In ‘PINTAR Voices’ we ask questions to international AMR experts about their work, the private sector, informing policy and the COVID-19 pandemic.
This month’s guest is Dr Kathy Holloway, from the Institute of Development Studies at the University of Sussex Campus, United Kingdom, former WHO Regional Advisor on Essential Drugs and Other Medicines for South East Asia, and a member of the PINTAR Study Advisory Committee.
1. How are you and your work contributing to protect Indonesia from the threat of antibiotic resistance?
My work focuses on the impact of essential medicines policies on antibiotic use and how to collect data on policy and use, including in Indonesia. Published results [1-5] show that data on antibiotic use and policies can be collected rapidly (in 2 weeks) and accurately by government workers using a workbook tool when well supervised.
Policies associated with less antibiotic misuse include:
• a government unit dedicated to promoting rational use of medicines
• a national strategy to contain AMR
• implementation (through training and distribution) of clinical guidelines and essential medicines lists
• regular public education campaigns on antibiotic use
• disallowing over-the-counter availability of antibiotics
• regulating drug promotion
• disallowing medicines sales revenue to supplement prescriber income
• and having medicines free at the point care in the public sector.
The more of these policies are implemented, the lower the antibiotic misuse.
2. What are your thoughts on the role of the private sector in improving appropriate use of antibiotics?
The private sector can help to improve appropriate use of antibiotics IF it is properly regulated by government and IF regular widespread effective public education campaigns are run.
Unfortunately, neither of these activities are often done by government. WATCH and RESERVE antibiotics should not be available without prescription and this should be enforced. Pricing policies whereby WATCH antibiotic prices are set higher than ACCESS antibiotic prices could help to reduce use of WATCH antibiotics.
3. What type of interventions involving private drug sellers could best inform AMR policy at national and international level?
Well documented effective interventions involving drug sellers are the only ones likely to inform AMR policy at national and international levels. Effective approaches are likely to require:
• education of both drug sellers and the public about antibiotic use and when not to use antibiotics, focusing on common conditions such as acute upper respiratory tract infections and acute diarrhoea, and if possible, involving local practitioners in delivering the education.
• regulatory input with regard to (1) enforcing disallowance of over-the-counter availability of WATCH and RESERVE antibiotics and (2) increased monitoring of promotion of antibiotics with a view to curbing inappropriate activities.
4. In your view, how will the COVID-19 pandemic affect efforts to address AMR in Indonesia and similar countries?
The COVID-19 pandemic is likely to increase antibiotic use and therefore AMR. Many cases of acute respiratory infections are likely to receive antibiotics due to fear that they could be caused by COVID-19 even though antibiotics are not effective for COVID-19 and the likelihood of secondary bacterial infection is much lower than with influenza.
The economic effects of lockdown and social distancing are likely to result in less funding for health and preventive measures such as good water, sanitation, and other infection control measures, which would actually help prevent the spread of both AMR and COVID-19.
References
- Holloway KA, Henry D, (2014) “WHO Essential Medicines Policies and Use in Developing and Transitional Countries: an analysis of reported policy implementation and medicines use surveys” PLOS Medicine, 11(9): e1001724. doi:10.1371/journal.pmed.1001724
- Holloway KA, Rosella L, Henry D. (2016) The Impact of WHO Essential Medicines Policies on Inappropriate Use of Antibiotics. PLoS ONE; 11(3): e0152020. doi: 10.1371/ journal.pone.0152020.
- Holloway KA, Kotwani A, Batmanabane G, Puri M, Tisocki K. (2017) Antibiotic use in South-East Asia and policies to promote appropriate use: reports from country situational analyses. BMJ; 358: j2291: http://dx.doi.org/10.1136/bmj.j2291
- Holloway KA, Kotwani A, Batmanabane G, Santoso B, Ratanawijitrasin S, Henry D (2018). “Promoting quality use of medicines in South-East Asia: reports from country situational analyses”. BMC Health Services Research; 18:526. https://doi.org/10.1186/s12913-018-3333-1.
- Holloway KA, Ivanovska V, Manikandan S, Jayanthi M, Mohan A, Forte G, Henry D (2020). “Identifying the most effective essential medicines policies for quality use of medicines: a replicability study using three World Health Organisation data-sets”. PLoS ONE 15(2): e0228201, https://doi.org/10.1371/journal.pone.0228201.
