Government Leadership Needed to Improve ‘Appropriate’ Access to Antimicrobials.

Improving global access to antibiotics and other antimicrobials will require strengthening health systems through sustained financial support, increasing the availability of diagnostic testing and vaccinations and improving monitoring of antimicrobial use and resistance, according to a study in The Lancet co-authored by a School of Public Health researcher.

In the online report—part of a Lancet series on antimicrobial access and use—the authors noted that universal access to such medications in low- and middle-income countries must be balanced by appropriate prescribing to combat “the global threat from bacterial resistance.”

The main drivers of such excess, they said, are related to high infectious disease burden as a result of inadequate prevention systems; the availability of substandard drugs because of deficient regulatory and enforcement capacity; and a shortage of trained health personnel or community health workers. Limited access to diagnostics and laboratory services to guide treatment compounds the problem.

“Universal access to antimicrobials is not only about availability,” wrote the team of researchers from multiple institutions, which includes David Hamer, professor of global health and of medicine at the School of Medicine. “Rather, an integrated approach to appropriate prescribing, enabled by availability of affordable antimicrobials, is needed.”

Hamer said an integrated, community case-management approach to care is an important equity-focused strategy to improve access to treatment of common childhood infectious disease killers such as malaria and pneumonia. Such an approach, which includes use of rapid diagnostic tests and training for community health workers, facilitates best practices in diagnosis and treatment and thereby improves access while reducing overuse of antimicrobials.

The research team recommended a “delinkage” of drug discovery initiatives from commercial profits by creating alternative incentives that orient research and development efforts towards “priority health needs,” rather than sales opportunities. Governments can create other incentives for companies to develop antibiotics and other antimicrobials that meet community needs by offering grants, patent buyouts, and other financial support, the authors suggest.

“Delinkage of innovation from profit projections and sales will ensure that public health needs drive innovation and marketing practices. As a global challenge, universal access necessitates a long-term commitment, with sustained financing from all affected countries, to move away from existing donor-driven models in resource-poor states,” they wrote.

They said the threat from bacterial resistance and lack of access to antimicrobials demands as much attention as infectious diseases such as HIV, tuberculosis, and malaria, which have been priorities in terms of access and drug research.

“As multidrug-resistant organisms become more prevalent, access to specific antimicrobials for these infections becomes an international issue,” they said. “Limited access to, and overuse of, antimicrobials often coexist within one health system and cannot be tackled by targeting any one of these challenges in isolation. For interventions and policies aiming for universal access and appropriate use to be successful . . . sustainable financing, governance, and leadership are necessary.”

The review, “Antimicrobials: Access and Sustainable Effectiveness”—part of a five-paper Lancet series—was led by Marc Mendelson of the Division of Infectious Diseases and HIV Medicine at the Department of Medicine, University of Cape Town, South Africa.

—Lisa Chedekel