Research Article: Antimicrobial resistance: The complex challenge of measurement to inform policy and the public

Date Published: August 17, 2017

Publisher: Public Library of Science

Author(s): Didier Wernli, Peter S. Jørgensen, Stephan Harbarth, Scott P. Carroll, Ramanan Laxminarayan, Nicolas Levrat, John-Arne Røttingen, Didier Pittet

Abstract: Didier Wernli and colleagues discuss the role of monitoring in countering antimicrobial resistance.

Partial Text: Progress has been accomplished regarding AMR monitoring. First, knowledge about the causes, consequences, and magnitude of the problem has improved through research and better surveillance [6]. Second, the amount and quality of relevant data on AMR from local, national, or regional centers for disease control have been enhanced. Third, we understand better what needs to be measured and how to do it. A generic set of national performance indicators has been proposed [7], and WHO, which recently released a list of pathogens for which new antimicrobials are urgently needed [8], has also suggested indicators for monitoring implementation of the GAP. Additional relevant metrics include the drug resistance index, which aggregates data on bacterial resistance to multiple antibiotics and provides a useful measure of the severity of AMR [9]; and the defined daily dose per capita per year, which makes antimicrobial consumption comparable across countries [10].

Addressing these information gaps is critical for successful implementation of the GAP. First, harmonized data collection will provide useful measures for individual countries to benchmark their national and subnational performance against others and help them tackle the problem based on the best scientific evidence. This could stimulate both domestic and transnational policy debates and help AMR remain on the political agenda. Second, as for many problems of international cooperation in which countries can free ride on the efforts of others, improved monitoring will reduce information uncertainty about the current situation and responses and create better conditions for cooperation through joint effort to produce global public goods [12]. This is extremely important because the increasing global movement of people and goods means that the preservation of antibiotic susceptibility depends largely on the magnitude of the weakest national efforts. Third, regular data collection across different countries could serve as a basis for a longitudinal assessment of AMR control and contribute to improve our understanding of where, when, how, and why particular interventions work, guiding the implementation of national and subnational policies. Fourth, better monitoring may result in greater involvement of and advocacy from health professionals, patients, and consumers, whose participation is critical to tackle AMR. Ultimately, the goal of expanded monitoring is to trigger a virtuous circle in which the collection of data constantly improves our understanding and capacity to tackle AMR, which in turn calls for new evidence.

Because AMR control is complex, the goal should be to measure the problem and progress across its multiple dimensions while at the same time making it more tractable to policy makers and the public. Over the last decade, several instruments aimed at measuring performance in the economic, education, environmental, and health sectors have been developed [13]. Lessons learnt from their implementation—including concerns about the validity of composite indexes, which seek to summarize many dimensions in one number—call for a robust approach to ensure their effectiveness [14,15]. From the more general to the more specific, 5 design challenges are important to expand monitoring of AMR control.

Fostering a global transformation to deal with AMR [31] requires political commitment and relevant governance mechanisms [32]. An effective mechanism to curb AMR globally would be the adoption of binding targets limiting antimicrobial use [10]. While it may take a long time for states to adopt these targets, expanding monitoring of AMR control will reduce information gaps and help governments maintain their commitments to tackle the problem. WHO, in collaboration with other relevant international organizations including the World Organization for Animal Health (OIE), the Food and Agriculture Organization (FAO), and the recently created UN Interagency Coordination Group on AMR should lead the process internationally.



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