Antimicrobial resistance is high on the agenda for this year’s World Health Assembly (May 2015). Under discussion will be the WHO Draft global action plan on antimicrobial resistance, published on 17th March 2015 and available here: http://apps.who.int/gb/ebwha/pdf_files/WHA68/A68_20-en.pdf

It is increasingly recognised that many if not most prescribers (and users) in low- and middle-income countries have little or no awareness of, or access to, independent reliable information on medicines.

The global action plan notes: ‘In some cases, industry’s spending on promoting products is greater than governmental investment in promoting rational use of antimicrobial medicines or providing objective information.’ That’s clearly an understatement – in fact, ‘pharmaceutical companies spend tens of billions of pounds every year trying to change the treatment decisions of doctors: in fact, they spend twice as much on marketing and advertising as they do on research ad development of new drugs’ (Ben Goldacre: Bad Pharma).

The action plan notes: ‘Health-care workers have a vital role in preserving the power of antimicrobial medicines. Inappropriate prescribing and dispensing can lead to their misuse and overuse if medical staff lack up-to-date information, cannot identify the type of infection, yield to patient pressure to prescribe antibiotics or benefit financially from supplying the medicines.’

The plan says: ‘Professional bodies and associations, including industry associations, health insurance providers and other payers, should develop a code of conduct for appropriate training in, education about, and marketing, purchasing, reimbursement and use of antimicrobial agents. This code should include commitment to comply with national and international regulations and standards, and to eliminate dependence on the pharmaceutical industry for information and education on medicines and, in some cases, income.’

The plan says the WHO Secretariat should ‘Develop, with FAO and OIE through the tripartite collaboration, core communication, education and training materials that can be adapted and implemented regionally and nationally…’

Increased cooperation between WHO, FAO and OIE is certainly important and to be welcomed. But, as a personal comment, I would suggest the emphasis should not be on developing yet more publications and information resources, but increasing the availability and use of existing resources.

Our discussions on HIFA have shown, for example, that the BNF (British National Formulary) is highly valued by prescribers in LMICs, even though they typically have old printed copies dating back as far as 20 years. It is becoming increasingly obvious and urgent to develop an independent, online ‘global formulary’, freely available to all, freely downloadable as a PDF for offline use, with guidance that is presented similar to the BNF, initially in English but in other languages also. The global formulary should list all commonly prescribed medicines (generic names only), with the WHO Essential Medicines List at its core. The global formulary should be seen as a public good, and should be published under an open access license so that it can be freely be used as a basis to develop national and institutional formularies.

Best wishes,

Neil

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