As countries build a more resilient health care system after COVID, can the AMR response be part of that agenda?

BILL RODRIGUEZ: We– those of us who worked in global health for a long time have known how massive the inequity is. But it’s been hard to convince people who don’t see it every day and don’t understand it. But when it’s in your face and when the inequity actually happens in wealthy countries in their local environment, where– as well as in low and middle income countries– it’s much more obvious. And then this pandemic has made it a sustained and global inequity in people’s faces, in their daily news feeds.

And that realisation has led to some– we’ve seen the real change in the approach of funders who control the purse strings, of advocates who feel energised to actually drive and demand change, of national governments in low and middle income countries who are now demanding that access be prioritised. Pandemics don’t really create any problems in the world. They just reveal all the existing problems that have always been there. And I think that’s true here. But now we actually have more attention on those problems than we’ve ever had before.

And it would be a real failure if those of us who have been working in global health can’t capitalise on that attention, and the real need and demand that there be substantive long-lasting change in how we support health care and countries that haven’t access to it in an equitable way before.

RAIVA SIMBI: We are really– I might not say it happened with COVID. But the budgets that we have seen, whether it’s Global Fund, whether it’s government itself, we have really benefited. I come from the lab side. So I’m really happy with what we have got. And even now, we can do genomic sequencing in the country, which was like a pie in the sky. But we have managed to sequence this COVID-19. And after COVID 19, we can also do it for other microbes that we can pick in the surveillance system. And also now, the other auxiliary equipment like the chemistry machine.

Like today, the permanent sector was pushing me to say, why are you not ordering a chemical luminescence machine so that we can do antibody tests for all these patients that are on treatment and some that they’ve been vaccinated to see whether they are responding to the vaccines? So that is when it’s a very positive thing. And then we are really happy with the progress.

AMAL SAIF AL-MAANI: Every time we look into the AMR, we have to look at it with One Health approach. What we are doing in many countries, that the health care is trying to control the spread of the AMR. And we have to understand that what we are dealing with as a health care is the results. And if we want to tackle a problem, we should go to the root cause analysis of this problem. And what is feeding this problem further? This might be different from one setup to another, from one country to another. But there’s a big headache. AMR is in the animal sector, environmental and human.

So if you are able to bring the three into One Health and look at how you can control the AMR in the animal sector, animal and agricultural sector, and in the environmental spread as well as in the human population through the health care, you get the magic solution.

PATRICIA GARCIA: We need to find ways to make it very simple to the public to understand that it’s in their hands also. Because sometimes, they are one of the most important pressures, for providers to prescribe antibiotics that are not needed. And if the provider doesn’t prescribe it, they will look for another provider that will prescribe it. Or they will go to the pharmacy where they can buy it. And if, for some reason, there is a policy that doesn’t allow the pharmacy to sell it, they will go to the black market. So I guess it’s not only a matter of a poor policy.

I think we need to give the power of information to the public, to the people, so they can be part of the solution. I think we need to restart explaining and informing better the public and also the providers about that and give them a tool to make the right choices. So those are the things that we really need. A simple tool is virus versus bacteria. I think that’s– that will be, really, a game-changer, number one. Eventually, if we are able to have tests that can allow us to rapidly add– show us resistance versus nonresistance, that will be a second game-changer. That probably will be more likely to be used at hospitals.

The other one will be more likely to be used at communities. But together with that, we really need to inform the public about when to use the right tools.

AMAL SAIF AL-MAANI: It’s very, very important that we educate the new generation, whether the new generation of professionals that are coming into the health care system, and not to focus only on one professional, which is the physician. Also include the nurses, include the technicians, include every and each workers within the health care sector in being aware about the AMR, being aware that even though it’s a huge problem, a simple measure like hand hygiene can prevent you from carrying it, carrying it for yourself, for your patients, or for your family and beloved. Preventing AMR is 80% of the solution.

The getting it and then what to do for the patients who have got it, I don’t think we have much options right now, especially with these superbugs. And it would mean for a person, morbidities, ICU care, and mortality. And for that part, I think, globally, there should be a serious stand with all the sectors under the umbrella of One Health to stop that from happening and stop us from losing all the success that we had over years and years achieved in the health care services and improving health care services.

DAVID HEYMANN: Testing of an infected person is indispensable. But it must be rapid. It must be point of care. And it must permit extremely rapid treatment and access to antibiotics. But don’t forget that prevention of infection is also important. Prevention not only prevents sickness and death, but it also prevents the use of antibiotics. Prevention has many forms. Infection prevention and control in health care settings with good hand-washing and good hygiene. Prevention of infection in the community through sanitation and hygiene in communities. And prevention of infection by using vaccines. When, for example, is the last time that a clinician has treated pertussis or diphtheria with an antibiotic?

It would be hard for most physicians to remember when they actually did treat these infections. Because they’ve been decreased by the use of effective vaccines. And there are many more vaccines against pulmonary infections, against other types of infections, such as sexually transmitted infections, that can also prevent illness, sickness, and death, and the use of antibiotics. Testing, however, remains extremely important while we wait for the new vaccines– which are in the pipeline– to become available.