Team:Sheffield/episode3

	GLOBAL POLICIES

STARTING QUESTIONS	DR. SIMON RUSHTON	INDIRECT AND DIRECT STAKEHOLDERS	REPORT QUOTES

A global problem

The reality is that antibiotic resistance affects the whole world. The globalised society enables bacteria to be transmitted from country to country bringing with them new resistances for antibiotics.

We wanted to find out if this issue is important to policy-making. Is this a current pronblem that is being discussed? Are action plans being established that aim to reduce this problem both in the short and long term?

Understanding the political dynamics

We interviewed Dr. Simon Rushton, a politics lecturer at the University of Sheffield and researcher on the global politics of health. Simon explained to us how the problem of antibiotic resistance sits in the political field.

Dr Simon Rushton,

Politics lecturer at The University of Sheffield

Simon told us that the problem of antibiotic resistance is on the radar of international organisations; both intergovernmental and non-governmental.

Before the interview we had found a policy package for combating antimicrobial resistance¹, put together by the World Health Organisation in 2011. The global action plan has 5 strategic objectives:

1. To improve awareness and understanding of antimicrobial resistance
2. To strengthen surveillance and research
3. To reduce the incidence of infection
4. To optimize the use of antimicrobial medicines
5. To ensure sustainable investment in countering antimicrobial resistance.

Of particular note is their fourth strategic point “To optimize the use of antimicrobial medicines”. The World Health Organisation (WHO) is calling for research and development in making new tools to combat this problem including “improving current diagnostic tests” This validates our project on a global scale.

We discussed the effectiveness of such a policy package with Dr Rushton. He explained that communication on a global scale is essential for the effective, global combating of antibiotic resistance. However, he also pointed out that organisations like the WHO are unable to respond to the problem beyond carrying out research, offering recommendations and appealing to governments.

The WHO is supporting member states to develop their own national action plans, in line with the objectives of the global plan but it is up to individual governments to have the willingness and the means to be able to respond to this problem with policy changes. Often conflicting interests can hinder this.

Reference:

1. Leung, E., Weil, D.E., Raviglione, M. and Nakatani, H., 2011. The WHO policy package to combat antimicrobial resistance. Bulletin of the World Health Organization, 89(5), pp.390-392.

Indirect and Direct Stakeholders: "The Talk and the Walk"

In addition to furthering our understanding of the WHO’s action plan, Dr. Rushton also pointed out to us there is a huge number of stakeholders and an interplay between them.

In developed countries the excessive consumption of antibiotics poses as a challenge. However, in the developing countries, it is the lack of supply that poses as a challenge. To combat antibiotic resistance, it takes a global collective effort, but these polarised situations could hinder collaborations. Second, governmental bodies design policies to tackle antibiotic resistance, but the policies’ effectiveness are ultimately dependent on the willingness of world citizens. Also, some patients put pressure on doctors to be given antibiotics, doctors have to weigh their own clinical judgement against patients emotive needs.

These are just a few examples of the interaction between stakeholders. The broad applications of antibiotics also lead to the great number of stakeholders at different levels. How our device would impact these stakeholders depends on their current interactions. Hence, we felt the need to develop a tool to help us visualise the stakeholders and the interactions.

We developed a mind map - "The Talk and The Walk". Derived from the saying “talk the talk and walk the walk”, we divided the groups of stakeholders that are mainly involved in policy making and management: The Talk; and the groups that are on the ground dealing with antibiotics directly: The Walk.

The Talk and The Walk identifies people that are involved in the antibiotic crisis and people that are important to our understanding.

These mindmaps show that antibiotic resistance is a complex problem and involves many stakeholders. We have focused on the members that we have access to, marked with a star.

Figure. 4 Flowchart of "The Talk"

The World Health Organisation (WHO) are a division of the UN who carry out research on health issues globally and produce recommendations for governments to implement in an effort to improve people’s health worldwide.

The UK government has recently recognised antibiotic resistance as one of the top problems facing the UK, an important step in tackling antibiotic resistance.

The Antimicrobial Resistance (AMR) steering group was one of several steering groups established after discussion between a number of governmental and NHS bodies: including Public Health England, NHS England, the Department for Health. This discussion created strategies for tackling antimicrobial resistance in 2013. The steering group monitors the progress of the strategies and reports back to governmental and NHS bodies.

As academics, this is where we fit in as part of iGEM. It provides young people with a platform to learn more about current problems and come up with creative solutions through synthetic biology and engineering, this paves the way for next generation to be active in tackling problems like antibiotic resistance. Academics at college and university institutions are also looking at the problem of antibiotic resistance.

The pharmaceutical industry has been reducing research into antibiotics and antibiotic resistance in recent years as it is no longer lucrative.

The National Health Service (NHS) sets targets for hospitals and GP surgeries to abide by at the level of management. These goals include antibiotic prescription rates. Hospitals can be fined for exceeding these goals.

Royal College of Veterinary Surgeons (RCVS) is a governing body for all vets in the UK. They set standards for good veterinary practice and monitor practice including antibiotic usage.

Figure. 5 Flowchart "The Walk"

Patients consuming antibiotics in the UK can only get antibiotics through having a prescription, although in other countries it is possible to get them over the counter. Family pets and farm animals also consume antibiotics at the discretion of vets.

GPs and hospital doctors prescribe antibiotics to patients with advice from a microbiologist, whilst nurses ensure patients take the course. Vets also prescribe antibiotics and it is the responsibility of farmers and owners to give antibiotics to their animals.

The global call to arms

We have found many reports calling for similar action to the WHO. We summarise our findings below with quotes from these reports:

“Finally, operational research and research and development to make new tools available are crucial in combating antimicrobial resistance. This includes improving current diagnostic tests...”

The WHO policy package to combat antimicrobial resistance (2011)

“What we urgently need is a solid global plan of action which provides for the rational use of antibiotics so that quality-assured antibiotics reach those who need them, but are not overused or priced beyond reach.”

MSF Response to WHO Report on Antimicrobial Resistance (2014)

“Develop and approve new diagnostics, including tests that rapidly distinguish between viral and bacterial pathogens”

U.S: National Strategy for Combating Antibiotic Resistant Bacteria (2014)

“I call on the governments of the richest countries to mandate now that by 2020, all antibiotic prescriptions will need to be informed by up-to-date surveillance information and a rapid diagnostic test wherever one exists.”

Tackling Drug-resistant Infections Globally Final Report And Recommendations (2016)

It is clear from these reports that there is a global need for a device such as ours, showing that our device could have a large international impact.

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