5.3 International efforts

In Section 3.3 you learned that the UN General Assembly gathered in September 2016 to discuss the problem of AMR.

The 193 member states committed to work collaboratively to take worldwide action to control AMR by signing the UN Declaration on AMR. All the declaration signatories have agreed that drug-resistant infections must be tackled as a priority and have committed to:

  • developing surveillance and regulatory systems on the use and sales of antimicrobial medicines for humans and animals
  • encouraging innovative ways to develop new antibiotics and improve rapid diagnostics
  • raising awareness among health professionals and the public on how to prevent drug-resistant infections.

By taking this course and discussing what you have learnt with colleagues, friends and family, you are already helping to raise awareness of AMR.

The UN held a second high-level meeting on antibiotic resistance eight years after the first, during the General Assembly in September 2024. Follow this link [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] to read more about the decisions taken at this meeting, including a target of reducing human deaths associated with AMR by 10% by 2030.

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Figure 9 Guidance on how to respond to AMR.
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This figure shows different international and national collaborations under the One Health approach to address the problem of AMR.

Figure 9 Guidance on how to respond to AMR.

AMR surveillance is critical to tackling AMR, and is the backbone of these efforts. In AMR surveillance and you you learned (or will learn) that AMR surveillance is the ongoing collection, analysis, interpretation and dissemination of data related to AMR.

  • At a global level, AMR surveillance provides quantitative data about the spread of resistant strains of bacteria, revealing trends and potentially identifying hotspots of resistant infections.
  • At a regional level, surveillance data informs intervention priorities and helps to identify gaps in service delivery.
  • At a national level, data guides planning and resource-allocation, and informs policies and responses to patterns and trends.

AMR surveillance data are important to inform policy-makers and decision makers at all levels.

Let’s look at two surveillance programs in the framework of the Global Action Plan on AMR supported by the quadripartite collaboration:

Use of antimicrobials in animals

As you learned in Section 4.3, there is limited information available on use of antimicrobials in animals. The World Organisation for Animal Health (WOAH) has developed a database on antimicrobial agents intended for use in animals. The progress on developing the database and the findings have been published in annual reports; at the time of writing, the most recent one is the eighth annual report published in 2024. These reports present estimates of antimicrobial agents intended for use in animals adjusted for animal biomass, based on quantitative data reported by countries to the WOAH.

In the eighth round of data collection, 152 member states submitted complete reports, of which 129 included quantitative data on animal use. However, based on challenges faced by countries to collect quantitative data on antimicrobial use in animals, the WOAH advises caution in interpretation and use of quantitative data. Based on data reported to the WOAH from 81 reliably reporting countries, the global estimate of antimicrobial agents used in animals in 2021 adjusted by animal biomass was 109.7 mg/kg (WOAH, 2024).

The WOAH provides more information about antibiotic use in animals and its control in ANIMUSE, a global database on ANImal antimicrobial USE.

GLASS, coordinated by the WHO

In 2015, the World Health Assembly (WHA), the decision-making body of the WHO, endorsed a Global Action Plan (GAP) to tackle antimicrobial resistance. The goal of the GAP is ‘to ensure, for as long as possible, continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way, and accessible to all who need them’ (WHO, 2015).

The Global Antimicrobial Resistance Surveillance System (GLASS) was launched in October 2015 to support the GAP on antimicrobial resistance. GLASS encourages and facilitates the establishment of routine national AMR surveillance systems that are capable of monitoring AMR (GLASS-AMR) and antimicrobial consumption (AMC) (GLASS-AMC) trends and producing reliable and comparable data. GLASS also leads on:

  • GLASS EAR and GLASS FUNGI: Focused surveillance activities for emerging resistance (GLASS EAR) and fungi (GLASS FUNGI).
  • EGASP: Sentinel gonorrhoea surveillance of men with urethral discharge and suspected urogenital infections.
  • Tricycle: An integrated multi-sector surveillance programme based on the extended-spectrum beta-lactamase (ESBL)-Escherichia coli.
  • PPS-AMU: A method for the conduct of point prevalence surveys (PPS) of antibiotic use (AMU) at the hospital level.
  • Studies estimating the public health impact of AMR.

You can learn more about some of these methods and programmes in other courses in this programme.

As of October 2024, 140 countries, territories and areas are enrolled in GLASS (WHO, 2024). Not all these countries will have completely functional surveillance systems, although they should all be developing them: countries in GLASS may be enrolled in systems for AMR surveillance, antibiotic consumption surveillance, or both.

Activity 25: The Global Antimicrobial Resistance Surveillance System (GLASS)

Take a look at Figure 10, taken from the WHO GLASS website:

Figure 10 International enrolment in different data surveillance systems. (AMR = antimicrobial resistance, AMC = antimicrobial consumption)
  1. Is your country enrolled in GLASS?
  2. If so, is it enrolled for AMR or antimicrobial consumption surveillance, or both?

You will learn more about GLASS in the course An overview of national AMR surveillance.

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5.2 One Health

6 End-of-course quiz