When policymakers, advocates, diplomats, and practitioners come together this month at the UN General Assembly, drug-resistant superbugs will be on everyone’s mind. Antimicrobial resistance (AMR), the phenomenon where bacteria and other infectious agents no longer respond to treatments, will be the topic of a UN High-Level Meeting on 26 September to discuss this serious and growing problem. 

AMR directly resulted in the deaths of more than 1.3 million people in 2019, according to The Lancet, and is making it more challenging to combat diseases like HIV, tuberculosis, and malaria as more drug-resistant strains emerge. 

AMR can also make routine surgeries and medical procedures riskier as the effectiveness of antibiotics declines. Low- and middle-income countries (LMICs) face the highest burden – dramatically accelerated by the overuse and misuse of antibiotics and other antimicrobials in people and animals. 

While drug-resistant pathogens can affect anyone, anywhere, at any time, LMICs face a relatively greater burden due to inadequate sanitation and hygiene, limited access to quality medicines and vaccines, the high cost of medicines, high disease burden, insufficient regulations and clinical training on appropriate practices, and low laboratory capacity to diagnose infections and detect drug-resistant microorganisms, among many other factors.

As governments convene to address AMR, one possible outcome will be adopting a new political declaration that analyzes the progress made so far, identifies gaps, and commits to a set of solutions. While a declaration is a welcome step that demonstrates strong political will and the high-level meeting itself is recognition of the severity and urgency of fighting AMR, the more critical part comes next: action. 

AMR is a complex issue that requires a multisectoral approach. Drawing on my decades of experience in pharmaceutical management – including time working for a ministry of health – there are three key ways that we can strengthen pharmaceutical systems to help squash these superbugs.   

Invest in supply chains and pharmaceutical systems 

It is hard to properly complete a prescribed course of antibiotics if the pharmacy has run out. Medicine shortages are often supply chain failures, so investing in supply chain improvements will keep medicines on the shelves.

This can be done in several ways. One is to integrate digital tools and strengthen health worker skills so they can accurately predict the demand for a drug, keep a sufficient quantity of that drug in stock, and make sure it reaches patients before it expires. Equally important is to boost distribution so that the right medicines are where they are needed, when they are needed, and in the right amounts.

A fully stocked shelf of medicines will not help a patient who can’t afford them. That’s where creative financing options like pooled procurement – when governments or state agencies band together to bulk order and negotiate for better drug prices—can help lower costs.

Lastly, developing and revising standard treatment guidelines and essential medicines lists prioritizes the right medicines and provides guidance on their use. These efforts to fortify pharmaceutical systems are critical to fighting AMR not only because of the availability of antibiotics but also because they help ensure a timely flow of safe and affordable vaccines and drugs to prevent diseases and quickly stop their spread, reducing the number of people who need antibiotics in the first place.

Strengthen laboratory systems 

It is difficult for a health professional to effectively treat an infection if they don’t know what it is. The answer to that question is most often found in a laboratory with the right technology and trained professionals.

LMICs, particularly those with remote or hard-to-reach areas, often have scarce or nonexistent testing facilities, and health workers treat illnesses based on symptoms rather than lab tests. Unfortunately, treating sick individuals with antimicrobial agents without knowing what is causing their illness or the sensitivity of the bug to the prescribed medicine can be ineffective and contribute to AMR. 

Ensuring that health care providers have access to laboratories equipped to test for a wide range of pathogens can go a long way toward ensuring that the right medication is used, thereby reducing the incidence of AMR. Strengthening laboratory systems can also improve a country’s ability to detect emerging or re-emerging AMR threats.

A strong surveillance system means that you have the necessary equipment and human resources to detect any threat quickly and the tools and platforms to communicate across borders and globally. Well-trained surveillance teams and well-equipped laboratories similarly are crucial for detecting diseases with epidemic or outbreak potential, such as mpox or COVID-19. 

Facility improvements, surveillance systems, and transparent data sharing demand attention on a legal and policy level. Stakeholders could make significant strides against AMR with a commitment to strengthening laboratory systems around the world.

 Address behavior to ensure appropriate use of antimicrobials  

While resources and technology play a crucial role in containing the threat of AMR, a comprehensive strategy should also incorporate the need for behavior change to correct inappropriate medicine use. 

For health workers, training and oversight on infection prevention and control will help stop hospital-acquired infections from happening in the first place. Prescribers need systems, tools, and training to foster awareness of AMR and how to combat it. 

For example, the World Health Organization’s AWaRe classification helps prescribers know which antibiotics to Access, which to Watch the use of, and which to Reserve for specific circumstances. 

Dispensers can benefit from training on proper counseling around antibiotic use, and regulations and oversight could curb falsified and substandard medicines and end the practice of selling antibiotics without a prescription. 

Communications campaigns that involve journalists and civil society organizations can help patients understand the problem and the importance of taking their full course of medications, not sharing medications with others, and seeing a medical professional to be prescribed the right medicine.

Many call AMR a “silent pandemic,” but AMR and the devastation it is causing has been speaking up plenty. The world just hasn’t always been listening. This month’s meeting in New York rightfully puts AMR in the spotlight as the major global health concern that it is. The bigger question is whether that attention will be sustained and translated into action. To make meaningful progress, governments should commit to a comprehensive systems approach and put enough resources toward adopting and implementing national action plans to effectively stop this not-so-silent pandemic once and for all.

Francis “Kofi” Aboagye-Nyame is a pharmaceutical management expert with the global health nonprofit Management Sciences for Health. A trained pharmacist, he has more than 30 years of experience including overseeing pharmaceutical strengthening projects on behalf of international donors in more than 40 countries.

Image Credits: National Cancer Institute/ Unsplash, Laurynas Me/ Unsplash.