The societal effects of antibiotic use justifies that measures need to ensure they should be accessed, prescribed, dispensed and used appropriately and accurately based on robust scientific evidence. Any stewardship framework should reflect this and firmly embed the principles of equity, justice and sustainability. It should reflect the complex system of antibiotic use and availability and the often pluralistic health systems, in which antibiotics are used.
It must consider the potential areas for synergy and, conversely, the potential unintended consequences of constituent parts.
Identifying the underlying conditions of antibiotic use and access provides key indicators for balancing access and appropriate use at scale. Understanding the interplay of logistical, environmental, financial and social drivers behind current access patterns is key to developing controlled access strategies. There are still many gaps in the information we must address, to ensure any future framework is effective.
- Mobilisation of funds and resources, coordinated across appropriate agencies, focused on addressing gaps in information with built-in accountability mechanisms;
- Monitoring access and use of antibiotics at national levels with clearly identified indicators comparable across countries;
- Harmonising national surveillance data with other SDG indicators;
- A priority setting mechanism that is publically transparent, accountable to public health authorities and with sufficient leverage;
- Prioritising the development and deployment of affordable diagnostics in low-resource settings.
Tackling AMR hinges on effective partnerships and coalition building, accurate evaluation systems and effective governance mechanisms. The activities of a large number of stakeholders will need to be aligned. We would like to see WHO take a leadership role. We need to see new kinds of partnerships, bringing in different voices beyond traditional health system boundaries.