Why national-level data is needed for an improved global response to antimicrobial resistance

The UN General Assembly High-Level Meeting on Antimicrobial Resistance (AMR) in September 2024 served as the backdrop for a global conversation on how the international community would collectively address the impact of this public health threat. Many countries, especially Barbados and Malta, who drove the negotiations behind the 2024 AMR political declaration, raised their voices to ensure that the catastrophic effects of this pandemic were front and centre, especially as the competition for funding with other public health priorities is not only obvious but fierce.

Among the most salient agreements that the declaration covers are the reduction of AMR-related deaths by 10% by 2030, the importance of multisectoral coordination, the value of access to the right therapeutic and immunization tools, the need to strengthen national surveillance systems for AMR and antibiotic use, and the pivotal role of national ownership in driving action. Failure to move fast could cost healthcare systems an additional $1 trillion in healthcare costs every year and $3.4 trillion in gross domestic losses by 2050.

Discussions at the UN in September also delved into a series of interconnected issues: the need for a more innovative pipeline of antibiotics, and the incentives required to develop and produce them, infection prevention through vaccines and stronger sanitation measures, and the linkages between health of humans, animals and the environment. The urgency to strengthen the national and international infrastructure to support antibiotic stewardship and keep track of AMR’s burden was also a critical part of these exchanges.

The conducting threat across these different topics was the unquestionable need and value of good-quality data as the foundation of current and new solutions. Evidence shows that major gaps in the availability of standardized and interoperable data make it extremely difficult for governments, health authorities, life sciences companies and global health organizations to make sound decisions on policy, financing, research and various interventions.

At the same time, AMR-specific complexities require a level of information granularity that is hard to achieve. On one hand, determining if antibiotics are being prescribed or used properly should incorporate insights stemming from proper diagnostics, patient behaviour and detailed monitoring of national use. On the other, ensuring access to necessary antibiotics should be informed by population health needs. Therefore, painting the most accurate picture of the phenomenon is a multilayered and complex affair.

Wherever data to unlock the AMR puzzle is abundant, it is often fragmented, not fit for purpose, collected using different methodologies, or missing critical disease burden metrics. In other cases, especially in low- and middle-income countries, data is scarce, if not inexistent. This generates a conundrum in which implementers are regularly caught in the middle of “half-truths”. For instance, while information on sales volumes of antibiotics presents telling trends about the growing use of antibiotics globally, as the infographic below illustrates, this data fails to explain how AMR is evolving or if the use of anti-infectives responds to specific national healthcare demands. Similarly, the Global Antimicrobial Resistance and Use Surveillance System (GLASS) run by the World Health Organization (WHO), represents one of the most important resources to share national data on AMR and antimicrobial use, but it falls short in informing countries about population exposure to antibiotics according to different healthcare settings.

As the next infographic depicts, resolving this dilemma calls for the standardized combination of multiple data sources through national antibiotic assessment reports, which could then serve as a central pillar for the formulation of national antibiotic policies. Such an effort would involve, first, the identification of a common method to connect diverse datasets; and, second, the incorporation of population health intelligence that links antibiotic use with the disease profile – or infection burden – of a given country. The circulation of the right volumes of antibiotics based on these estimates would not only favour their more responsible use, but also provide assurances that national access targets are driven by evidence-based need.

National antibiotic assessments cannot, nevertheless, exist in isolation. To realize their positive effects in guiding antibiotic use, such assessments should inform the formulation of national antibiotic policies as tools to steer, among other things, financing, procurement, health system enhancements, and the strengthening of clinical practices.

Since the mid-2000s, following WHO guidance, many countries embarked upon the creation of AMR national action plans (NAPs), whose main purpose is to manage antibiotic use, strengthen surveillance, improve infection prevention and control, and boost awareness. Despite this original intent, based on an analysis conducted by IQVIA, only 35% of currently available NAPs present comprehensive and targeted strategies on antibiotic access and use. Therefore, shaping policies could be a natural progression of NAPs, or at least one of their main aspirations. The 2024 AMR political declaration advocates for the stronger financing of these plans – and the importance of making them more robust – as a fundamental component of local action.

Allowing countries to own the national response to AMR opens the door for a more targeted approach towards antibiotic access and use, revamping different components of the value chain associated with the control and treatment of infections. By the same token, more precise data underpinning national policies in the form of domestic assessment reports can function as a key reference point for the estimation of global antibiotic access targets. By applying this data-driven rationale, as the infographic below summarizes, a host of positive effects are unleashed.

Creating national antibiotic assessment reports and the policies they would support is only achievable through collaboration across multiple public and private partners, so that the relevant datasets, or the processes necessary to collect them, can come together. As countries prepare to advance their national responses through enhanced NAPs, the present opportunity to up the game through more responsive partnerships is invaluable. It is only by operating in a coordinated fashion, deploying the capabilities of different stakeholders, that healthcare systems and other actors within the One Health space will be able to deliver on the commitments of the 2024 AMR political declaration. Such goals aim at a reduction of global deaths, but more notably at the creation of national capacities that will render AMR a manageable challenge.

The authors would like to acknowledge the contributions of Dr. Mike Sharland, Professor of Pediatric Infectious Diseases at City St. George’s University, London, as co-author of the white paper that inspired this article.