By Carlos Onyango
The World Health Organization (WHO) today launched a global campaign urging governments to adopt a tool – Access, Watch and Reserve – (AWaRe) to reduce the spread of antimicrobial resistance, adverse events, and costs.
As an effort to improve medical advancements, WHO Essentials Medicines List (EML), developed the AWaRe tool to contain rising resistance and make antibiotic use safer and more effective.
It classifies antibiotics into three groups – Access, Watch, and Reserve – and specifies which antibiotics to use for the most common and serious infections, which ones should be available at all times in the healthcare system, and those that must be used sparingly or preserved and used only as a last resort.
The ACCESS antibiotics are first- and second-choice options for common infections: they should be available in all countries and all facilities.
WHO recommends that antibiotics in the ACCESS group be available at all times as treatments for a wide range of common infections. Examples include amoxicillin, a widely-used antibiotic to treat infections such as pneumonia.
The WATCH group includes antibiotic classes that should be prescribed only for specific indications since they are at higher risk of bacterial resistance. Some ACCESS antibiotics, such as ceftriaxone or azithromycin, are also part of the WATCH group.
And the RESERVE group is made up of last-resort options, such as Colistin or IV Fosfomycin.
Antibiotics belonging to the WATCH and RESERVE groups should be particularly targeted by antibiotic stewardship programs at national and international levels.
The campaign aims at improving the proportion of global consumption of antibiotics in the Access group to at least 60%, and to reduce the use of the antibiotics most at risk of resistance from the Watch and Reserve groups. Using Access antibiotics lowers the risk of resistance because they are ‘narrow-spectrum’ antibiotics (that target a specific microorganism rather than several). They are also less costly because they are available in generic formulations.
“Antimicrobial resistance is one of the most urgent health risks of our time and threatens to undo a century of medical progress,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
“All countries must strike a balance between ensuring access to life-saving antibiotics and slowing drug resistance by reserving the use of some antibiotics for the hardest-to-treat infections. I urge countries to adopt AWaRe, which is a valuable and practical tool for doing just that.”
Dr Hanan Balkhy, WHO Assistant Director-General for Antimicrobial Resistance, recommends that in order to tackle antimicrobial resistance, a careful balance between access and preservation is required. She further adds that the aware tool can guide policy to ensure patients keep being treated, while also limiting the use of antibiotics most at risk of resistance.
In the absence of new significant investments into the development of new antibiotics, improving the use of antibiotics is one of the key actions needed to curb further emergence and spread of antimicrobial resistance. By classifying antibiotics into three distinct groups, and advising on when to use them, AWaRe makes it easier for policy-makers, prescribers and health workers to select the right antibiotic at the right time, and to protect endangered antibiotics.
“Antimicrobial resistance is an invisible pandemic,” said Dr Mariângela Simão, Assistant-Director General for Access to Medicines. “We are already starting to see signs of a post-antibiotic era, with the emergence of infections that are untreatable by all classes of antibiotics. We must safeguard these precious last-line antibiotics to ensure we can still treat and prevent serious infections.”
WHO has been leading multiple initiatives to address antimicrobial resistance:
World Antibiotic Awareness Week
Held every November since 2015 with the theme “Antibiotics: Handle with care”, the global, multi-year campaign has an increasing volume of activities during the week of the campaign.
The Global Antimicrobial Resistance Surveillance System (GLASS)
The WHO-supported system supports a standardized approach to the collection, analysis and sharing of data related to antimicrobial resistance at a global level to inform decision-making, drive local, national and regional action.
Global Antibiotic Research and Development Partnership (GARDP)
A joint initiative of WHO and Drugs for Neglected Diseases initiative (DNDi), GARDP encourages research and development through public-private partnerships. By 2023, the partnership aims to develop and deliver up to four new treatments, through the improvement of existing antibiotics and acceleration of the entry of new antibiotic drugs.
Interagency Coordination Group on Antimicrobial Resistance (IACG)
The United Nations Secretary-General has established IACG to improve coordination between international organizations and to ensure effective global action against this threat to health security. The IACG is co-chaired by the UN Deputy Secretary-General and the Director General of WHO and comprises high-level representatives of relevant UN agencies, other international organizations, and individual experts across different sectors.
The AWaRe campaign – ‘AdoptAWaRe, Handle antibiotics with care’ – will be officially launched on 19 June by the Ministers of Health of The Netherlands and Indonesia and WHO Assistant-Director General Hanan Balkhy, at the second ministerial conference on AMR in Noordwijk, The Netherlands. The campaign web site AdoptAWaRe.org provides advocacy and communication materials and resources for policymakers.
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