Healthcare Getting It Right : Antimicrobial Resistance

Global health excels at attention to antimicrobial resistance. This attention is mirrored nationally and locally in the US.

The WHO Global Action Plan from 2015 [1] could be updated.

Global burden estimates, broader surveillance strategies, and laboratory solutions that solve for barriers to optimal research [2] could be a component to an updated plan.
SORT-IT and TDR work [3] could take a leadership position in the Global Action Plan.
Specific interventions could be determined using strength of evidence, available recommendations or feasibility, yet there should be consensus. For example, anti-malarial resistance research lists 24 separate intervention actions [4]. Funding and philanthropy could set expectations.
The culture around patient safety and antimicrobial resistance should include access to pharmaceuticals and labs through measures of wrong diagnosis or wrong treatment. In essence, global health should know an average estimate of delayed labs, no access to labs and the wrong antibiotic given.
The pharmaceutical industry should be specific about their pursuit of antibiotics. We often here how R&D funding goes to new antibiotic research, and how necessary various industry practices with questionable revenue are to R&D. Is the pursuit a match to the evidence [2]?

Excellent attention to antimicrobial resistance is mirrored nationally and locally in the US.

Local and state public health should be consistent and up to date on actions taken to support antimicrobial resistance in the community.

Specific steps to measure and collaborate with long-term care facilities should be clear. Local and state health should be able to report this work with standardization, especially as healthcare-acquired infections and other patient safety data is reported federally. State alignment is not out of reach.
Specific steps to better address urgent care and primary care partnerships should be outlined by state health departments.
Local and state public health reports from 2013 and 2015 [5] should be updated.

Objectives with deadlines during the height of the pandemic should be evaluated for extension of date. There’s no reason to wait for 2025 to assess whether or not these have been met.
All objectives needing deadline extensions should be assigned those extensions now. Or, funding should spark immediate movement forward to get the job done.
Objectives involving local and state health departments need clarity and realization. It is not enough to ask local health departments to refer to NHSN. What are the hospitals, long term care and ambulatory care doing alongside local health? What are the short, medium and long term goals outlined in local and state plans?
CDC could be tasked with real-time updates [8] to acknowledge ongoing barriers or challenges with plan implementation.

Research on antimicrobial resistance should fall under a strategic gameplan across federal agencies. The funding and implementation of the research [7] could match the National Action Plan [6] and WHO Global Action Plan [1]. Research could also set expectations for local and state health department involvement.

Military involvement in antimicrobial resistance is strong.

Research involving military funds or operational support should be a component to the national research gameplan, not a luxury or nice-to-have partner.
DoD and VA involvement in the National Action Plan [6] should be assessed now, not after 2025, and tweaks should be made accordingly.
DoD and VA data should be a component to local health department work. The federal tables of DoD and VA should not be separate from the state and local tables. Antimicrobial resistance work is a great way for public health to facilitate the shared table.

References