Analysis of the progress of antimicrobial resistance management in the Pacific Island Countries and Territories through the development and implementation of National Action Plans
The magnitude of the antimicrobial resistance (AMR) crisis is globally acknowledged. Approximately 700,000 deaths per year are attributed to resistant infections. By 2050, it is estimated to reach 10 million deaths. The most impacted by AMR are the lower-middle income countries (LMICs), largely because of insufficient resources and inadequate infrastructure. The south Pacific Islands Countries and Territories (PICTs) are comprised of mostly LMICs. The region is highly susceptible to disease outbreaks and natural disasters. It is anticipated that these threats will rise owing to the worsening effects of climate change. With a population of approximately 2.3 million, the PICTs comprise of hundreds of islands scattered over an area equivalent to 15% of the earth’s surface. With the increase in holiday and medical tourism to and from this area, the developing PICTs are at a heightened risk of increased spread of multi-drug resistant organisms. To minimise the effects of AMR on countries, the World Health Organization (WHO) developed a Global Action Plan (GAP). They encouraged each member country to implement their own National Action Plan (NAP) developed from objectives aligned with the GAP. There is a paucity of data on AMR governance framework for this region. This paper assesses the AMR National Action Plans of the PICTs and evaluates their alignment to the Global Action Plan. With the aim of monitoring the progress of AMR in PICTs, this study compiles and analyses the responses of PICTs to the Tripartite AMR Country Self-Assessment Survey (TrACSS) from 2016 to 2020. Review of recent Antimicrobial Stewardship (AMS) studies from the Pacific region provides an additional understanding of the significant drivers of AMR impacting on this region and the actions needed to limit the spread of AMR. There were significant areas for future development identified by this study. These include NAP development and implementation from most of the PICTs, strengthening AMR surveillance, introducing mechanisms to prevent stock-outs of medications and essential medical products, dedicated AMS education for antimicrobial prescribers, improved infection prevention and control practices, and ongoing AMR awareness campaigns for the public and healthcare professionals. Developing, implementing, and monitoring NAPs that are aligned to the objectives of the Global Action Plan will determine and support best practises for controlling the spread of AMR in PICTs.