APO funds research to explore effect of AMR action plans

Benjamin Anderson, infectious disease epidemiologist and assistant professor of global health

A research consortium including Duke Kunshan faculty Benjamin Anderson and Annemieke van den Dool has received US$60,000 in funding from the World Health Organization’s Asia-Pacific Observatory on Health Systems and Policies (APO) to investigate the impact of national policies on antimicrobial resistance (AMR) in Asia.

AMR is a major global health threat that reduces the ability to treat effectively infections caused by bacteria, viruses, parasites and fungi. It has led to the development of so-called superbugs such as MRSA and VRSA, and scientists warn that AMR could cause more than 10 million deaths a year by 2050 and cost global production US$100 million.

Several countries have adopted national action plans to tackle the main contributing factors, including the misuse and abuse of antimicrobials in human medicine and livestock farming, and improper storage and disposal. However, research on the impact of intervention polices is limited.

To fill the information gap, the APO is funding a two-year study to look at how policymakers’ perception of AMR has affected regulation on the use of antimicrobials in Bangladesh, Cambodia, the Chinese mainland and Hong Kong, Singapore, and the Philippines.

Annemieke van den Dool, assistant professor of environmental policy

‘There is political commitment from health ministries to work on this problem, but AMR is a complex issue because it involves multiple stakeholders in multiple sectors of society, such as the pharmaceutical and animal feed industry, academics, and other government bodies such as the Ministry of Agriculture,’ said Van den Dool, assistant professor of environmental policy. ‘A first step in tackling AMR is to map who is doing what in terms of making and implementing policies to address the issue of AMR.’

Van den Dool and Anderson, an infectious disease epidemiologist and assistant professor of global health, will work together to focus on understanding the existing policies to address AMR in the Chinese mainland.

China, home to 1.4 billion people, uses more antibiotics in human and animal medicine than any other country. The Chinese government introduced a national action plan against AMR in 2016 and set a four-year target to develop new antimicrobial drugs, enhance surveillance of antibiotic utilization, and increase education on AMR for clinicians and consumers.

‘China has made progress in reducing antibiotic consumption, but there still remains a high level of overall use,’ said Anderson. He said the animal agriculture sector is particularly important, as the routine practice of using broad-spectrum antibiotics in livestock production has contributed to the emergence of AMR pathogens, notably colistin-resistant strains of E. coli.

For the study, researchers will examine existing legislation and identify gaps in the surveillance of and access to antimicrobials at all levels. They will also conduct in-depth interviews with policymakers in health, agriculture and other sectors to understand their perspectives on AMR.

The findings will form the basis of policy recommendations on how to improve processes and procedures to reduce the risk of AMR.

‘Our study also aims to influence policy on a global level,’ said Van den Dool. ‘We’re hoping the information will help strengthen systems and practices in low-, middle- and high-income countries.’

The APO is a conglomerate of governments, development agencies and the research community. Since 2014, Duke Kunshan has been an APO research hub for health policy and system research, working with partner institutions including Duke-NUS in Singapore, Fudan University in Shanghai, the Hanoi School of Public Health, and The Chinese University of Hong Kong.

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