Reflections on access to antimicrobials in a time of increasing global attention to antimicrobial resistance

David L.  Heymann, M.D.

London, UK. David is a Professor of Infectious Disease Epidemiology at the London School of Hygiene and Tropical Medicine. He is also Head and Senior Fellow at the Centre on Global Health Security at Chatham House in London.

In the 1980s when I was on assignment from the US Centers for Disease Control and Prevention (CDC) in Malawi, I worked for five years with the ministry of health to better understand how to develop a more effective malaria control programme in view of the challenge caused by chloroquine resistance.  One of the lessons I learned at that time is that there is a fine line to walk between rapid access to life-saving antimicrobials, and the need to use them responsibly by confirming diagnosis before treatment.  Children with high fevers caused by plasmodium falciparum die if treatment is delayed while awaiting a diagnostic test result from a distant laboratory. 

This lesson remains valid today as antimicrobial resistance continues to erode the effectiveness of medicines to cure malaria, and also the effectiveness of the medicines used to cure other parasitic, bacterial, and viral infections.  Easy access to life-saving antimicrobials must be a part of the agenda to control antimicrobial resistance, and it cannot be compromised or delayed. 

Recently I spoke with a developing country colleague who told me that he is aware that some governments are considering legislation to require laboratory diagnosis prior to treatment of any suspect infection, a national interpretation of the WHO Action Plan on Antimicrobial Resistance.   Any clinician faced with infectious diseases day in and day out knows the harm that would come if such legislation were developed and enforced in a country where access to diagnostics is limited because of lack of laboratory infrastructure and/or cost or of point of care diagnostics that are already on the market.   
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The need for rapid, inexpensive and stable point-of-care diagnostics to guide treatment and slow the evolution of antimicrobial resistance has never been greater.  Medicines For Africa must advocate for their development, and ensure that as they become available countries have access to them as well.