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The Fleming Fund has worked with partners to strengthen the collection and use of data on antimicrobial resistance (AMR) and on the use of antimicrobial medicines. This is done through our Global Grants programme.
The priorities for these grants are to:
- improve awareness and understanding of AMR and the importance of antibiotics
- develop the tools, protocols and systems that will enable all countries to establish or strengthen their surveillance systems for AMR and for monitoring the use of antimicrobial medicines
- develop tools and guidance for countries to use and share data, and to support global data-sharing and analysis
- identify and address key gaps in data on AMR and the use of antimicrobial medicines
Increase societal awareness and understanding of AMR and the importance of antibiotics ▾
Through grants to the Food and Agriculture Organization (FAO) and the World Organisation for Animal Health (OIE), the Fleming Fund is supporting the development and application of a range of communication materials, including posters, infographics and videos. These are being used for education and advocacy, including during World Antibiotic Awareness Week.
The South Centre helps the countries of the South develop common points of view and to work together on major international development-related policy issues. We have partnered with the South Centre to support policy engagement on AMR and support action to tackle the issue. The Centre will work directly with developing countries’ governments to achieve this, as well as working with civil society in low and middle income countries to develop broader awareness of AMR.
Developing tools and systems, enabling countries to strengthen their surveillance and monitoring systems for AMR ▾
Since 2016, the Fleming Fund has been working with the World Health Organisation (WHO) and FAO to help countries develop and implement their national action plans on AMR. Through the WHO, the Fleming Fund has provided support to many countries across Africa and Asia. With the FAO, we have helped deliver additional support to 12 countries (Bangladesh, Cambodia, Ethiopia, Ghana, Laos, Kenya, Philippines, Sudan, Tanzania, Vietnam, Zambia, Zimbabwe) for the inclusion of actions on animal health and agriculture, so that their national action plans address the One Health aspects of AMR.
The first step in determining investment priorities is to assess a country’s existing capacity and need. Through its grant to the FAO, the Fleming Fund has supported the development of ATLASS, an assessment tool that enables countries to map their surveillance for AMR in agriculture, and to monitor further development of surveillance. ATLASS has already been put to use in Cambodia, Ghana, Kenya, Laos, Philippines, Tanzania, Vietnam, Zambia, Zimbabwe.
Professional capacity is vital when it comes to implementing national action plans, including when establishing surveillance of antimicrobial medicine use. The Fleming Fund is supporting the work of the OIE to include AMR in its tool to evaluate the performance of veterinary services (the PVS pathway).
The Fleming Fund has supported the development of protocols that will form the basis of common standards and practices for the collection of data on AMR and on the use of antimicrobial medicines. These include:
- AMR surveillance in low- and middle-income settings: a roadmap for participation in the Global Antimicrobial Resistance Surveillance System (GLASS). Developed at the London School of Hygiene and Tropical Medicine (LSHTM), this guideline for surveillance in human health allows for flexibility across different systems, but has sufficient standardisation of core protocols to ensure data will be valid and comparable.
- tricycle surveillance protocol. Developed by the WHO, this protocol sets out standardised methods for surveillance of antibiotic-resistant E. coli in human health, animals (particularly poultry) and the environment. The protocol is currently being field-tested in Ghana, Indonesia, Malaysia and Pakistan.
- protocols for the collection of data on the use of antibiotics in healthcare, such as through prescribing or dispensing. Developed by the WHO, these are currently being field-tested.
- methods for the collection and reporting of national volumes of antibiotic use (antimicrobial consumption data). The OIE has developed methods to collect data on antibiotics intended for use in animals and the WHO for human-use antibiotics.
Develop tools and guidance for countries to use and share data, and to support global data-sharing and analysis ▾
Regulation and standards
The FAO is working with several countries across Africa and South East Asia to assess and strengthen their legislation and regulations, and encourage good practices, on the use of antimicrobial medicines in animal health and agriculture. These countries include (Bangladesh, Cambodia, Ethiopia, Ghana, Kenya, Laos, Philippines, Sudan, Tanzania, Vietnam, Zambia and Zimbabwe.
The OIE is working with its National Focal Points on Veterinary Products, and through the PVS pathway, to improve the regulatory frameworks targeting veterinary medicines, including antimicrobial medicines.
The Fleming Fund has supported the 2017 revision of the antibiotics section in the WHO model Essential Medicines List (EML). In the biggest ever revision of the antibiotics section in the EML, WHO experts have grouped antibiotics into three categories – access, watch and reserve – with recommendations on when each category should be used.
The change aims to ensure that antibiotics are available when needed, and that the right antibiotics are prescribed for the right infections. It should enhance treatment outcomes, reduce the development of drug resistant bacteria, and preserve the effectiveness of "last resort" antibiotics that are needed when all others fail.
As countries generate their own data on AMR and antimicrobial use, they will be able to adapt the model EML to suit their own circumstances.
Burden of disease associated with AMR
Reliable quantification of the burden of disease is a vital when making decisions on where to prioritise health resources and investments. However, there is little information on the health and economic burdens of drug-resistant infections (AMR) across all countries.
The Fleming Fund has partnered with the Wellcome Trust and the Bill and Melinda Gates Foundation to provide a grant to the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, and the Big Data Institute and the Centre for Tropical Medicine and Global Health at the University of Oxford. The money will be used to collect data on the burden of disease associated with AMR, analyse the data and ensure AMR is included in the Global Burden of Disease project.
The project will use complex geospatial modelling to improve understanding of the burden of disease associated with AMR in each country, and therefore the public health threat this poses.
Identify and address key gaps in data on AMR and use of antimicrobial medicines ▾
Surveillance of the quality of antimicrobial medicines
Poor quality antimicrobial medicines can contribute to AMR in different ways. For example, medicines that do not provide a sufficient dose may allow drug resistant bacteria to grow, as Sir Alexander Fleming predicted in his Nobel prize acceptance speech.
Monitoring the quality of antimicrobial medicines is fundamental to the overall goal of the global action plan on AMR, which is to ensure we can treat and prevent infectious diseases with effective and safe medicines. If a patient does not recover from their infection when given an antimicrobial medicine, it may be because of drug resistance, a misdiagnosis, or a poor-quality medicine. To address AMR properly, we need to tackle all of these.
The Fleming Fund is supporting the WHO programme to prevent, detect and respond to substandard and falsified (SF) medical products.
Through this grant, the Fleming Fund will support global information-sharing on suspect medicines, through the WHO’s global surveillance and monitoring system (GSMS), quality surveys of antimicrobial medicines being sold in Africa and Asia, and the development and application of tools to aid detection and reporting of poor quality medicines that can be used in low income settings.
The Open University (OU), in consortia with Mott MacDonald, hold a global grant for the development of online learning tools and resources…Read more