The following is a summary of “Measuring the global response to antimicrobial resistance, 2020–21: a systematic governance analysis of 114 countries,” published in the June 2023 issue of the Infectious Diseases by Patel et al.

To evaluate progress and guide future planning, it is necessary to comprehend the national, regional, and international strategic commitments and policy responses to antimicrobial resistance. National action plans (NAPs) are the primary mechanism for steering national antimicrobial resistance governance strategy and action. Although several NAPs have been developed, there is no comprehensive analysis of their contents. Using a governance framework, the researchers intended to evaluate all publicly available NAPs on antimicrobial resistance. Applying a governance framework containing 18 domains and 54 indicators in three critical areas: policy design, implementation tools, and monitoring and evaluation, they comprehensively reviewed the contents of NAPs on antimicrobial resistance from 114 countries. Several data sources, including the Tripartite Antimicrobial Resistance Country Self-Assessment Survey, the Global Antimicrobial Resistance and Use Surveillance System, the Global Antimicrobial Resistance Research and Development Hub, and various WHO datasets, were used to generate scores, in addition to manually searching NAPs and conducting online. Literature searches pertinent to specific indicators from repository inception to June 1, 2022. 

NAPs were included if the country had also submitted them to the Tripartite Antimicrobial Resistance Country Self-Assessment Survey 2020–21, if they were retrievable through a publicly accessible database or website, and were either published in English or eligible for machine translation. Three researchers evaluated each NAP independently and were initially blinded to the results of the other researchers. Using a quantification system, they assigned a score to each of the 54 indicators. Following the Cochrane protocol for assuring reliability. The three researchers then removed their blindfolds and met to resolve any scoring discrepancies and reach a consensus. In every instance of disagreement, researchers struck a consensus. Investigators established criteria to standardize the quantification of each indicator. In addition, they weighted and compiled relevant national data from various sources to generate composite governance scores. They transformed these data to a scale ranging from 0 (worst) to 100 (best), ranked countries based on their mean scores, and analyzed global and regional trends using descriptive statistics. 306 NAPs were identified, of which 114 qualified for analysis. 

The mean antimicrobial resistance governance score was 51 (SD = 14) between 2020 and 2021. Norway had the highest governance score (mean 85 [SD 32]), while the Federated States of Micronesia had the lowest (28 [37]). The domain with the highest score was participation (83 [16]), while the domains with the lowest scores were accountability (30 [18]) and feedback mechanism (30 [25]). Domains associated with policy design (55 [13]) and implementation instruments (54 [17]) received comparable scores, whereas monitoring and evaluation (38 [20]) efforts were rated lower. Countries’ international efforts to combat antimicrobial resistance varied considerably. Monitoring and evaluation efforts must be enhanced to comprehend national and international progress continuously. The international response to antimicrobial resistance may not be commensurate with its scope and severity.

Source: sciencedirect.com/science/article/pii/S1473309922007964