Bulletin of the World Health Organization


25 February 2002

No country acting alone can adequately protect the health of its population against antimicrobial resistance (AMR), researchers warn in the latest issue of the Bulletin of the World Health Organization.

Health economists Richard Smith & Joanna Coast say the resistance of microbes to drugs against diseases such as tuberculosis, malaria and meningitis is a major threat to global public health. It can lead to increased illness and deaths, and to health care costs which in the USA alone have recently been estimated at more than US$ 7 billion a year. "The greatest problems associated with AMR undoubtedly remain to be seen," the British-based authors say. Among the examples they cite are Staphylococcus aureus, the main cause of hospital infections, and Salmonella, a bacterium that causes food poisoning.

The authors, senior lecturers at the University of East Anglia and Bristol University, England, say that the spread of AMR is due in large part to the misuse of antimicrobial medicines. Uncontrolled over-the-counter availability, poor manufacture or counterfeiting, and the sale of these medicines from roadside stalls and by hawkers exacerbate the problem.

To contain the spread of AMR, surveillance is required, together with systems for tracking antimicrobial consumption, encouraging research and development in new antimicrobials and alternative treatments, and fostering the appropriate use of existing antimicrobials. Financial incentives can help to bring this about both through private sector investment and through such measures as subsidizing price increases to offset losses due to decreased sales. The extreme differences between countries with regard to economic conditions and health priorities make international coordination indispensable, in addition to measures designed to respond to the particular circumstances in each country.

"The global nature of AMR calls for a global response," the authors say. They recommend that international bodies should do three things to promote international collective action: make AMR a conspicuous and high priority in countries; collect global AMR surveillance data to which countries contribute and have access; and stimulate investment in research and development for new antimicrobials.

"The greatest problems associated with AMR undoubtedly remain to be seen. It is necessary to persuade decision-makers at the national and international levels of the importance of AMR relative to other pressing health and non-health priorities. Only if adequate strategies of collective action are implemented soon is it likely that high future morbidity and mortality attributable to AMR can be averted in all countries," the authors conclude.

Background information on work in progress can be found in WHO’s Global strategy for the containment of antimicrobial resistance, available at http://www.who.int/emc/amr_interventions.htm (date 2001)

Authors alone are responsible for views expressed in The Bulletin's signed articles, which are not necessarily those of the World Health Organization.

For further information, contact Thomson Prentice, Tel. (+41 22) 791 4224. Email prenticet@who.int All WHO Press Releases, Fact Sheets and Features as well as other information on this subject can be obtained on Internet on the WHO home page http://www.who.int/