Noor Al-Gallas Antimicrobial resistance and supply chain: A neglected relationship

Delegates at the 68th World Health Assembly in May 2015 endorsed a global action plan to tackle antimicrobial resistance (AMR), directing the world’s attention toward AMR as an acknowledged serious threat to global health. The recent World Antibiotic Awareness Week campaign further raised AMR awareness, aiming to encourage best practices among the public, health professionals, and policy makers. WHO’s overarching message for the campaign was that “antibiotics are a precious resource and should be preserved. They should be used to treat bacterial infections, only when prescribed by a certified human or animal health professional. Antibiotics should never be shared or saved for the future.”

This threat of AMR has not developed overnight. WHO attributes it to the overuse and misuse of antimicrobial drugs everywhere in the world, which causes infectious organisms to adapt and become resistant to the antimicrobial drugs that were designed to kill them. The Center for Disease Dynamics, Economics & Policy’s report, “The State of the World’s Antibiotics, 2015,” suggests that 20 percent to 50 percent of global antibiotic use can be classified as inappropriate. “Inappropriate” is largely defined as prescribing and usage when no health benefit is possible, prescribing the wrong antibiotic, prescribing the wrong dosage, or patients’ poor adherence to a prescription.

The supply chain component. In the African region, there are two significant AMR-related supply chain challenges, according to WHO. Stockouts of essential medicines and antibiotics can lead to increased circulation of counterfeit or substandard antibiotics. While overall supply is a challenge, it is clear that increased appropriate prescribing and usage would decrease the burden of stockout.

The second and more urgent challenge is a lack of laboratory reagents and consumables, which makes proper testing, diagnosis, and treatment difficult or impossible, even when appropriate laboratory equipment is available. Physicians then face the hard decision of treating patients using antimicrobial agents to the best of their knowledge rather than based on an accurate diagnosis from test results. Addressing this gap in the supply chain of diagnostic tests can make the difference between appropriate use of antibiotics and overuse or inappropriate use.

The availability of diagnostic tests is only one part of the equation. WHO has also asserted that AMR is not monitored in low-resourced countries because they often lack a surveillance network or data system to collect and analyze the results of diagnostic tests, making it harder to identify the profile of infectious agents and their distribution in certain regions. Without data collection and analysis, properly monitoring prevailing infectious profiles and identifying new emerging ones is ever more challenging.

A starter package to address AMR. Diagnostic tests and a data collection system are a potential “starter package” for developing countries to jump-start the efforts to tackle AMR. Such an approach would encourage public health policy makers to enforce AMR surveillance, and would enable physicians to access diagnostic tests before prescribing antimicrobial agents.

WHO also calls for strengthening health systems, including diagnostic laboratories. Ensuring a strong supply chain of reliable diagnostic tests, reagents, and consumables is one of the key factors for creating a sustainable, strong diagnostic laboratory system.

During the last decade, we have observed the role of strong supply chains in addressing and managing the availability of diagnosis and treatment of HIV/AIDS, malaria, and TB; ensuring the availability of reproductive health commodities; and responding to other health challenges in the developing world. Making diagnostic tests and treatment available for these health burdens has helped to save millions of lives in the developing world.

The same consideration for the necessity of a strong supply chain is now urgently needed in addressing the significant risk of AMR.

Amna-Noor Al-Gallas, MD, MA
Global Health Expert
Market Dynamic Committee Strategic Advisor
Procurement Operations Manager—NPU