By Cheruto Valentine

The World Health Organization (WHO) recently launched a global campaign urging governments to adopt a tool to reduce the spread of antimicrobial resistance.

The AWaRe (Access, Watch, Reserve) tool was developed by the WHO Essential Medicines List (EML) to contain rising resistance and make antibiotic use safer and more effective.

In March 2017, the WHO updated their EML. This is a list that contains the medications considered to be most effective and safe to meet the most important needs in a health system. It is a guideline used by countries to aid in developing their own local lists of essential medicine.

As part of the review of antibacterial drugs, a new categorization into three groups was proposed: Access, Watch and Reserve. Access group antibiotics are first and second choice antibiotics for the empiric treatment of most common infectious syndromes. Watch group includes antibiotics with higher resistance potential whose use as first and second choice treatment should be limited to a small number of syndromes or patient groups. Reserve antibiotics, being the strongest of the three, are to be used mainly as ‘last resort’ treatment options.

The overall goal of the AWaRe campaign is to reduce the use of Watch Group and Reserve Group antibiotics, which have higher risk of resistance, and to increase the proportion of global consumption of antibiotics in the Access group to at least 60 percent.

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.”

The AWaRe campaign also warns that should we fail to tackle antimicrobial resistance, the consequences will be severe.

To begin with, infections will become untreatable; even very common infections. In addition, conducting surgeries will be an extremely risky affair. This will place lives at risk, with those at highest risk being mothers and newborns. Health resources of the world will also deplete rapidly due to antimicrobial resistance. When antibiotics stop working effectively, more expensive treatments and hospital admissions are needed, taking a heavy toll on already stretched health budgets.

“Tackling antimicrobial resistance requires a careful balance between access and preservation,” said Dr Hanan Balkhy, WHO Assistant-Director General for antimicrobial resistance. “The AWaRe tool can guide policy to ensure patients keep being treated, while also limiting use of the antibiotics most at risk of resistance.”

Currently, WHO estimates that more than 50 percent of antibiotics in many countries are used inappropriately such as for treatment of viruses when they only treat bacterial infections or use of the wrong (broader spectrum) antibiotic, thus contributing to the spread of antimicrobial resistance. WHO also estimates that although over 100 countries have put in place national plans to tackle antimicrobial resistance, but only about one fifth of those plans are funded and implemented.

In order to effectively implement the AWaRe campaign, countries are advised to monitor and report antibiotic use in community and hospitals using the AWaRe categories for evaluation, benchmarking and setting targets. In addition to hospitals and the community, veterinary and agricultural fields are also advised to use the WHO list of medically important antimicrobials and the AWaRe categorization.

Countries are also advised to incorporate the AWaRe categories into pre- and in-service training for health-care professionals. The campaign should also be adopted as part of national antibiotic stewardship programmes to improve access to essential 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.”

Contacts: bagozzid@who.int, lindmeierch@who.int

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