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Diagnostics at Davos: A Call to Deploy POCT to Address the Tolls of Antimicrobial Resistance

Diagnostics at Davos: A Call to Deploy POCT to Address the Tolls of Antimicrobial Resistance

At this year’s World Economic Forum in Davos, Switzerland, a major theme among global health stakeholders was treatment access. In an AdvaMedDx-sponsored side event that I participated in, global health experts and industry leaders also discussed access – specifically, access to diagnostics and rapid point-of-care testing (POCT) to help combat antimicrobial resistance (AMR).

The proliferation of AMR is a global public health crisis. Most infections are treated empirically in both developed and developing countries, without the benefit of diagnostic tests. This has led to antibiotics being prescribed unnecessarily at least 30% of the time in the United States,1 and the percentage is estimated to be even higher in the rest of the world. Based on these trends, by 2050 AMR is projected to cause 10 million annual deaths and $100 trillion in lost global economic productivity.2

Other issues compound the problem. In the poorest countries, fewer than 1% of patients are treated at clinical facilities equipped with diagnostic microbiology laboratories.3 Even more alarming, some countries offer patients over-the-counter access to antimicrobials, which removes diagnostics from the treatment equation altogether.

The proliferation of AMR is a global public health crisis. Most infections are treated empirically in both developed and developing countries, without the benefit of diagnostic tests.

Although leading health agencies like the CDC and WHO have issued strong warnings and guidelines for implementing antimicrobial stewardship (AMS), these reports prioritized strategies like preventing infection and improving the accuracy of antibiotic prescribing via laboratory tests, rather than focusing on POCT.4 In 2016, former United Kingdom Prime Minister David Cameron commissioned Lord Jim O’Neill to develop a report titled “Tackling Drug-Resistant Infections Globally,” which was the first to emphasize POCT as a strategy to address AMR. The report called on governments in developed countries to mandate that all antibiotic prescriptions be informed by a rapid diagnostic test—where one exists—by 2020. Panelists at the AdvaMedDx event echoed this call by discussing the steps necessary for expanding POCT capabilities around the world.

AdvaMedDx and the Joint United Nations Program on HIV/AIDS (UNAIDS), along with Alere and other diagnostics manufacturers, set forth commitments to ensure access to innovative diagnostic solutions. Specifically, the participant groups called for the establishment of public-private partnerships to expand access to diagnostics and ensure their effective utilization worldwide. Michel Sidibé, executive director of UNAIDS, concurred with the commitments made at the side meeting. He said, “We must galvanize action in both private and public sectors to accelerate the uptake of diagnostics. Quality care, including timely diagnosis, should be ensured for everyone to save lives and to prevent widespread resistance.”

Alere has long been an active advocate for antimicrobial stewardship and last year signed the Industry Declaration supporting the O’Neill report. Alere has also advanced several other recommendations that emerged from the AdvaMedDx side meeting to reduce unnecessary prescribing of antimicrobials. These include emphasizing the use of currently available diagnostics to quickly facilitate the goal of reducing antimicrobial usage worldwide; accelerating pathways for regulatory approval of new diagnostics and implementing financial incentives for POCT in markets where reimbursement schemes have favored lab testing; and expanding/coordinating global education and advocacy efforts to mobilize stakeholders for action around antimicrobial stewardship. These activities, if bolstered by the implementation of the recommendations set forth at the Davos side event, can be instrumental in reducing the grave and growing threat of AMR.

  1. Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010 – 2011. JAMA. 2016;315(17):1864 – 1873.
  2. Review on AMR, Tackling drug-resistant infections globally: Final report and recommendations, 2016.
  3. Sosa AJ, Byarugaba DK, Amábile-Cuevas CF, et al, eds. Antimicrobial Resistance in Developing Countries. New York, NY: Springer; 2010.
  4. Antibiotic Resistance Threats in the United States, 2013.

   

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