Better use and affordability of antimicrobials will help us reach universal health coverage
By Timothe Chevaux
Achieving universal health coverage (UHC) won’t be possible without paying close attention to one of our most pressing global health threats: drug-resistant infections.
Antimicrobial resistance (AMR) occurs when microorganisms develop resistance to a medicine that was originally intended to disable or kill them. While microbes naturally develop resistance to antimicrobials over time, excessive or inappropriate use of antibiotics speeds up AMR. The issue is a big challenge to UHC, jeopardizing the effectiveness of surgical procedures and threatening the treatment of many infectious diseases, including malaria, tuberculosis, and HIV/AIDS.
According to estimates from The Review on Antimicrobial Resistance, a report commissioned by the U.K. government and the Wellcome Trust, the financial burden from AMR could be as much as USD 100 trillion and the global gross domestic product could decrease 3.5% by 2050. AMR also causes immense loss of life — 700,000 people die from drug-resistant infections each year, and this number is expected to grow to 10 million by 2050 if AMR is not contained.
Antimicrobials are one of the most flagrantly overused and misused agents contributing to a significant waste of resources. The World Health Organization estimates that more than half of all medicines are prescribed, dispensed, or sold inappropriately, and that half of all patients fail to take them correctly. To finance and deliver antimicrobials and related pharmaceutical services for infectious diseases under a UHC plan, countries will need to make sure these precious commodities are used appropriately.
BUILDING STRONG COALITIONS
The current move toward UHC offers a great opportunity to fight AMR, but these goals can only be achieved by improving the drivers that contain it — accessible and affordable medicines; safe, quality services; and overall strengthened health systems.
The USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Project, which MSH leads, recently published a guide on building strong coalitions to defeat AMR by engaging stakeholders across multiple sectors and by prioritizing effective and locally relevant interventions to contain the spread of drug-resistant infections.
The guide focuses on the importance of awareness and coalitions among important stakeholders to generate concerted actions to contain AMR. It has several examples of country- and regional-level coalitions. For example, SIAPS partnered with the Ecumenical Pharmaceutical Network, a regional organization that conducts awareness-raising campaigns in Africa, to carry out awareness, advocacy, and interventions to fight AMR.
Also key is sound pharmaceutical management. Many interrelated factors, including excessive or inappropriate use of antibiotics and poor infection prevention and control practices, contribute to acceleration and spread of AMR. Health professionals, including pharmacists, need to make sure that antimicrobial supplies are uninterrupted, safe, and of good quality. Training and capacity building are needed for many stakeholders across health systems to strengthen pharmaceutical management and infection control practices.
Improving affordability of antimicrobials is another priority, which can be achieved by identifying approaches to subsidizing and lowering drug prices and implementing effective medicine insurance programs.
Timothe Chevaux is a communications associate for the USAID-funded and MSH-implemented Systems for Improved Access to Pharmaceuticals and Services, a project that works to ensure access to quality pharmaceutical products and effective pharmaceutical services through systems-strengthening approaches.