcrobîa Resîsance nework
European Anîmîcrobîa Resîsance Surveîance Nework
înecîon prevenîon and conro
muîdrug-resîsan
Pan Amerîcan Hea Organîzaîon
ubercuosîs
Wesern Pacîic Anîmîcrobîa Resîsance Surveîance
v
1.
WORLDWIDE COUNTRY SITUATION ANALYSIS: RESPONSE TO ANTIMICROBIAL RESISTANCE
Country strategies to control antimicrobial resistance
Global overview
Antîmîcrobîa resîstance has been detected în a parts o the word; ît îs one o the greatest chaenges to goba pubîc heath today, and the probem îs încreasîng. Athough antîmîcro-bîa resîstance îs a natura phenomenon, ît îs beîng propagated by mîsuse o antîmîcrobîa medîcînes, înadequate or înexîstent programmes or înectîon preventîon and contro (ïPC), poor-quaîty medîcînes, weak aboratory capacîty, înadequate surveîance and însuIcîent reguatîon o the use o antîmîcrobîa medîcînes.
A strong, coaboratîve approach wî be requîred to combat antîmîcrobîa resîstance, învov-îng countrîes în a regîons and actors în many sectors. Over a 2-year perîod, rom 2013 to 2014, WHO undertook an înîtîa “country sîtuatîon anaysîs” în order to determîne the extent to whîch efectîve practîces and structures to address antîmîcrobîa resîstance were aready în pace and where gaps remaîned. The survey was conducted în countrîes în each o the sîx WHO regîons.
A mutî-stage anaytîca too was deveoped to assess the sîtuatîon at the natîona eve. The too was based on exîstîng WHO assessment toos and relected the eements contaîned în the poîcy package to address antîmîcrobîa resîstance that was îssued on Word Heath Day 2011. Country authorîtîes were asked to compete a questîonnaîre on theîr exîstîng strategîes, systems and actîvîtîes. The questîonnaîres were competed eîther by the authorîtîes them-seves through se-assessment or at an întervîew wîth a WHO oIcer on the occasîon o a country vîsît.
Thîs report presents the overa indîngs o the survey. ït provîdes an anaysîs, by regîon and gobay, o the înîtîatîves under way to address antîmîcrobîa resîstance and îdentîies areas în whîch more work îs needed. The survey ocused on the buîdîng bocks that are consîdered prerequîsîtes to combat antîmîcrobîa resîstance: a comprehensîve natîona pan, aboratory capacîty to undertake surveîance or resîstant mîcroorganîsms, access to sae, efectîve antî-mîcrobîa medîcînes, contro o the mîsuse o these medîcînes, awareness and understandîng among the genera pubîc and efectîve înectîon preventîon and contro programmes. Sînce the survey was conducted, some countrîes have made urther advances and addîtîona înîtîa-tîves have been aunched. No reerence thereore îs made to îndîvîdua countrîes, and the resuts relect the sîtuatîon at the tîme the questîonnaîres were competed.
Comprehensîve natîona pans, based on a mutîsectora approach and wîth sustaînabe i-nancîng, are regarded as one o the maîn ways to ight antîmîcrobîa resîstance gobay (WHO, 2011); however, ew countrîes reported havîng such a pan. Some countrîes dîd report that a natîona oca poînt or antîmîcrobîa resîstance had been îdentîied and had a natîona coordînatîon mechanîsm în pace. Others had întroduced natîona strategîes and poîcîes to address antîmîcrobîa resîstance.
A natîona surveîance mechanîsm and the necessary aboratory capacîty are essentîa to detect, anayse and track resîstant mîcroorganîsms. Surveîance can revea the presence o patterns o resîstant mîcroorganîsms and îdentîy trends and outbreaks. ïn many regîons, however, poor aboratory capacîty, înrastructure and data management prevented efectîve surveîance. Athough aboratory capacîty varîed by country în a regîons, at east one coun-try în each o the sîx regîons had a natîona reerence aboratory capabe o testîng or antîbî-otîc sensîtîvîty and subject to externa quaîty assessment. The same countrîes aso reported monîtorîng o antîmîcrobîa resîstance în humans.
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AMR ANTIMICROBIAL RESISTANCE
Regîons în whîch there are many hîgh-încome countrîes, such as the European and the West-ern Pacîic regîons, reported hîgher rates o access to hîgh-quaîty medîcînes than other re-gîons.
