Australia’s National Antimicrobial Resistance Strategy is a timely initiative; the U.S. Presidency convened a forum on the same subject on the 2nd of this month.  The strategy needs to be implemented as a matter of urgency. We are in a comparatively good situation regarding antimicrobial resistance thanks to good infection control practices, restrictions to the use of certain antibiotics in food production and a predominantly extensive animal husbandry, as opposed to over-packed animal farms requiring tons of antimicrobials as growth promoters and for infection control. All those measures may delay dissemination of drug resistant microbes into humans and animals but they will not prevent it, because bugs ride with people and international travel is frequent and on the rise. Thus the urgency is real and making virtue out of necessity we could set ourselves the goal of leading in aspects such as the use of combination therapies, mandatory for HIV, TB and malaria but surprisingly not for other types of infections. Antibiotics and vaccines increased life expectancy in the mid-twentieth century as in no other time in human history. Existing compounds should be used judiciously but it is imperative that the decades-long gap in the development of new antibiotics be brought to an end. The U.S. and Europe are gearing up to lead the way but Australia also has the required know-how and can be a significant player.  Academic groups here are researching novel approaches to control infections and if they could be brought together with the biotechnology industry life-saving products could be the outcome.

The release of this document and planned action against the urgent problem of antimicrobial resistance in Australia is the best news I’ve heard in a long time! We are already on our way back to the pre-antibiotic era, and urgent action in several areas is required to address it. That Australia is now committed to facing this problem is excellent news and I am highly impressed with the broadness of approach to address this problem, and the presentation of the One Health concept. Key to the issue is prevention of these diseases, as this does not require any use of antimicrobials.  Prevention of the transfer of infecftions from animals to humans is paramount here. As scientific researchers we are of course  prepared to be creative and think outside-the-box to address this issue for all angles, and we look forward to working further with all stakeholders to address this most urgent issue. This is a team effort, and an informed community is also vital.

This is a long overdue statement of policy that recognises the threat that antimicrobial resistance poses to health in Australia. This mirrors similar policies developed in many other countries, particularly in Europe and North America. A particular strength is that this strategy spans not just hospitals, the traditional domain of antibiotic resistant bacteria, but also the broader community and animal health.

Australia once led the world in having a co-ordinated national policy with the JETACAR report in the late 1990s, but this dropped off the radar in the mid 2000s. Although many small agencies and groups have taken up the fight by contributing to surveillance and action, having a national policy focuses resources and helps identify the gaps that need to be filled.

“It is great to finally see a comprehensive strategy to combat antimicrobial resistance announced by the Australian government, and particularly timely given that only yesterday the  EU formally adopted an international World Health Organisation plan.

These are well aligned with Australia’s response to the threat of superbugs. We clearly need to allocate resources to combat the very real and growing threat of AMR and the medical and research communities are looking forward to concrete next steps to back the fight back against superbugs."

The government’s national antimicrobial resistance strategy is a positive step towards a nationally and regionally coordinated, comprehensive and effective approach to dealing with the looming crisis of antimicrobial resistance.

Committed implementation of the strategy over the long term will be the key – this will involve sustained funding, leadership and vision from government and health service providers for years to come. The document provides an overview of each of the key strategies, but the success of each component will depend on a detailed approach supported by scientific evidence, generated by research.

I particularly applaud the strategy of national coordination – antimicrobial resistance is a problem that transcends state and even international boundaries. I also applaud the promotion of a One Health approach, involving the animal health sector as true partners, the focus on prevention and the community rather than simply seeing antimicrobial resistance through the narrow prism of a clinical, hospital-based problem, and the strong statements in favour of research, which will be critical for the development of future, novel strategies.

The national strategy needs to be outward looking, and coordinated with regional partners in our increasingly globalised world. The national strategy deserves national support, from all sectors, so that it can be translated into meaningful action.

I warmly welcome this National strategy to help contain antimicrobial resistance and the spread of Superbugs.

“Superbugs” are bad for us. People with infections caused by resistant isolates have much higher death rates as well as increased complications and suffering. Antimicrobial resistance also has important economic costs such as the use of more expensive drugs, waste and increasing the length of hospital stays.

This strategy covers both human medicine and agriculture. It will put in place much better ways to measure both the usage of antibiotics and the levels of resistant bacteria. It will also help implement better ways to control further developments of Superbugs and their spread,

Antibiotic resistance develops and spreads wherever antibiotics are used. With people, this is not only in medical facilities but in the community. Poor infection control, poor water sanitation and poor hygiene all facilitate the spread of resistant bacteria from person to person.  The majority of antibiotic usage worldwide is in animals that are consumed as food. This usage leads to the development of resistant bacteria, which spread to people via the food chain and/or water.

