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  • The starting point is to address the

    2019-06-29

    The starting point is to address the huge gap in surveillance capabilities identified in 2014 by the WHO\'s first global report on surveillance of antimicrobial resistance. To address this Tubacin gap, WHO\'s action plan is being implemented in phases from early 2016 onwards, gathering information from an initial set of countries with institutional capacities to implement the programme, assessing that information while enabling other countries to collect and analyse information, and making progress with other phases of data analysis and developing policy responses at the global, regional, and national level. Full implementation will need a few years of collaborative effort. To achieve the best possible results, we need to understand the different conditions prevailing across developed and developing economies. The 2014 WHO global report showed that many countries do not have the capacity or systems to undertake surveillance of antimicrobial resistance, with data deficiencies in large parts of the world, existing systems remaining largely uncoordinated, and data being shared infrequently. Although some regional systems and global disease-specific systems exist, no overall global system for surveillance of antimicrobial resistance exists to bridge the gaps, pool data from all sources, and do analyses to better understand the problem and drive effective solutions. The efforts at WHO also need to be supplemented by other initiatives that are already addressing some of these issues. In December, 2014, in Stockholm, Sweden, WHO, along with its member states and partner organisations, proposed an agreed set of standards for surveillance of antimicrobial resistance. These standards list the priority bacteria and diseases for surveillance; explain the metrics to be used to ascertain the incidence of resistance; and advise how the data should be collected, reported, and analysed. Recently the proposed standards were published as a manual: the Global Antimicrobial Resistance Surveillance System (GLASS) for all countries to collaborate in the surveillance of antimicrobial resistance. GLASS should be coordinated with a national action plan on antimicrobial resistance prior to participation. The programme requires active participation and input of partners around the world—in local health-care facilities, national laboratories, ministries, and regional networks. It will even reach out beyond the health sector to capture data about antimicrobial resistance wherever it is occurring. Both the UN Food and Agriculture Organization and the World Organisation for Animal Health are joining WHO to ensure the integration of data from the human and animal health sector and from the agriculture and food industries. WHO will invite countries to join the GLASS via an open call at their . Effective implementation requires the needs of low-income and middle-income countries to be addressed, their workforces to be trained to do surveillance, and improvement of their access to the microbiology laboratory. Achievement of these targets needs time but is key to adequately deal with the disease burden of health- care-associated infections and antimicrobial resistance. The benefits of addressing antimicrobial resistance are global. Therefore, developed nations must help developing countries to equip themselves for such an initiative and to identify steps that might be relevant for diverse conditions. An important relevant initiative was taken at a recent Asian Pacific Economic Coalition and Global Health Security Agenda meeting, which outlined several key components for establishing robust infection prevention and control infrastructure. One of them—promotion of hand hygiene using alcohol-based handrub at the point of patient care—has received much attention in both developed and developing countries because of the major infection prevention effect of this simple technique that can be cost-effectively launched in low-income and middle-income countries. For greater reach and possibility of earlier implementation, the initiatives taken by governments can be combined with public–private partnerships.