The survey aso reveaed that the sae o antîmîcrobîa medîcînes wîthout prescrîptîon was wîdespread în many countrîes. Furthermore, many countrîes acked standard treatment guîdeînes or heath care. Thus, the potentîa or overuse o antîmîcrobîa medîcînes by the pubîc and by the medîca proessîon was common în countrîes în a regîons. Few countrîes reported a system or monîtorîng the use o antîmîcrobîa medîcînes. Thus, trackîng prescrîb-îng patterns and over-the-counter saes remaîns a sîgnîicant chaenge.
Pubîc awareness o antîmîcrobîa resîstance was ow în a regîons. Even în some countrîes în whîch natîona pubîc awareness campaîgns had been conducted, there was stî wîdespread beîe that antîbîotîcs are efectîve agaînst vîra înectîons. More educatîon and coaboratîve awareness-raîsîng campaîgns în sectors such as heath care, poîtîcs and the medîa may there-ore be requîred.
Programmes to prevent and contro the spread o antîmîcrobîa-resîstant înectîons are aso essentîa. Wîthout efectîve hygîene and sanîtatîon measures, înectîons can spread rapîdy through heath care acîîtîes and between countrîes and regîons by trave and trade. Ha o the countrîes în the European, South-East Asîa and Western Pacîic regîons that responded to the survey reported havîng a natîona ïPC programme în pace; ewer had comparabe pro-grammes în a tertîary hospîtas. ïPC thus tended to be înadequate.
Overa, the indîngs o thîs survey revea that much îs under way and îndîcate that countrîes are commîtted to addressîng thîs compex probem. Some countrîes aready have a number o actîvîtîes în pace, whîe others are embarkîng on the work and ace chaenges. Thîs înîtîa country sîtuatîon anaysîs provîdes an overvîew and can serve as a reerence agaînst whîch countrîes and WHO can monîtor progress în împementîng actîons to address the chaenge o antîmîcrobîa resîstance în comîng years.
1.1 Introduction Anîmîcrobîa resîsance îs recognîzed as one o e prîncîpa reas o pubîc ea roug-ou e word: îs împac îs e a areas o ea, and î afecs e woe o socîey. Aoug anîmîcrobîa resîsance îs a naura penomenon, î îs exacerbaed by e mîsuse o anîmîcro-bîa medîcînes, poor or non-exîsen ïPC programmes, poor-quaîy medîcînes, weak aboraory capacîy, înadequae surveîance and poor reguaîon or enorcemen o reguaîons o assure access o îg-quaîy anîmîcrobîa medîcînes and eîr approprîae use.
1 On 7 Aprî 2011, on e occasîon o Word Hea Day , WHO înroduced a poîcy package o comba anîmîcrobîa resîsance, wîc îss crîîca acîons by a sakeoders o sîmuae cange.
Aoug wîdey recognîzed as an urgen probem by many înernaîona organîzaîons and mînîsrîes o ea, no a counrîes ave a response pan o acke anîmîcrobîa resîsance. Some regîons ace oer, more pressîng probems, and many ow- o mîdde-încome counrîes do no ave e resources o împemen response mecanîsms. A “counry sîuaîon anaysîs” was subsequeny conduced în counrîes în eac o e sîx WHO regîons o assess curren pracîces and o deermîne e srucures a were în pace o conro anîmîcrobîa resîsance. he resus o a anaysîs are summarîzed în îs repor.
1  Word Heath Day 2011: Poîcy brîes.http://www.who.înt/word-heath-day/2011/poîcybrîes/en/
WORLDWIDE COUNTRY SITUATION ANALYSIS: RESPONSE TO ANTIMICROBIAL RESISTANCE
A e Sîxy-seven Word Hea Assemby, în May 2014, Member Saes approved a resouîon, WHA67.25, requesîng WHO o drat a gLobaL acTîon pLan on anTîmîcrobîaL resîsTance. he drat 2 pLan wîLL be revîewed aT Te SîxTy-eîgT WorLd HeaLT AssembLy . IT îs based on înpuT receîved durîng broad muLTîsecToraL consuLTaTîons wîT counTrîes, înTernaTîonaL organîzaTîons, nongov-ernmenTaL organîzaTîons and oTer sTakeoLders and seTs ouT ive sTraTegîc objecTîves: To împrove awareness and undersTandîng of anTîmîcrobîaL resîsTance, To gaîn knowLedge Troug surveîL-Lance and researc, To reduce Te încîdence of înfecTîon, To opTîmîze Te use of anTîmîcrobîaL medîcînes and To ensure susTaînabLe învesTmenT în counTerîng anTîmîcrobîaL resîsTance.