Antibiotic resistance is a growing problem not only in Australia but internationally.  It is a problem both in hospitals and in the community. It needs to be tackled on multiple fronts, including in foods we grow locally and import. In hospitals it means improved infection control and better limits on what antibiotics are currently used.

Having good data on antibiotic usage and the resistance patterns of pathogens, for both people and food animals is an important step to be able to better manage this problem. This strategy will help to implement better approaches that allow us to successfully restrict what and how antibiotics are used in these different environments.

By 2050, it is estimated that 10 million people will die every year from antibiotic resistance at a cost of $100 trillion. Even now, it is a problem. For example, in the US, more than 23,000 deaths and two million illnesses are attributed annually to antibiotic-resistant infections. The UK’s Chief Medical Officer has designated antibiotic resistance as a catastrophic threat and called for it to be included in the National Risk Register for Civil Emergencies.

The challenge with antimicrobial resistance is that is multifactorial and “multinational”; therefore, a coordinated response across various government departments, hospitals, laboratories and animal and human health groups is required WITHIN a country. “EVADE BUGS” is an acronym reflecting the complexity of the factors involved in antibiotic resistance:  Education, Vaccine Development, Animal health, Diagnostics, Environment controls, Surveillance, Better antibiotics, Universal infection control and hand hygiene, Government and political will, Stewardship of antibiotics in hospitals”. We also need to know the extent of the problem in OTHER countries, given the ease of global travel.

It appears that this new Australian strategy is trying to improve the interaction between key stakeholders within Australia to get timely surveillance on antibiotic resistance and then keep in touch with our international colleagues about the state of antibiotic resistance in their jurisdictions.

Surveillance of antimicrobial resistance and antimicrobial usage in human health and animal care (objective three) is timely and much needed. It would be ideal though if monitoring programmes were extended not only to the use of antibiotics, but also to include biocides used in many household products e.g. antibacterial soaps. There is increasing evidence that residual biocides contribute to the development of antimicrobial resistance in microbes in the environment and that environmental microbial communities can act as reservoirs of resistance. Micro-organisms obtain resistance to biocides and other toxins by virtue of their drug efflux pumps which are proteins in the bacterial membrane that can expel biocides and any other toxins from the bacterial cell and thereby lower their concentration inside the cell to sub-toxic levels. Importantly, these drug efflux pumps also expel a wide range of antimicrobial compounds and so render the micro-organism resistant against many different classes of antimicrobial agents.

“Antimicrobial resistance witnessed in superbugs is a global issue and a serious threat to human and animal health. Without a counter action against the emergence and spread of superbugs no antibiotics will be available to treat infections. This issue can take away a lot of the privileges modern medicine provides.

For the matter of fact, through our research we are witnessing bacteria that are resistant to last-line antibiotics making them very difficult to treat. The national action plan is well addressing this issue and focusing on seven objectives. I salute the action plan for starting with Object number 1: Raising Awareness; because this will raise AMR profile not only in the health sector but also social and in the non-for-profit world. For example, communicating cancer to the public raised their awareness and as a result public became more cancer conscious and more foundations exist to support cancer research. We need to do the same with AMR. We need to make the public aware about the consequences of inappropriate use of antibiotics, and their vital role to combat superbugs. We can make a real difference by bonding together as a human race against the marsh of superbugs. Hence we have launched our international awareness programs, including the upcoming superbugslayerspolo.org. 

Surveillance is the key to monitor the emergence and spread of superbugs. Recent surveillance report published by the WHO showed that global surveillance for AMR is poor. Australia has a very strong health infrastructure that can support active surveillance systems. However, as AMR is a global issue, more countries need to establish superbugs surveillance programs.

As an example for our effort to track superbugs in the world, we have successfully identified a variety of bacteria that are multidrug resistant in the Gulf States. Please visit (link), (link) and (link). Because superbugs don’t respect political boarders, they can reach to many continents at once. Hence fostering global surveillance will help the global combat against AMR.

Urgent support for research and development is well needed to support innovation for rapid diagnostics and novel treatments. Similar to cancer research, different sectors are needed to contribute in this battle. I am privileged to be supported by different sectors including (link), (link), (link) and of course my academic scholarship and a research grant from my home country Saudi Arabia. Please follow here and here to read my op-ed regarding AMR.”