WAAAR (World Alliance Against Antibiotic Resistance) is a not-for-profit NGO based in Paris. As a research, advocacy and practice forum dedicated to overcoming antibiotic resistance, its programmes have been endorsed by more than 140 societies or professional groups throughout the world. In an interview, Dr Jean Carlet MD, President of WAAAR and Chair of the 2015 French Task Force on AMR, shares the view that governments have been slow to respond to this threat, even though all knowledgeable medical authorities are aware that the danger of AMR is increasing by the day. Edited excerpts:
In spite of scientific evidence directly linking the overuse of antibiotics with the emergence of resistant strains, these drugs are still being prescribed without any sort of restrictions across the world by clinicians. How does WAAAR look at this scenario?
AMR is due to many factors. Antibiotic (over)consumption is, of course, one of them. However, the prevention of the cross-transmission of resistant bugs in the community is also key, as well as, more broadly, sanitation issues, in particular in low-income countries. There are still many controversies and fights over the relative weight of different mechanisms, such as whether we should add the role of AMR in animals and transmission to humans, the role of the environment — in particular via effluents — and other factors.
Many countries are yet to put in place a surveillance programme on antibiotic resistance. How will this lack of concerted action affect global efforts to prevent cross-transmission of resistant bugs?
We need data on both the consumption of antibiotics and resistance levels, in a given country, city, or even a unit. Those data are mandatory to be able to choose the appropriate therapy. We also need a strong team for antibiotic stewardship. However, this is not enough. Preventing the transmission of resistant bugs is also key. It needs a multifaceted programme. The main problem is that it requires a lot of work and needs considerable resources. Many countries cannot afford such a wide programme.
What strategies does WAAAR have to address the deficit of novel antibiotics to counter drug resistance?
WAAAR has not worked a lot on this topic, apart from a strong lobbying of the deciders. The 2015 ministerial task force that I chaired, in which many members of ACdeBMR/WAAAR were present, proposed many actions to cope with this serious problem.
The use of rapid, point of care diagnostic tests may help clinicians in the judicious use of antibiotics. The cost and availability of these tests, however, remain a key hurdle. Your comments?
The issue of the development of appropriate diagnostic tests is of paramount importance. We need tests to differentiate viral from bacterial infection. This is key in the community, and such tests could spare a huge amount of antibiotics. We also need a very rapid answer concerning the name of the bacteria involved, and its resistance profile.
WAAAR has plans to request UNESCO to include the “concept of antibiotic” in the list of the intangible cultural heritage. In what ways will this measure help to tackle the threat of antibiotic resistance?
Both the public and healthcare professionals must realize that antibiotics are a real treasure, and must be protected — like water, trees etc — under a philosophy of sustained development. They have to realise that every person, consumer or prescriber, is an important actor in the preservation of those drugs. We think the inclusion of the protection of antibiotic is rather similar to the protection of a wonderful, but fragile geographic site. It is obvious that UNESCO has decided recently to extend the list of what they should protect. Therefore, we will try again.