Finding progressive and practical solutions to health challenges – including antimicrobial resistance – starts with understanding the context in which those challenges exist
Health issues have a face. Context plays an important role in understanding health issues. Progressive and essence-capturing concepts lead to the formulation of health policies in many countries. It would be extremely effective if concepts could be considered in terms of practical issues and used to solve them. This is true for antimicrobial resistance.
Many people desire to live long, full and happy lives. However, by the time they reach the end of their healthy life expectancy, many will have some illness and require medical care. Older adults who require medical care are at a high risk of AMR problems. We have witnessed the Covid-19 pandemic, which puts these high-risk individuals at further risk. AMR in the older adult population is a significant problem, including in Japan, which is one of the most rapidly ageing countries in the world. In the context of medical care for older adults at healthcare institutions, AMR control has taken the form of nosocomial infection control. To a certain extent, this has been effective.
However, the problem exists within the community. The challenge of AMR in community long-term care facilities and nursing homes has proven quite significant. It is a major problem in these facilities as well. However, as in many countries, the AMR issue in these facilities and communities is largely unrecognised by society, and, as a result, no resources are devoted to it. Therefore, it is extremely difficult to control AMR in such facilities and communities. This problem must be addressed: resources should be allocated to these facilities.
The same challenge is occurring with regards to Covid-19. To return the functioning of society to where it was before the pandemic, it is necessary to strengthen measures in such institutions and communities. This problem, exposed during the pandemic, needs to be solved, too.
Inequalities in education also affect health. Health disparities exist as disparities in education exist. Inadequate education leads to inappropriate behaviour. This has also been a problem with the Covid-19 pandemic, and is true for AMR. According to a survey on the knowledge, awareness and behaviour regarding drug resistance and antimicrobials in Japan, adults in their 20s and 30s were less likely to have accurate knowledge about AMR and antimicrobials than older adults. Similarly, the rate of accurate knowledge of AMR and antimicrobials in Japan is lower than in European Union countries. This needs to be addressed.
Treatment should reach those people who require it on time and reliably. One of the critical problems of AMR is limited access to treatment. There are two aspects to this problem. First, there is an unstable supply of important antimicrobial agents. In recent years, Japan has been experiencing recurring problems related to the supply of essential antimicrobials such as cefazolin, which have been attributed to the weak supply chain for manufacturing and supplying antimicrobials. Like other products, antimicrobials are products of global supply chains. Each country needs to take measures to ensure a stable supply, but it is also necessary to share awareness of problems and cooperate with other countries.
Second, research and development of new antimicrobial agents has slowed down worldwide. A major reason for this slowdown is that the investment required for R&D cannot be recovered in profits once antimicrobial agents are launched. The current economic model does not ensure a sustainable supply of new antimicrobials to combat the threat of AMR. G7 members are discussing the introduction of pull incentives. It is necessary to make this model successful and simultaneously establish a system to ensure that therapeutic agents reach patients worldwide.
Japan is currently revising its national action plan for AMR, which will serve as a guideline for concrete solutions to these issues.