Lancet Infect Dis: Measuring the global response to antimicrobial resistance, 2020–21

17 January, 2023

Dear HIFA colleagues,

The full text of this study finds that 'Education was the lowest scoring domain of all implementation tools, highlighting that basic and continuous education for health-care workers has not been robustly established in most countries'. There were few crieteria relating to antibiotic stewardship, including 'Are there national guidelines on antimicrobial use and rapid diagnostic tools for both animal and human health?'

Citation, abstract and a comment from me below.

CITATION: Measuring the global response to antimicrobial resistance, 2020–21: a systematic governance analysis of 114 countries

Jay Patel et al.

The Lancet Infectious Diseases

Open Access Published: January 16, 2023DOI:


Background: Understanding strategic commitments and policy responses to overcome antimicrobial resistance at the national, regional, and global levels is required to evaluate current progress and direct future planning. National action plans (NAPs) are the primary mechanism for guiding national strategy and action for antimicrobial resistance governance. Although several NAPs have been developed, no comprehensive content analysis of these plans exists. Using a governance framework, we aimed to assess all publicly available NAPs on antimicrobial resistance.

Methods: We systematically reviewed the contents of NAPs on antimicrobial resistance from 114 countries, applying a governance framework containing 18 domains and 54 indicators in three integral areas: policy design, implementation tools, and monitoring and evaluation... We transformed these data to a scale of 0 (worst) to 100 (best), ranked countries on the basis of their mean scores, and used descriptive statistics to analyse global and regional trends.

Findings: 306 NAPs were identified and 114 were eligible for analysis. Between 2020 and 2021, the mean antimicrobial resistance governance score was 51 (SD 14). Norway had the highest governance score (mean 85 [SD 32]), and the Federated States of Micronesia had the lowest governance score (28 [37]). The highest scoring domain was participation (83 [16]), and the lowest scoring domains were accountability (30 [18]) and feedback mechanism (30 [25]). Domains relating to policy design (55 [13]) and implementation tools (54 [17]) scored similarly, whereas monitoring and evaluation (38 [20]) efforts were lower.

Interpretation: International efforts to control antimicrobial resistance varied considerably between countries. Monitoring and evaluation efforts need improving for continuous understanding of national and international progress. International response might not be commensurate with the scale and severity of antimicrobial resistance.

COMMENT (NPW): 1. HIFA's systematic review (2020) emphasised there is a massive problem with the availability and use of reliable information on antibiotics, both for prescribers and users [ ]. And yet this issue is not addressed in national action plans on antimicrobial resistance. Many prescribers continue to get most if not all their information from pharmaceutical companies, who are motivated by profit (sales, overprescription) rather than public health. There is one category in the above paper - Are there incentives to reduce inappropriate use of antibiotics? The full text does not expand on this. HIFA member Massimo Serventi has previously emphasised that the incentive of profit is a key driver to the overprescription of antibiotics, especially in typical situations where pharmacies are included in the health facilities where consultations take place. There is a lack of debate and discussion on these issues, let alone solutions.

I invite HIFA members to comment on the above.

Dr Neil Pakenham-Walsh, HIFA Coordinator

Healthcare Information For All

Global Healthcare Information Network

Working in Official Relations with the World Health Organization

20,000 members, 400 supporting organisations, 180 countries, 6 forums, 4 languages