The global threat of antimicrobial resistance
Antimicrobial resistance (AMR) poses a significant threat to global public health, driven by interconnected human, animal, and environmental factors. The World Health Organization’s (WHO) Global Action Plan on AMR, adopted in 2015, has catalyzed national efforts to develop and implement AMR national action plans (NAPs). However, translating political commitment into effective action remains a challenge, especially in low- and middle-income countries (LMICs).
Countries’ capacity to address AMR at the human-animal-environment interface is crucial. Recent studies have highlighted gaps in AMR surveillance and control, including shortcomings in the implementation of NAPs across various settings. In LMICs, accountability, ownership, and clarity of stakeholder roles in NAP implementation have emerged as critical obstacles to progress.
Argentina’s experience in tackling AMR
Argentina is an upper-middle-income country that has made significant strides in developing and implementing an AMR NAP since 2015. The country has gradually banned the use of colistin, a critical antibiotic, in food-producing animals and prohibited the use of antibiotics as growth promoters. However, challenges remain in achieving a coherent, multisectoral approach to AMR surveillance and control.
A recent study employed a mixed-methods approach, combining a historical synthesis of AMR-related regulations and qualitative interviews with key stakeholders, to understand the opportunities and challenges Argentina faces in implementing its NAP. The study’s findings provide valuable insights that can inform the development of AMR policies in India and other LMICs.
Fragmented governance and stakeholder coordination
One of the key challenges identified in Argentina was the fragmented governance structure and limited cross-coordination among stakeholders involved in AMR control and surveillance. The country’s decentralized administrative system, with 24 distinct provinces, has led to variable quality of care and access to healthcare and antibiotics, both in human and animal sectors.
“We have a fragmented structure of the food production chain, poor cross-coordination between stakeholders, limited surveillance and regulation among food-producing animals, and geographical disparities over access, diagnosis, and treatment.” – Participant from a public institution (ID=9), female.
Effective coordination and alignment of efforts across national, provincial, and local levels, as well as between human and animal health sectors, are crucial for successful NAP implementation. Strengthening accountability and providing adequate resources to ensure long-term sustainability of AMR control measures are key priorities.
Awareness, knowledge, and behavioral change
Raising awareness and improving understanding of AMR among diverse stakeholders, from healthcare professionals to food producers, emerged as another significant challenge. While progress has been made in increasing AMR knowledge, particularly among leading institutions, awareness campaigns often have limited reach to the wider population, including meat producers.
“There is a problem with vets’ knowledge of antibiotics, specifically in terms of pharmacokinetic and pharmacodynamic aspects, the correct calculation of the dose administration. It is the duration of treatment in the form of clinical criteria and corresponding to specific physiological situations. All these aspects are related to rational antibiotic usage. If you forget these aspects, you can reach a therapeutic failure despite having chosen the correct antibiotic based on what the laboratory said; and this is largely prevalent in the country.” – Veterinarian, academia (ID=14), male.
Effectively addressing AMR requires a comprehensive approach that promotes behavioral change and responsible practices across various sectors, including human health, animal production, and the general public. Tailored educational programs and targeted awareness campaigns are necessary to empower different stakeholders and foster a culture of antimicrobial stewardship.
Antimicrobial use and regulation
Ensuring appropriate access, use, and regulation of antimicrobials in both human and animal sectors emerged as a significant challenge in Argentina. While the human health sector has made progress in antimicrobial stewardship and surveillance, the animal sector lags behind, with issues related to traceability, prescription, and control of antibiotic usage.
“Antibiotics are still sold without a prescription either for human or animal use (more frequent among animals), even if prescriptions are mandatory by law, including keeping track of their usage by health professionals (electronic sales). Another issue is the dosage; antibiotics are usually sold in dosages greater than needed, which incentivises inappropriate utilisation maximising commercial interests.” – Participant, academia (ID=14), female.
Strengthening regulatory frameworks, improving prescription practices, and enhancing traceability and monitoring of antimicrobial use in the animal sector are essential to curbing the development and spread of AMR. Innovative approaches, such as promoting alternative, non-antimicrobial interventions in livestock production, can also contribute to reducing reliance on antibiotics.
