Doctors Without Borders USA Inc.

Saving lives by tackling antibiotic resistance (ABR) among vulnerable populations

Lead Organization

Doctors Without Borders USA Inc.

New York, New York, United States

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To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

While the World Health Organization has declared that “antibiotic resistance is one of the biggest threats to global health, food security, and development,” international efforts to combat it focus on wealthy countries. A global solution is essential. Over the past decade, Doctors Without Borders/Médecins Sans Frontières (MSF) has developed effective approaches for stemming the spread of antibiotic resistance (ABR) in healthcare facilities in diverse, low-resource settings. MSF will scale up ABR activities in 45 projects to improve patient care. We will produce significant health data and conduct operational research to assess, improve, and simplify a replicable, comprehensive, standardized model of care. Increasing laboratory and hospital capacity, intensive local staff training, and engaging key stakeholders are essential components. This initiative will influence national protocols and has the potential to dramatically improve medical care for millions of people—including the world’s most vulnerable—and ultimately help to preserve lifesaving antibiotics for future generations.

Problem Statement

Antibiotic resistance will have a disastrous impact within a generation unless the world acts now. Antibiotic-resistant infections can be deadly and are expensive to treat – often requiring long hospital stays, complex testing, and expensive drugs. According to the O’Neill Report, resistant infections already kill hundreds of thousands of people annually and scientists predict that drug resistance, including tuberculosis, could kill 10 million people per year and cost the global economy $100 trillion dollars by 2050. According to the WHO, drug-resistant organisms exist in all countries, making ABR a risk to everyone, everywhere. In low-resource countries, its spread is accelerated by widespread overuse of antibiotics in the public and private sectors, high burdens of infectious disease, high transmission rates, and weak regulations/enforcement of use and quality of antibiotics. Further, it is the world’s most vulnerable who are more likely to die from drug-resistant infections (e.g. 200,000 infants already die from resistant sepsis annually) and the World Bank predicts that economically poor countries will suffer most.Yet nearly all global health investments — from research to preventative measures — are occurring in wealthy countries. While efforts to control ABR in high-income countries show promise, ABR rates are increasing dramatically in the rest of the world. Stemming ABR faces three key challenges: 1)a lack of data on ABR impedes development of new drugs, diagnostic tools, medical protocols, and public policy; 2)current ABR guidance is poorly adapted to low-resource health systems; and 3)low-resource settings frequently lack skilled staff to fulfill critical ABR roles.

Solution Overview

This initiative will save lives, refine an ABR model of care, and provide critical surveillance data on drug-resistant infections. With the appropriate use of antibiotics, MSF will provide better care to millions of patients at 45 projects based mostly in public hospitals and health centers in diverse settings across Africa, Asia, and the Middle East. The implementation of advanced ABR care will focus on people most at risk, including those with war wounds or trauma, those who are displaced, children, and immunocompromised patients. Building on nearly 10 years of experience assessing what is practical and effective, this initiative will address critical gaps in laboratory capacity and skilled local human resources. In the Middle East, where ABR is widespread, the biggest impact will be reduced mortality and transmission prevention. In Africa, where resistance is poorly understood, the primary impact will be improved surveillance and revision of protocols. Lab simplification and setup, simplified care, prevention protocols, and training programs will be designed for use by all stakeholders, including health ministries. Systematic data analysis and targeted operational research will allow us to identify best practices and refine and adapt the ABR model of care; track progress; and demonstrate feasibility and effectiveness. Surveillance data will improve global understanding of resistance, which is needed to improve quality of care and the development of adapted diagnostic tools and new drugs. Furthermore, this initiative has the potential to influence protocols and policies at the national and international level, which could save millions of lives.

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