Comment

Leveraging universal health coverage to leave no one behind

in tackling AMR
Antimicrobial resistance (AMR) is a leading global AMR-related goals and health for all by 2030 will only Published Online
July 10, 2024
health and development threat. Left unchecked, it be achieved if the AMR response integrates with efforts https://doi.org/10.1016/
will roll back a century of medical progress. Already to achieve UHC for everyone, everywhere. AMR can only S2214-109X(24)00309-7

an estimated 4·95 million deaths are associated with be addressed equitably if all people have affordable This online publication has
been corrected. The corrected
AMR every year, including 1·27 million deaths for which access to quality health services, including for the version first appeared at
AMR is directly attributable.1 The devastating effects of prevention, diagnosis, and appropriate treatment of thelancet.com/lancetgh on
August 14, 2024
drug-resistant infections can affect anyone, anywhere, infections. As global leaders are preparing to convene
but those who are not protected by universal health at the UN General Assembly High-Level Meeting on
coverage (UHC) are especially at risk of the emergence Antimicrobial Resistance on Sept 26, 2024, we, the UHC
and spread of AMR. Movement Political Panel, call on Member States to
A key reason for why this occurs is the limited use this opportunity to leverage UHC to take a systems
availability of quality essential antimicrobials, vaccines, approach to addressing AMR, with individuals, families
and diagnostics.2 In settings where people do not and communities at the centre by:
have access to preventive services, proper diagnosis • Investing in health systems, based on a primary health
and quality treatment, preventable and treatable care approach, that can deliver high-quality health
diseases are more likely to spread and go undiagnosed services to people for prevention, diagnosis, and
or misdiagnosed, increasing the need for antibiotic appropriate treatment of infections including drug-
consumption and the threat of AMR. resistant infections
Other key drivers of AMR are sepsis, which significantly • Ensuring reliable supply of high-quality and affordable
contributes to broad-spectrum antibiotic use,3 and a lack vaccines, laboratory supplies, and diagnostics and
of adequate infection prevention and control (IPC) and essential antimicrobials, as well as a well-trained and
water, sanitation and hygiene (WASH) in health facilities. motivated health and care workforce working in clean
Data show that more than 1 billion people worldwide and safe facilities with adequate water, sanitation,
visit health-care facilities with inadequate or no WASH and hygiene and infection prevention and control
services, essential for preventing many hospital- measures
associated infections.4 In such settings, health workers • Implementing adequate financial protection
may resort to antimicrobials as a substitute for adequate measures that enable individuals to access essential
IPC practices, especially when lacking training and health-care services, including preventive services,
awareness of adverse effects, further increasing AMR.5,6 timely and accurate diagnosis, and appropriate
High prices of health services and poor financial quality-assured treatment of infections including
protection add another layer of burden. Worldwide, drug-resistant infections
2 billion people experience financial hardship due to out- • Supporting effective governance on AMR that
of-pocket spending on health.7 Unable to afford health promotes a strong human health sector response
services, patients may refrain from seeking medical to AMR linked with UHC under the umbrella of
diagnosis and treatment and self-medicate instead, multisectoral national action plans on AMR that
particularly in settings where antimicrobials can be address the interconnectedness of health issues across
purchased without a prescription. Financial constraints humans, animals, and the environment through a
paired with a lack of health literacy and poor knowledge One Health approach, in line with the quadripartite
about appropriate use of antimicrobials may lead call to action for One Health.11
patients to access informal sources of health care and The UNGA High-level Meeting on Antimicrobial
buy falsified or substandard antimicrobials that further Resistance will be a unique opportunity for Member
drive AMR—a problem which is apparent in countries of States to commit to finding and implementing joint
all income levels.8–10 multisectoral solutions for addressing this health threat.

www.thelancet.com/lancetgh Vol 12 September 2024 e1389

 Comment

By integrating actionable commitments on UHC into 4 Food and Agriculture Organization of the United Nations, World
Organisation for Animal Health, WHO. Technical brief on water, sanitation,
the political declaration and translating them into hygiene and wastewater management to prevent infections and reduce
action at the national level, countries will be better the spread of antimicrobial resistance. https://iris.who.int/bitstream/
handle/10665/332243/9789240006416-eng.pdf?sequence=1 (accessed
equipped to ensure a strong AMR response that leaves July 2, 2024).
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no one behind. inequality: reframing the entrenched problem of antibiotic overuse.
We declare no competing interests. We thank Helena Schmitt for her support in BMJ Global Health 2019, 4: e001590.
drafting and editing this Comment. 6 Otaigbe II, Elikwu CJ. Drivers of inappropriate antibiotic use in low- and
middle-income countries. JAC Antimicrob Resist 2023; 5: dlad062.
Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open
7 WHO, World Bank Group. Tracking universal health coverage: 2023 global
Access article under the CC BY-NC-ND 4.0 license.
monitoring report. https://iris.who.int/bitstream/handle/10665/
374059/9789240080379-eng.pdf?sequence=1 (accessed July 2, 2024).
*Pamela Cipriano, James Chau, Mariam Jashi, 8 Janatolmakan M, Abdi A, Andayeshgar B, Soroush A, Khatony A.
Ilona Kickbusch, Justin Koonin, Tlaleng Mofokeng, The reasons for self-medication from the perspective of Iranian nursing
Joy Phumaphi, Magda Robalo, Akihisa Shiozaki students: a qualitative study. Nurs Res Pract 2022; 2022: 1–7.
[email protected] 9 Belachew SA, Hall L, Erku DA, Selvey LA. No prescription? No problem.
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antimicrobial resistance in 2019: a systematic analysis. Lancet 2022; 10 Carney KA, Wisnieski L, Lackey T, Noah D. Prevalence and factors of
399: 629–55. self-medication with antibiotics in Claiborne County, Tennessee.
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2 WHO. Antimicrobial resistance. https://www.who.int/docs/default-source/
antimicrobial-resistance/amr-factsheet.pdf (accessed July 2, 2024). 11 WHO. Quadripartite call to action for One Health for a safer world.
https://www.who.int/news/item/27-03-2023-quadripartite-call-to-action-
3 WHO. Global report on the epidemiology and burden of sepsis: current
for-one-health-for-a-safer-world (accessed July 9, 2024).
evidence, identifying gaps and future directions. https://iris.who.int/
bitstream/handle/10665/334216/9789240010789-eng.pdf (accessed
July 29, 2024).

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