Surveillance and data integration
Effective AMR surveillance, integrating data from human, animal, and environmental sectors, is a crucial component of NAP implementation. While Argentina has made progress in human health surveillance, with well-established hospital networks and antimicrobial stewardship programs, the animal sector lags behind in terms of comprehensive, nationwide surveillance.
“INTA monitors some animal production chains, but surveillance is the primary task of SENASA, for example, in dairy, we evaluate animals experiencing a mastitis disease and track AMR and potential environmental reservoirs with technology developed locally. Another example, we detect Salmonella in animals and utilise microbiological analyses, including phenotyping and genotyping to analyse AMR and evolution, as part of surveillance routines hand by hand with SENASA. However, most surveillance comes from the governmental side, sampling seasonality is not often captured due to limited resources, the quantity of livestock farms is massively distributed throughout the country, and local producer’s veterinary diagnostics are often sent to private labs where traceability is missing.” – Veterinarian, public organisation (ID=15), male.
Establishing integrated, cross-sectoral surveillance systems that capture data from human, animal, and environmental domains is crucial for understanding the full scope of AMR and informing targeted interventions. Strengthening laboratory capacity, improving data collection and sharing, and ensuring representativeness of surveillance data are essential steps towards building a comprehensive AMR monitoring framework.
Opportunities for progress
Despite the challenges, Argentina’s experience also highlights several opportunities for progress in AMR policy development and implementation:
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Institutionalization of the National Commission for AMR Control (CoNaCRA): The establishment of CoNaCRA as the coordinating body for the NAP has been a significant step forward, facilitating interdisciplinary engagement and knowledge sharing among various stakeholders.
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Regulatory advancements: The recent introduction of a new law on AMR prevention and control, which prioritizes the One Health approach and establishes a dedicated network and surveillance system, represents a positive step towards a more coherent and sustainable AMR policy framework.
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Collaboration and partnerships: Argentina has fostered strong relationships with international organizations, which have helped secure funding and technical support for local AMR projects and initiatives, expanding the country’s capacity to tackle this challenge.
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Alternatives to antibiotics: Efforts to develop and promote alternative, non-antimicrobial interventions in animal production, such as vaccines, additives, and plant-based biomolecules, hold promise in reducing the reliance on antibiotics and mitigating the emergence of resistance.
Lessons for India and other LMICs
The insights from Argentina’s experience in tackling AMR offer valuable lessons for India and other LMICs as they work to develop and implement effective AMR policies:
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Strengthening multisectoral coordination and accountability: Ensuring robust governance structures, clear delineation of roles and responsibilities, and effective coordination mechanisms across human, animal, and environmental sectors are crucial for successful NAP implementation.
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Investing in surveillance and data integration: Building comprehensive, cross-sectoral AMR surveillance systems that capture representative data from various domains is essential for informing evidence-based policymaking and targeted interventions.
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Promoting behavioral change and awareness: Implementing multi-stakeholder educational programs and awareness campaigns to foster a culture of antimicrobial stewardship and responsible practices across different sectors is vital for sustainable AMR control.
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Enhancing antimicrobial regulation and access control: Strengthening regulatory frameworks, improving prescription practices, and enhancing traceability and monitoring of antimicrobial use in both human and animal sectors are necessary to curb the development and spread of AMR.
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Exploring alternative interventions: Investing in the research and development of non-antimicrobial alternatives, such as vaccines, additives, and improved animal husbandry practices, can help reduce the reliance on antibiotics and mitigate the emergence of resistance.
By addressing these key areas and learning from the successes and challenges faced by countries like Argentina, India and other LMICs can develop more robust and effective AMR policies, ultimately safeguarding public health and environmental wellbeing.
Conclusion
Antimicrobial resistance poses a complex, multifaceted challenge that requires a coordinated, multisectoral response. The insights from Argentina’s experience in tackling AMR underscore the importance of strengthening governance, enhancing surveillance, promoting behavioral change, and improving antimicrobial regulation and access control. As India and other LMICs work to develop and implement their own AMR policies, these lessons can serve as a valuable guide to navigate the opportunities and challenges that lie ahead.
Embedding a One Health approach, fostering stakeholder collaboration, and prioritizing sustainable, context-specific solutions will be crucial for LMIC countries to effectively combat the global threat of antimicrobial resistance and safeguard the wellbeing of their populations and environments.
