together4AMR#1 Together for AMR: An Introduction to a collaborative approach

The podcast series "Together for MR" discusses the threat of antimicrobial resistance (AMR). AMR is when bugs like bacteria, viruses, parasites, and fungi become resistant to drugs, making them ineffective. The World Health Organization declared AMR as a top 10 global health threat. Collaborative efforts between organizations and leaders can help prevent and manage AMR. The podcast interviews global health leaders who share their personal views on combating AMR. Drug-resistant bacterial infections are causing more deaths than HIV or malaria, and resistance rates are projected to rise. The irresponsible use of antimicrobials, poor infection control, and lack of new treatments contribute to the problem. Collaboration and responsible antibiotic use are needed to address AMR. Disease-specific programs for tuberculosis and malaria have been successful, but lack collaboration. Collaborative leadership involves mutual relationships, shared goals, and shared resources. The podcast explores how Together for MR is a series of podcasts about a collaborative approach to one of the major public health threats of our time, antimicrobial resistance. Now imagine a disease that leads to more deaths than HIV and tuberculosis combined. That could cause more than 10 million deaths a year. That could cause economic loss of 100 trillion American dollars. Sounds like a disaster, isn't it? Would you believe if I told you that this has already started happening? Antimicrobial resistance is the ability of bugs such as bacteria, viruses, parasites and fungi to nullify the effects of antimicrobial drugs, which results in these drugs becoming ineffective against those bugs. The World Health Organization, or WHO, declared AMR, or antimicrobial resistance, as one of the top 10 global public health threats that face humanity in 2019. But this problem can be prevented, and better prevented if people, organizations and leaders work together collaboratively to deal with it. Vertical programs, also known as disease-specific public health programs, especially for HIV, tuberculosis and malaria, or similar diseases of public health importance, have decades of experience dealing with antimicrobial resistance. If efforts to prevent and manage AMR join hands with disease-specific vertical programs systematically, then synergies amongst them can yield better results. My name is Anwar Parvez Syed, and I welcome you to this series of podcasts, Together for AMR. In this podcast series, we interviewed five global health leaders who have dedicated their professional careers to combating communicable diseases and antimicrobial resistance. Although they are affiliated with esteemed organizations such as WHO, CDC and World Bank, the views they shared in these interviews are personal and based on their extensive work experiences, and they do not reflect the official positions of their organizations. So before we go into details about what questions we asked them and hear their responses, let me give you some more information of the problem of drug resistance and why we care about this approach. In 2019, over 1 million people died as a result of drug-resistant bacterial infections, which was more than HIV or malaria. Resistance rates to available treatments are projected to continue to rise to possibly 100% in the next 10 years. It is estimated by 2050, AMR would cause 10 million deaths a year, costing the global economy a cumulative 100 trillion US dollars. So AMR is not a recent problem. In 1928, Alexander Fleming made a game-changing discovery of the first antibiotic, penicillin. This drug played a crucial role in treating infections during the World War II. But before the first clinical use of penicillin in 1942, Dr. Fleming warned everyone about the risk of resistance to the drug. When he received the Nobel Peace Prize in 1945, he mentioned this risk of bacteria becoming resistant to penicillin if the drug was not used properly. So since then, we humans started using antimicrobials for prevention and treatment of infectious diseases or communicable diseases or transmissible diseases, which can spread from one person to another or one to another. So the risk of resistance to these drugs also increased simultaneously. While bacterial resistance to antibiotics can occur naturally, human activities have significantly accelerated this process. So basically, human beings are responsible for development of resistance to antibiotics. The rapid development and spread of antibiotic resistance are primarily driven by the irresponsible and irrational use of antimicrobials. We see overprescription, incomplete courses of treatment, and the use of antibiotics in agriculture, animals, and other sectors, which can greatly contribute to this problem. Additionally, poor infection prevention and control practices in healthcare settings, self-medications, and lack of new antibiotic development, all of this exacerbates this issue. Addressing antibiotic resistance requires responsible antibiotic use, adherence to prescribed treatments, better infection control, regulation of agricultural and aquaculture practices, and investment in new treatments alongside public education to raise awareness about these issues. Severe tuberculosis and malaria are significant public health problems, for which disease-specific programs have been implemented in low- and middle-income countries around the world for many decades. These programs aim to control, prevent, and eventually eliminate these diseases, which have a substantial impact on public health and economic stability in the regions and countries where these diseases are prevalent. Prevention or treatment with antimicrobials is one of the major strategies to manage such infectious diseases of public health importance. Now, many of the low- and middle-income countries have been dealing with drug resistance problems for many decades, but most of the strategies that are applied to deal with the resistance are unique to the programs themselves, as the programs are implemented vertically in silos. Most of the programs endorse to collaborate or integrate with health systems, especially the primary health care, and to collaborate with each other to leverage the successful outcomes. But the lack of flexibility in programmatic structures and implementation designs itself make this integration or collaboration difficult. The programs mainly focus on achieving their targets to be successful and stay funded, and efforts for collaboration usually take a backseat. When we say collaboration, it means a mutually beneficial and well-defined relationship between two or more organizations to achieve common goals. The relationship between them includes a commitment to defining mutual relationships and goals, a jointly developed structure and shared responsibility, mutual authority and accountability for success and sharing the resources and rewards as well. And the collaborative leadership is the capacity to engage people and groups outside one's formal control and inspire them to work toward common goals, despite differences in convictions, cultural values, and operating norms. Collaborative leadership aims to bring professionals out of their silos and push them to work together. In this series of podcast interviews, we explored insights from public health leaders on how synergies among communicable disease programs can enhance the fight against AMR. We discussed the benefits and barriers of a collaborative approach to AMR in public health practice to improve the public health response to AMR, particularly within the communicable disease programs. We tried to identify leadership opportunities that could advance collaborative approach to AMR at global, regional, national, and local levels. We also dived into questions that could identify leadership skills and competencies that public health leaders need to possess to strengthen the overall response to AMR. In a sense, what we are doing here is to understand from these public health leaders what it takes to work together and achieve more through collaboration than by working in isolation. So stay tuned for the next podcast in this series, Together for AMR, about synergies amongst disease-specific vertical programs that could be used to strengthen overall response to combat AMR. Thank you very much. See you in the next podcast.