Priorities in human AMR research

In 2021, the G7 summit discussed a number of global issues at length, including antimicrobial resistance (AMR). Acknowledged by all world leaders present as a pressing issue and significant risk to global health, AMR continues to have a significantly negative impact on the economy, our health care systems, and other aspects of society, with an estimated 700,000 deaths annually (almost 1.2% of global deaths).

A wide spectrum of research is focused on tackling the growing threat of AMR, with contemporary research largely focused on the discovery of novel antimicrobial agents and the development of new technologies. The themes under which global funding is available in human AMR research can be seen below.

Is this the best way forward?

Whilst the development of new antimicrobial agents is widely acknowledged as a vital and important aspect of AMR, there is also a need for research into optimising the use of antimicrobial agents both novel and established to ensure future effectiveness. While progress is being made through research initiatives focused on AMR, further efforts need to be made to fully address this gap in priority research.

Four broad themes have been identified as research priorities in the optimisation of antimicrobial use. We have broken each of them down for you below, including timelines to visualise a proposed plan for identified research priorities.

Policy and strategic planning

Supportive strategies and tools in place for interventions include the development and implementation of national action plans (NAPs) for AMR, based on the best available evidence. These interventions must be aligned with recommendations that are acceptable, feasible, contextual, economic, and sensitive.

A 2019 study found that 117 of 208 countries had government-approved AMR NAPs reflecting the World Health Organisation (WHO) Global Action Plan objectives. However, only 26 of these had identified funding sources, and the remaining 91 countries were still at the development stage.

Medicines management and prescribing systems

Medicines management refers to the processes, behaviours, and systems determining medicine use in clinical practice. Accessibility and availability of antimicrobials depends on their legal classification and the extent to which this is enforced and monitored. Timely access to antimicrobials is internationally recognised through their inclusions in country-specific essential medicines list (EMLs). However, keeping this list updated remains challenging.

The WHO AWaRe system categorises antibiotics based on their activity against multi-drug resistant organisms. This system adds value to antimicrobial studies, and has reported rapid increases in consumption in the Watch category, particularly in Low- and Middle-Income Countries (LMICs).

Technology to optimise prescribing

Effective medicines management requires data and technological advances that are capable of supporting and providing this. Examples of existing technologies that can be readily applied to optimise antimicrobial use include rapid diagnostic devices, clinical decision support systems, wearable devices, biosensor technologies, and artificial intelligence.

There are limitations in infrastructure and systems which can block innovation uptake. For example, technology developed in one setting cannot be assumed to be directly translatable to others, for example High Income Countries (HICs) vs LMICs. Frameworks for the funding, development, and evaluation of technologies must take this into account to ensure that targeted interventions are developed and implemented appropriately.

Context, culture, and behaviours

AMR is a multifaceted issue, with it’s drivers and consequences manifested socially. This includes impacts from professional hierarchies, socioeconomic status, gender, ethnicity, and race. Inequalities harm AMR as well as health. It is vital that the intersection of socioeconomic factors and AMR and how it puts individuals at greater risk of poor outcomes is better understood if we are to bring forth sustainable change for vulnerable populations.

Optimising antimicrobial use is key to tackling AMR

However, the use of antimicrobials is a dynamic and complex subject that, in order to be fully understood, must be considered in the sociocultural context. Individual characteristics among a changing population will also have a significant impact on how antimicrobials are utilised, as such interventions cannot always be universally applied. What may work well in HICs may not in LMICs, where the largest health and economic burden from drug resistant infection is experienced.

Following these roadmaps, within two years, countries should have achieved a detailed understanding of challenges they face and be capable of developing context appropriate policies and interventions to address them. Within five years, countries should be implementing these policies and interventions, refining their approach, and incorporating emerging developments. And, finally, within ten years, they should be moving towards a sustainable model, incorporating a sustainable system of research and evaluation.

Sustainable progress depends on: developing economic and contextually appropriate interventions, facilitating better use of data and prescribing systems across healthcare settings, and supporting appropriate and scalable technological innovation.

To truly optimise the use of antimicrobials, a comprehensive and broad research base must be used to inform intervention.

When you are ready, click ‘next’ to proceed to the following section, where we will explore the importance of social sciences in tackling AMR and introduce qualitative methodologies.