WHO / Yoshi Shimizu
A health worker at a laboratory in National Center for Laboratory and Epidemiology.
© Credits

Tracking and combating antimicrobial resistance

Antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity. It occurs when bacteria, viruses, fungi and parasites change over time becoming “superbugs” and no longer respond to medicines. As a result, treatment can become ineffective, infections harder to treat and persistent in the body, and there is increasing risk of severe illness, death and further spread to others.

Globally, at least 700 000 people die each year due to drug-resistant infections. This number is projected to rise to 10 million deaths each year by 2050. By 2030, AMR could force up to 24 million people into extreme poverty.  

AMR not only poses a threat to human health, but animal health, and agriculture and livestock sectors, requiring a multisector approach. Management of the factors driving AMR—primarily misuse of antimicrobials like antibiotics, including for human health and animal husbandry as growth promoters—and surveillance of AMR organisms, is essential to understand resistance, trends, and solutions.  

AMR monitoring and response capacity building is in progress in Lao PDR, particularly infrastructure and technical capacity. In the past, a national cross-sectoral strategy and designated AMR laboratories were absent—only 1 hospital performed AMR surveillance, largely for research purposes. Provincial-level hospitals lacked capacity to accurately detect and monitor AMR pathogens, and no mechanism existed for monitoring antimicrobial consumption (AMC) within the health-care sector to better understand patterns of antimicrobial use nationwide.  

Ongoing support by the international community has begun to alter Lao PDR’s fight against AMR, with many of the above gaps being addressed and established processes in place for detecting and reporting AMR pathogens and monitoring AMC nationally and globally. 

  

Our support and results

WHO provides a wide range of support on human health to combat AMR at a national and policy level, and at the operational health-care level.  

This is often carried out in collaboration with national and international partners including UN agencies, research institutes and NGOs operating across related sectors.  

Key areas have included:

  • Development of the National AMR Strategic Plan (2019–2023) and a strong supporting governance structure, the National AMR Committee, including relevant line ministries like the Ministry Agriculture and Forestry, to ensure implementation;
  • Establishment of systematic and regular sharing of AMR surveillance data among hospitals and laboratories at the national level, and with the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) at the international level;
  • Establishment of a national AMR surveillance system and structure, consisting of the National Center for Laboratory and Epidemiology as the national reference laboratory (NRL), Department of Communicable Disease Control (DCDC) as the national coordinating center, and 12 surveillance sites;
  • Establishment of mechanisms for collecting, compiling, managing, and analyzing AMC data, with all 22 central and provincial hospitals performing AMC monitoring, allowing for informed policy decisions on antibiotic selection and use, and historical data sharing with the Western Pacific Regional Antimicrobial Consumption Surveillance System; and 
  • Development of key national guidelines, including the national AMR guidelines, the national antimicrobial use (AMU) monitoring guidelines, and a national AMR investigation and response manual, disseminated alongside training for healthcare workers.

 

     

Laboratory technician performing a test in a clinical laboratory setting at the National Center for Laboratory and Epidemiology in the Lao People’s Democratic Republic.
©WHO / Yoshi Shimizu
A laboratory technician performs a test at the National Center for Laboratory and Epidemiology, the Lao People’s Democratic Republic.
© Credits

     

The work ahead

It is critical to improve the quality of national AMR surveillance and enhance capacity to continuously produce AMR/AMC data for use in national policy and decision-making regarding rational use of antibiotics across health settings and more widely (i.e. farming and agriculture, livestock and animal management, horticulture and food preservation).  

Building on progress made from substantial development partner investments, WHO will continue to support the Ministry of Health to sustain AMR improvements and expand further, moving beyond a project-based approach.  

For example, AMR surveillance should be part of hospitals’ routine activities, allowing improved diagnosis and rational use of antibiotics. This will require further investment from the Government and partners.  

WHO plans to work with the Ministry of Health and hospitals to:  

  • Expand AMR surveillance sites and build technical capacity to institutionalize AMR surveillance for outbreak detection, understand transmission dynamics, and inform appropriate actions to fight AMR; 
  • Take the next step to link AMR surveillance data with relevant AMC/AMU data to inform optimal patient care, treatment guidelines, and infection prevention and control interventions under antimicrobial stewardship initiatives; and
  • Build capacity for AMU monitoring at the national and subnational levels, using the Ministry of Health AMU guideline. Continue work with other ministries and stakeholders to enhance AMR awareness, advocate for reservation of antibiotics for treatment of human infections versus agricultural productivity enhancers, and urge collective efforts to tackle AMR as antimicrobial stewards.

Longer-term support from partners will be critical to move the AMR agenda forward in Lao PDR and sustain the hard-won gains made thus far in tackling this global health threat.