Pakistan’s national action plan for antimicrobial resistance: translating ideas into reality

The threat of antimicrobial resistance has appeared as a global health crisis that could lead to 10 million deaths every year by 2050. WHO instituted a global action plan to tackle antimicrobial resistance in the 68th World Health Assembly in 2015. This global action plan was endorsed by all countries, including Pakistan—the world’s sixth most populous country, and which is expected to rise to fourth place by 2050.
The first follow-up action was the development of the National Strategic Framework for Containment of Antimicrobial Resistance, which was translated into the national action plan of Pakistan for antimicrobial resistance.
An intra-sectoral core committee on antimicrobial resistance was formed by the Government of Pakistan, with the mandate to identify key stakeholders and experts in policy making, assess the existing status of antimicrobial resistance, prepare a policy document, and provide recommendations.1
Pakistan also completed the process of joint external evaluation of the International Health Regulations and the global health security agenda for assessment of priority areas for action on antimicrobial resistance.
By participating in the Global Antimicrobial Surveillance System, the Pakistan National Institute of Health is the custodian of antimicrobial resistance surveillance in Pakistan.3
However, these activities are not prioritised because there are no domestic resources allocated for antimicrobial resistance, and the funding from the health department of Pakistan and donors might not be sufficient. Therefore, WHO’s mission report has warned that Pakistan is not completely prepared to detect, prevent, and respond to internal or external health threats that could threaten the country’s population, and have the potential to jeopardise travel and trade, because Pakistan is a signatory to the International Health Regulations but is yet to meet the essential core capacities, despite several extensions.
In April, 2018, the Pakistan Global Antibiotic Resistance Partnership launched a situation analysis report about antimicrobial resistance in Pakistan.4
The major challenges and issues identified in the report include an unnecessarily large number of registered products, misleading advertisements, polypharmacy, so-called quacks, irrational prescribing by physicians, availability of over-the-counter drugs without prescription, bias towards costly broad-spectrum antibiotics, lack of surveillance systems and experts, and widespread use of antibiotics in poultry, animals, and agriculture.
Pakistan has also not responded to a recent WHO survey about monitoring global progress on addressing antimicrobial resistance.5
Nonetheless, there is optimism because some existing infrastructure can be used for antimicrobial surveillance by upgrade of existing facilities. The Government of Pakistan should galvanise national efforts to deal comprehensively and successfully with the crucial issue of addressing and containing antimicrobial resistance in Pakistan.
Effective Surveillance  

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