A time for action: antimicrobial resistance needs global response

Editorials 558 Given the magnitude and severity of the threat of antimicrobial resistance, it is a sign of progress that Member States of the World Health Organization (WHO) are now developing national action plans in response to WHO's Global action plan on antimicrobial resistance. 1 To accelerate these efforts, in April 2016 the Wellcome Trust held an interdisci-plinary international summit, bringing together policy-makers and scientists from more than 30 countries to review and debate a set of 25 policy options. The summit's discussions reflected the multidimensional challenge posed by antimicrobial resistance. There are social, economic and environmental dimensions that encompass food production systems as well as human and animal health. 2 Public attitudes and behaviours have a major impact on antibiotic use in health care. 3 In many countries, agricultural use of antibiotics exceeds medical use. 4 The solutions to antimicrobial resistance must be similarly broad in scope. The 'One Health' concept captures this scope, by recognizing the interdependence of human health, agriculture and animal health and the environment. There are multiple tools and a growing knowledge base to enable national decision-makers to address antimicro-bial resistance. Although evidence gaps have been cited as barriers to action, 5 the summit concluded that knowledge gaps will always exist and that current evidence justifies immediate action. In particular, a range of policy interventions need to be implemented in three key areas. First, antibiotic use in agriculture must be phased out without compromising the food system's capacity to meet increasing global demand. The use of antibiotics for growth promotion and disease prevention should be phased out in favour of improved animal husbandry practices. Given the potential economic impact of such measures, particularly in low-and middle-income countries, insurance schemes could be developed to mitigate the risk to farmers of income loss through lower productivity during this transition. Research into alternative treatments and husbandry practices is required to support reduced antibiotic use in agriculture. Food production systems should also do more to limit consumer exposure to drug-resistant microbes. Second, we need to develop a much better understanding of drug resistance levels and antibiotic use at the local level, in both human and animal medicine. Surveillance and monitoring are needed to provide a clear picture of local situations and to assess the impact of interventions. More comprehensive data are required on both antibiotic usage and resistance. Quantitative data will enable policy-makers to track the impact of interventions …