Victoria Rutter
Chief Executive Officer, Commonwealth Pharmacists Association
Recommendations from the Commonwealth Pharmacists Association (CPA) offer a roadmap for more resilient and effective healthcare systems that are better equipped to protect us from future health challenges.
Effectively addressing antimicrobial resistance (AMR) requires a comprehensive approach. By strengthening pharmaceutical systems, we can not only contribute to combating this global health threat but also improve overall healthcare outcomes.
Access to high-quality antimicrobials
The United Nations General Assembly High-Level Meeting on AMR, held in New York in September 2024, has reinvigorated the urgent, global focus needed to improve access to high-quality antimicrobials. While AMR affects people across the world, this global health crisis is particularly devastating in low and middle-income countries (LMICs), where access to essential medicines is often limited. These nations are particularly vulnerable to unreliable supply chains, poor-quality products and inadequately trained healthcare staff, making it difficult for patients to access life-saving antimicrobials when needed.
Improving antimicrobial education and regulation
The CPA emphasises the need for a comprehensive approach to tackle AMR in LMICs. It is advocating for urgent action to strengthen pharmaceutical systems, including improving access to high-quality antimicrobials, enhancing supply chain management and ensuring appropriate antimicrobial use through education and regulation.
To realise the complexity of this challenge, we first need to appreciate that not all antimicrobials are the same. It must be the correct antimicrobial taken in the correct amount, or we risk treatment being ineffective and creating ‘superbugs’ that are even harder to kill. With a limited supply of new antibiotics on the horizon, and those coming through likely to be at premium prices, it is critical to preserve the power of these essential medicines to save lives.
Addressing access barriers responsibly
At the heart of CPA’s recommendations is to address barriers to antimicrobial access when their use is justified. ‘Stock outs’ are a common problem in LMICs, often leaving patients with limited treatment options. Strengthening supply chains, particularly through the use of digital technologies, is an essential (often overlooked) strategy for tackling AMR.
Equally important is the delicate balance between facilitating access and enforcing regulations to support responsible antimicrobial use. Education is, therefore, a key enabling element. Effective antimicrobial stewardship can only be achieved when the supply of medicines is handled by appropriately trained and regulated staff.
It must be the correct antimicrobial taken
in the correct amount, or we risk treatment
being ineffective and creating ‘superbugs’
that are even harder to kill.
Significance of pharmacies and pharmacists
Pharmacies are often the first and, sometimes, the only point of contact for healthcare in the community. Pharmacists are highly trained professionals and have a key role in ensuring safe and effective use of medicines. However, their potential is often overlooked and specialist skill sets underutilised. The CPA is advocating for the regulation of pharmacists and pharmacies to ensure that essential healthcare services are overseen by qualified professionals.
Quality of medicines is a major concern
Substandard and falsified antimicrobials are widespread, with an estimated 1 in 10 medicines in LMICs being of poor quality, and an alarming number of antimicrobials falling into this category. These low-grade medicines not only fail to treat infections but also fuel the development of drug-resistant microorganisms. To address this crisis, the CPA recommends stricter enforcement of pharmaceutical regulations and strengthened supply chain security to ensure that only safe and effective medicines reach patients.
Financial incentives for antimicrobial stewardship
Financial incentives, such as the establishment of effective reimbursement models, can also help improve antimicrobial use. In many LMICs, financial pressures often lead healthcare providers to prioritise sales volume over patient safety, leading to antimicrobial overuse. The CPA advocates for sustainable remuneration models that reward patient-centred quality care and discourage unnecessary dispensing of antimicrobials.
Strengthening supply chains and leveraging tech
To effectively combat AMR, we must ensure a reliable supply of high-quality antimicrobials. Strengthening pharmaceutical supply chains and leveraging digital technologies are crucial. Additionally, training healthcare providers and appropriately regulating supply of medicines are essential to promote responsible antimicrobial use. Focusing efforts towards cross-sector health systems strengthening approach will not only help address AMR but also build resilience against future health threats such as pandemics, disasters and the effects of climate change.