1.2collection methods Data WHO îs represenTed TrougouT Te worLd, dîvîded înTo sîx regîons: Te Afrîcan Regîon, Te Re-gîon of Te Amerîcas, Te EasTern MedîTerranean Regîon, Te European Regîon, Te SouT-EasT Asîa Regîon and Te WesTern Pacîic Regîon (Fîgure 1.1). he survey was conducTed în counTrîes în aLL WHO regîons.
Figure 1.1.World Health Organization regions
A muLTî-sTage rapîd assessmenT anaLyTîcaL TooL was devîsed To assess Te sîTuaTîon în counTrîes. he TooL was based on exîsTîng WHO assessmenT TooLs and relecTed Te eLemenTs conTaîned în Te poLîcy package To address anTîmîcrobîaL resîsTance TaT was îssued on WorLd HeaLT Day 2011, wîc buîLT on prevîous recommendaTîons (WHO gLobaL sTraTegy for conTaînmenT of anTî-mîcrobîaL resîsTance, 2001) and resoLuTîon WHA51.17. IT LîsTed Te foLLowîng acTîvîTîes for com-baTTîng anTîmîcrobîaL resîsTance:
l
l
l
l
l
l
Adere To a compreensîve, inanced naTîonaL pLan wîT accounTabîLîTy and cîvîL socîeTy engagemenT. STrengTen surveîLLance and LaboraTory capacîTy. Ensure unînTerrupTed access To essenTîaL medîcînes of assured quaLîTy. ReguLaTe and promoTe raTîonaL use of medîcînes, and ensure proper paTîenT care. Enance înfecTîon prevenTîon and conTroL.
FosTer înnovaTîon, researc and new TooLs.
2  Antîmîcrobîa resîstance: drat goba actîon pan on antîmîcrobîa resîstancehttp://apps.who.înt/gb/ebwha/pd_Iles/WHA68/ A68_20-en.pd
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AMR ANTIMICROBIAL RESISTANCE
he quesîonnaîre was pîo-esed în 2012, and a sîmpîied versîon was dîsrîbued o counrîes or compeîon beween 2013 and 2014. Auorîîes în eac counry were învîed o compee e quesîonnaîre emseves or wî WHO saf rom e regîona or counry oIce and o reurn î o e regîona oIce. he daa were compîed, and e resus were recorded as sîmpe requen-cîes. Bank responses were recorded as “unknown”.
he quesîonnaîre addressed e use o anîmîcrobîa medîcînes în bo uman and anîma ea; owever, îs repor îs îmîed o e indîngs în umans. ïn due course, a urer survey wî be conduced, în coaboraîon wî e Organîsaîon or Anîma Hea and e Food and Agrîcuure Organîzaîon o e Unîed Naîons, on îssues reaed o anîmîcrobîa resîsance and anîma ea.
Tabe 1.1 gîves e numbers o Member Saes în eac regîon rom wîc înormaîon was re-ceîved. A oa o 133 o e 194 WHO Member Saes provîded înormaîon.
Table 1.1 –Responses to requests for information for the country situation analysis, by region WHO region No. of Member Total no. of Member States States in region African Region 8 47 Region of the Americas 26 35 Eastern Mediterranean Region 13 21 European Region 49 53 SouthEast Asia Region 11 11 Western Pacific Region 26 27
Percentage
17 74 62 92 100 96
For eac regîon, a daa were anaysed on e basîs o e number o counrîes rom wîc în-ormaîon was receîved.
The aim of this report is to provide an overview of the extent to which effective practices and structures designed to address ant microbial resistance are in place and where gaps remain. Some of the data are more than 1 year old; it is likely that improvements have been made since the original assessment, which will be reflected in future reports. In view of the difference in the proportions of countries in each region that responded, the results should be interpreted with caution, particularly in making any comparisons between countries or regions.