One of the primary aims of the Fleming Fund is to support countries in increasing the quality and quantity of available data relevant to antimicrobial resistance (AMR).
Despite the serious risk that AMR poses to global health we still know very little about its geographical distribution and the scale of the problem, particularly in low and middle income countries where there is less capacity to collect and share data. Without this evidence our ability to combat the problem is limited.
To truly understand the scope and scale of the problem we need to improve access to data on:
- Antimicrobial resistance;
- The burden of disease associated with AMR;
- Trends in use of antimicrobial medicines;
- The quality of antimicrobial medicines being used.
Data on resistance
The Global AMR Surveillance System
We will support countries as they develop their capacity to collect and share data on antimicrobial resistance on the Global AMR Surveillance System (GLASS).
The Global AMR Surveillance System was launched and is managed by the World Health Organization (WHO) to collect data on resistance patterns. This is a global surveillance system built on data from national AMR surveillance systems. The platform shares, synthesises and harmonises national data on antimicrobial resistance patterns in order to:
Assess and report on selected indicators of AMR globally.
Detect emerging resistance patterns including geographical hot spots.
Illustrate the global threat and geographical distribution of AMR.
The Fleming Fund is not funding GLASS itself, but we are keen to ensure low resource countries have a roadmap for developing the capacity and capability needed to enroll and regularly contribute data to GLASS from their own national surveillance system.
The Fleming Fund supported the development of a roadmap, through the London School of Hygiene and Tropical Medicine (LSHTM), which outlines a tiered approach to building and improving laboratory surveillance capacity for AMR in low resource settings, with the ultimate aim of uploading data to GLASS.
This protocol can be found here.
Data on the burden of disease associated with AMR
The Global Burden of Disease – AMR project
A new collaboration to conduct geospatial modelling and develop maps of the likely burden of antimicrobial resistance is being funded by the UK Department of Health and Social Care via the Fleming Fund, the Wellcome Trust and the Bill and Melinda Gates Foundation.
The project will use complex geospatial modelling to improve understanding of the burden of disease associated with AMR in each country and therefore the public health threat that this poses.
The Global Burden of Disease Study (GBD) is a free, open access platform which uses mathematical modelling to estimate the levels of mortality and disability associated with major diseases around the world.
Who is involved?
Scientists from the Big Data Institute and the Centre for Tropical Medicine and Global Health both at the University of Oxford, and researchers at the Institute for Health Metrics and Evaluation (IHME) University of Washington, will work together on the initiative.
“This ground-breaking collaboration will enable us to better understand the extent of death and disease that AMR is causing globally and will guide future efforts and allocation of resources globally.”
UK Health Minister, Steve Brine MP
The Global Burden of Disease - AMR project will:
Gather and assemble data on selected bacteria-antibacterial drug combinations to create mathematical models.
Use the models to generate globally comparable AMR burden estimates for those “bug-drug” combinations from 1990 to the present for the 195 countries and territories included in the Global Burden of Disease study.
Produce heat-maps of modelled AMR burden that will allow policymakers and researchers to tailor future studies and interventions to the local level.
Provide free, public access to study results through interactive data visualisations.
Data on the use of antimicrobial medicines
The Fleming Fund is supporting work to help countries understand and track the scale of antimicrobial consumption and use in human health and in animals, through its grants to WHO and World Organisation for Animal Health (OIE).
Data on the prevalence of antimicrobial resistance and drug resistant infections needs to be considered and analysed alongside data on the availability and use of antimicrobial medicines. Important points to consider include:
It is clear from existing data that high use of antimicrobial medicines can lead to higher prevalence of resistance to those medicines. Identifying regions or situations where there is high use of antimicrobials, especially where there is corresponding high prevalence of resistance, is essential is determining what action is needed, and where.
Among the actions needed to address AMR is a reduction in unnecessary or inappropriate use of antimicrobials. Surveillance on the use of antimicrobials is therefore a key part of monitoring and evaluation action on AMR.
The overall goal of action on AMR (as set out in the global action plan) is “to ensure, for as long as possible, … the ability to treat and prevent infectious diseases with effective and safe medicines”. Alignment of information on the drug susceptibility of infections (through clinical microbiology and surveillance) with data on the use and availability of antimicrobials is necessary to demonstrate and support progress towards this goal.
Work by the WHO includes the development and implementation of a protocol for the collection of national antimicrobial consumption data, and the development of protocols for point prevalence surveys of antimicrobial use in hospital and community settings.
Work by OIE comprises the development and implementation of a survey for collation and analysis of national data on consumption of antimicrobials. OIE’s second annual report resulting from this work, published in 2017, can be found at http://www.oie.int/fileadmin/Home/fr/Our_scientific_expertise/docs/pdf/AMR/Annual_Report_AMR_2.pdf.
Surveillance on antimicrobial consumption and use in human health, animal health and agriculture is an important part of the Fleming Fund programme. As well as supporting countries through the grants to WHO, FAO and OIE, the Fund will consider providing direct support to countries through the Country Grant programme for this work as well as that on surveillance of AMR.