September 29, 2016

Fighting Resistance With Resilience: Preparing For A Future With Sustainable Antimicrobial Medicine

September is National Preparedness Month: an opportunity for governments, private and public organizations, communities, and individuals to support emergency preparedness efforts and instill the importance of resilience in the public.  In his Presidential Proclamation - National Preparedness Month, 2016, President Obama emphasizes “the importance of readying ourselves and our communities to be resilient in the face of any emergency we may encounter.”

The emergencies we most often plan for are natural disasters, acts of bioterrorism, and infectious disease outbreaks.  Clearly, advance preparation in these areas is critical.  Yet preparation for existent threats which have the potential to rapidly escalate is arguably of equal importance. 

Antimicrobial resistance (AMR) is a global problem of enormous magnitude that suffers from lack of visibility, urgency, and action. Continued rise in AMR could result in a yearly death toll of 10 million people worldwide and could cost the global community $10 trillion USD by 2050.  The devastating effects of AMR are already upon us: at least 50,000 patients in the U.S. and Europe and 700,000 across the globe succumb to drug resistant antimicrobial infections each year. Antimicrobials are a precious natural resource and because of careless stewardship over the past 75 years we have jeopardized their long-term efficacy.  AMR is similar to climate change: our choices about not completing a course of antibiotic treatment or driving fuel inefficient cars are intricately tied to outbreaks of drug resistant bacteria or devastating floods occurring in our own hometowns or even in geographically remote parts of the world.

At the September 21, 2016 UN General Assembly meeting, all 193 UN member states signed a treaty pledging to combat the spread of AMR.  It is in the best interests of the U.S., both as an independent nation and as an integral member of the global community, to expand its paradigm of preparedness to include the rising threat of AMR. We have the power to reduce and control the spread of AMR if we take key steps to ready ourselves now. To emphasize the power of preparedness, during the month of September, the Office of Public Health Preparedness and Response at the CDC adopted a targeted approach to their outreach, focusing on a different area of preparation each week.  We applied their preparedness themes to the rising threat of AMR in effort to broaden what it means to be prepared.

Week 1: Prepare globally.  AMR is a global problem requiring global commitment.

  • AMR surveillance entails building global consensuses on data collection and sharing as well as laboratory capacity.
  • Global stewardship of existing antimicrobials is essential for reducing our dependence on new antimicrobial discovery.

Week 2: Prepare to respond.  We need to both conserve and innovate.

  • We can reduce the need for antimicrobials through improvements in public health, sanitation, and vaccinations.
  • We can minimize unnecessary antimicrobial use in human and animal sectors by phasing out antimicrobials as growth promoters and ensuring responsible prescription of antimicrobial medicine in the clinic.
  • Microbes will eventually evolve resistance to existing therapies thus financial incentives are necessary to spur development of new antimicrobial drugs and diagnostics.

Week 3: Prepare locally.  Global strategies to combat AMR should account for differences in local capacity.

  • Low and middle income countries still report more deaths due to untreated bacterial infections rather than antibiotic resistant bacteria thus responsible universal access to antibiotics is still a priority.
  • National, regional, and city governments need to regulate antibiotic effluents from pharmaceutical manufacturing, agriculture, and hospital waste to minimize the introduction of resistance genes into water sources.

Week 4: Prepare together.  Multi-sectoral partnerships will increase resilience and efficiency.

  • The One Health approach, which recognizes the interconnectedness of human, animal and environmental health, is critical for mounting a concerted effort against all potential sources of AMR.
  • Collaboration between the public and private sectors spurs innovation by concentrating talent, sharing technical expertise, and reducing the financial risk of antimicrobial drug development.

Week 5: Prepare yourself.  Individual behaviors to reduce reliance on antimicrobials make a difference.

  • We need education and awareness campaigns to increase understanding about what AMR is and how simple actions such as hand washing and vaccinations can help in reducing the emergence and spread of antimicrobial infections.
  • Global public health concerns like AMR often seem disconnected from individual actions; outreach efforts need to convey how consumer behavior has a direct bearing on the outcome of our fight against AMR.

As September comes to a close, it is incumbent upon all of us to consider how we can prepare ourselves to be resilient in the face of natural disasters, bioterrorism, and infectious disease threats like AMR.  HSP is dedicated to playing its part in the global effort to empower governments, communities, and individuals to withstand even the most daunting global health challenges.


Liz Meier is a graduate student pursuing a PhD in Biochemistry, Molecular, and Cellular Biology (BCMB) at Johns Hopkins University in Baltimore, MD. As a Health Security Policy Fellow, she is supporting HSP’s work in Pakistan, Afghanistan, and Malaysia.