Health for All Begins at the First Bar of the Patient Care Cascade

By guest contributor Reeti Desai Hobson

Antimicrobial pathogens take center stage this September as the world convenes to counter its growing threat. Against this backdrop are the stark facts – an estimated 4.95 million deaths associated with drug-resistant pathogens out of a total 7·7 million deaths were attributable to bacterial infections and analysis from the World Bank stated that AMR will cause a GDP shortfall of at least USD 3.4 trillion annually and push 24 million more people into extreme poverty. These statistics lay bare the need to take urgent action, for the sake of individuals, for communities, and countries. The economic value of such action is clear – integrating antimicrobial stewardship into infection control and prevention programs and as part of broader public health programs can save lives and impact economies over generations. However, ensuring food security, building resiliency against climate shocks, curbing the spread of infectious disease outbreaks, and other competing priorities complicate an already complex context for health service delivery in resource constraint settings.

Limited resources lend support for novel approaches to counter antimicrobial resistance (AMR) at national and regional levels, such as One Health, which align animal, human, and environmental health interventions, and integrated service delivery at primary healthcare settings in support of universal healthcare. Communities too, are taking greater stewardship over their own health outcomes. Despite years of investments in health programs, advancements toward 2030 Sustainable Development Goals, WHO End TB Targets, and WHO Health for All strategies are slow and achieving global targets are in jeopardy.

Varied country contexts mean that in some places there already exists significant capacity to detect and treat infectious diseases while in others, access to curative services remains limited. Injecting additional funds into health systems might actuate change, but there is also growing consensus that development needs to happen differently and that holistic approaches at the first bar of the patient care cascade – diagnosis – is the key to sustainably addressing AMR related challenges. In line with this, the 2021 Lancet Commission on Diagnostics estimated that over 50% of the world’s population cannot access diagnostic services and in sub-Saharan Africa, only 1–2% of clinical laboratories can undertake bacteriology testing.

Optimizing diagnostic networks and coupling them with effective treatment programs has the potential to address the dichotomy presented by overdiagnosis and prescription of antimicrobials in some contexts with under diagnosis of AMR infections and associated costs in other contexts. Decentralized approaches to diagnostics are critical – these ensure equitable reach of individuals with otherwise limited access to advanced testing and ensure that they can be linked to the right treatment at the right time. An effective decentralization strategy for diagnostics means that countries must shift away from traditional laboratories for testing to mobile, community-based options, such as Truenat, which is an example of a multi-disease testing platform that can reach populations in the communities in which they reside to test for Drug-Resistant TB (DR-TB), malaria, and other AMR. As Elijah Kahn-Woods, Innovation Advisor for USAID’s Center for Innovation and Impact noted during the recent World AMR Congress in Philadelphia, this must be rolled out with improved quantification and forecasting of supply chain and strengthened referral pathways. At the same conference, Associate Director of the Mary Heersink Institute of Global Health at the University of Alabama, Professor Stephen Obaro, emphasized the need for increased education of laboratorians and pharmacists on newer diagnostics and appropriate AMR treatment regimens. Clinicians must also move away from syndromic response to illnesses to more accurate diagnosis which can lead to tailored treatment and care guidance to patients.

As new challenges to the AMR response arise, the development landscape is also shifting. Countries must continue to embrace private sector partners and communities to address funding and operational gaps for AMR response within their health systems, catalyzing both the demand and supply sides of the first bar of the patient care cascade – diagnosis. The United Nations High Level Meeting (UNHLM) on AMR provides just that opportunity, providing a voice to organizations that have aligned themselves with this mission, and who are eager to contribute to more than just the bottom line, taking responsibility for making diagnostics accessible to all. It is only then that there is hope that a different outcome is possible.

About the author:

Reeti Desai Hobson is Vice President, Global Health Programs and Partnerships at Molbio Diagnostics, where she supports the introduction and scale up of point-of-care diagnostics globally. Her work focuses on strategic growth, thought leadership, business development, and innovative public-private partnerships to maximize impact at the last mile.

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