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Skip to 0 minutes and 7 seconds Good to see you again. We are approaching the end of this course now and I’m sure that you have learned about the complexity of the issue and how many actors that really need to be involved in the solutions of this major problem. Complex problems need complex solutions! When I was engaged some 20 years back in this problem and initiated ReAct, an international network, Action

Skip to 0 minutes and 35 seconds on antibiotic resistance, we posed the question: Who is responsible for this problem? Of course, ultimately, the national governments are responsible for health and also then including antibiotic resistance and availability to essential medicines. But all of society needs to be engaged. This is something that concerns everyone. Everyone needs to take part of it. Everyone needs to change behaviour. And we ultimately need to change social norms.

Skip to 1 minute and 5 seconds In the ReAct work, we have been trying to merge academia, research, health care, and civil society together. I think that is in essence, what I’m trying to say. It’s not sufficient with government action. Civil society and action from professionals and everyone is also needed. Because this is again, something that could be related to, or making similar to climate change, where everyone is responsible to take action. Now, back to the government’s responsibility. Who the government would then be responsible? Of course, the minister of health, surely. But also the minister of agriculture, the minister of research and development and education, but not the least, the minister of finance. This issue is a cross-cutting issue.

Skip to 2 minutes and 0 seconds It’s an issue that needs to be worked up in collaboration at all levels. On the government part, the WHO Global Action Plan asks and urges all countries to put up a national action plan. And that plan needs to contain a lot of different parts. In this slide, you can see those areas. It’s about surveillance and monitoring. It’s about prevention to decrease the need for antibiotics. It’s about rational use and access. It’s research. And also not the least, addressing the non-human side, the animal side and also the environmental side. So for surveillance, we need to have a good picture on the use of antibiotics and the resistance levels.

Skip to 2 minutes and 48 seconds But also the health care-associated infections and not the least, the costs for society of these infections that are caused by antibiotic-resistance bacteria.

Skip to 3 minutes and 0 seconds We need to decrease the use by prevention: sanitation, improving clean water, and hand hygiene, and infection control practises in hospitals. But also vaccinations. Research and development, not only for antibiotics, but also for diagnostic tools that make it easier for doctors to identify those infections that really need antibiotics. Access and rational use is a major part of this. We need to have good guidelines. There need to be strict regulation about use in both human and animal sides. But also, we need to promote understanding with the society at large on how antibiotics should be used, when they should be used. We need to work up a strong behavioural change.

Skip to 3 minutes and 53 seconds We know that in the human sector, at least 50% of antibiotics are unnecessary, and in the animal sector it’s even more. So that area needs to be incorporated strongly in this comprehensive national action plan. But countries cannot do this by themselves. This is such a big issue that national governments need to go together. And the low-income countries have - I mean, the burden of antibiotic resistance falls disproportionately on the low-income countries. So they need support financially and by capacity building. So, we need a global collaboration also, which will include, again, measuring the burden of disease so that policymakers and politicians understand the dimensions of the problem and the cost for the world and the global development issues that are involved.

Skip to 4 minutes and 52 seconds We need global funding mechanisms for innovation. We know that we need new antibiotics and diagnostics and alternatives. We know that this has been standing still for too long time. There need to be collaborations scientifically and also financially. In that, we need new business models. What do we mean with a new business model? Well, the old model, where we get a new antibiotic is heavily marketed by the pharmaceutical industry. It’s misused leading to resistance. That doesn’t work! We need to have another model where the return of investment from the private sector is not gained by big sales. This debate is now ongoing, and I surely hope that we will materialise– it will materialise in some concrete action in the near future.

Skip to 5 minutes and 44 seconds As I said, low-income countries have a major problem. They need help with capacity building or laboratories, regulations, and making ways for dealing with this complex issue. They also need a global fund. We need all of us to share best practises. What works? What doesn’t work? How can we go together in trying to find good ways to intervene and make progress? So, many things need to be coordinated at the global level. If we do that, we may manage. But the next slide is telling us what is going on today. We are trying to pour in new antibiotics in the system, which is leaking all the time. It leaks because we are misusing these drugs.

Skip to 6 minutes and 35 seconds It leaks because we are spreading resistance all over the place– with travel, with livestock, and the food chain. So we need to mend all these holes in the bucket also simultaneously. That is really something that we have to realise. That’s why innovation is not the only solution. We also need to have conservation. And my end slide here is telling us that we need to get back the balance. We will never ever get rid of antibiotic resistance, as long as we are using these drugs. Any antibiotic use, even the best and most rational antibiotic use will lead to resistant development in bacteria. So we simply just have to get back to balance.

Skip to 7 minutes and 20 seconds We need new drugs, but we have to use them more cautiously. We need to conserve their use and if we get back to that balance, we will manage. Thank you.

What do we need to do for the future?

Watch professor Otto Cars talk about what he thinks we need to do to ensure the effectiveness of antibiotics in the future.

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This video is from the free online course:

Antibiotic Resistance: the Silent Tsunami

Uppsala University