AMR: How to expand monitoring?


In a recently published article in PLOS Medicine, the authors address the complex challenges regarding AMR and the coordinated action to inform policy and public. One of the main questions is: How to expand monitoring? We asked co-author Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy (CDDEP).

In the focus of your efforts stands the question „How to expand monitoring“, an effort, that seems to be very ambitious if we take under consideration the many countries where appropriate data is not available. As the Semmelweis Foundation is focusing on the CEE-region – this point is very interesting for us: What can be done to help this countries to get this important data, and when do you think the LMICs (low-income and middle-income countries) will have the necessary structures?

This could take a long time in countries which lack both public and private laboratory capacity.  But lots can be done in the short terms with even aggregating available information.  The GARP situation analyses have been successful at doing this.

What is GARP exactly, and how does it work?

GARP stands for Global Antibiotic Resistance Partnership. It started in 2009 to create a platform for developing actionable policy proposals on antibiotic resistance in low-income and middle-income  countries. On the GARP webpage is a resistance map where you can klick on a country and choose the pathogen you are interested in and the trend of the last years.

In which way WHO and other institution will support LMIC-s?

WHO can do their bit in providing technical expertise for laboratory capacity but eventually countries will have to spend their own funds or seek assistance from bilateral donors for surveillance.  Surveillance continues to be seen as a luxury and does not receive much attention.

What are the most important challenges in relation to extension of monitoring?

First of all, we must choose an appropriate scientific approach to conceptualize AMR and related control efforts. Then we have to define what to measure. The third challenge is to select appropriate measurements from human, animal and planetary health, and the fourth challenge is the data. Developing surveillance capacities is one of the core legal requirements of the International Health Regulations. However, many countries have so far failed to meet this requirement. Multilateral initiatives such as the global health security agenda, a partnership of over 50 countries, can support the capacity to collect data in LMICs.


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Carola Timmel is journalist for print and radio and professional speaker. Her focus lies on the topic Medicine & Health.

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