CGD Drug Resistance and Global Health E-Newsletter Featured Column
By Emma Back
Consultant to the DRWG
Drug efficacy is a common property resource that must be protected, and the basis for effective protection measures is having information about where and how resistance occurs. This type of information – including scientific, population and systems data – constitutes a global public good, and should be available to all who need it.
Based on this premise, the Center for Global Development’s Drug Resistance Working Group commissioned an assessment of available information about drug resistance in the developing world. The paper identifies data sources, systems, and mechanisms for conveying and sharing information, which are critiqued along four dimensions: accessibility, transparency, cost and quality. The paper also explores several key challenges constraining the generation of high-quality data from developing country settings, as well as broader and more proactive information sharing.
The challenges are many. Most critically, weak laboratory capacity and limited reporting systems are an issue in many countries, particularly across Africa, and this constrains basic data collection and analysis. Much of our understanding about drug resistance in developing country contexts is therefore based on discrete population-based studies and, for HIV/AIDS, TB and malaria particularly, on data collected by WHO and global health initiatives. This means that, for acute bacterial infections in particular, data are patchy. Where data are collected by global programs – including those under the auspices of bilateral aid donors – local ownership and use of such data may be limited, and where programs use different data collection systems they can duplicate and cut across one another.
There are challenges in accessing and using data too. For example, data may not be available in a format that is useful for policy-makers, advocates or public health workers. There may be cost or technological barriers to accessing data – a particular constraint in resource-poor settings. Or, quite simply, there may be no incentive for people to use or share information about drug resistance. For example, clinicians may see little rationale for drug susceptibility testing where they have no alternative therapies to offer the patient; laboratories may be reluctant to collect data in a systematic way if there is little or no guarantee that this will be used to inform public health programs. In some cases, local or national authorities may be reluctant to publicize any data they have collected for political reasons.
The paper outlines three potential areas of action in response to these and other challenges. Consistent with the Working Group’s mandate, they focus on actions that can be taken at a global policy level and that add value to existing efforts.
First, there is a need for the global health community to support developing country governments in investing resources – financial and technical – in building drug resistance surveillance capacity, as part of their overall efforts to strengthen public health systems.
With improved surveillance comes the potential for better data on drug resistance. New mechanisms to aggregate drug resistance data – nationally, regionally and globally – should be developed, to facilitate policy-making, allocation of resources, communications and advocacy. Again, the global health community would need to assist developing countries in using this data to inform national drug policy and guidelines.
Lastly, there is a need to improve information sharing and collaboration to inform research and development (R&D) activities. Improved surveillance data will obviously be of value here too. But there may be other ways in which information sharing could accelerate R&D. The paper explores the option of establishing a web-based facility allowing researchers to ‘showcase’ emerging technologies with the potential to address drug resistance, and which require investment to take them through the R&D process. Information about shelved chemical compounds offering ‘resistance reversal’ potential and other resistance characteristics could also be shared through such a facility.
Over the next few months, the Working Group will be considering these and other options in more depth to develop recommendations to improve drug resistance information availability, access and use. In the meantime, you will be able to access the background paper on the Working Group website later this month.