DRWG's Draft Report Recommendations

The DRWG’s consultation draft report proposes eight recommendations for global action on drug resistance. We will continue refining these recommendations so that the final report prioritizes the most effective and feasible actions for global organizations to take against drug resistance. To do this, we need your input here. To get you started, we have listed below some of the important questions we are still exploring about what works to combat resistance. We welcome your responses.

Recommendation #1:  Develop a multi-disease laboratory and surveillance system to confirm and track the emergence and spread of drug‐resistant strains of disease.

1. What are the pros and cons of deploying lab capacity across diseases, compared to more disease specialized labs? Could the use of molecular technology increase overall capacity? What are the most cost-effective ways to build such capacity?
2. Which types of drug resistance data are most needed to inform effective drug/health policy development?
3. What are the best ways to share drug resistance information with those who need it, including through the internet and social media?  Would a drug resistance data 'one stop internet shop' help, and if so, what kinds of resources/services should it offer?

Recommendation #2: Support regional networks of drug regulators to protect drug efficacy.

1. Which are the best examples of functioning and sustainable regional regulatory networks within and outside of public health? What factors make them work?
2. How are they funded, and what do they cost?
3. What should be the main functions of regional drug regulatory networks supported by governments and donors?

Recommendation #3: Develop uniform industry standards and procedures to measure and monitor drug resistance.

1. What steps can manufacturers take to improve the rational use of drugs and diagnostics and reduce opportunities for resistance emergence?
2. What would it cost manufacturers to meet standards established for drug resistance such as those indicated in question 1, and how could developing country manufacturers be supported to do so?
3. How can major purchasers of drugs and diagnostics be incentivized to select products that meet post-marketing standards that reduce drug resistance potential?

Recommendation #4:  Create a web‐based marketplace to share resistance‐specific research and technological innovations across diseases.

1. What prevents resistance-related technologies from moving along the R&D pathway? How might a web-based 'marketplace' address these blockages? 
2. Who is most likely to use a web-based marketplace, and what kinds of information should it be designed to share?
3.  What kind of facilitation would be needed for the marketplace to work? What would it cost to sustain the marketplace?
4. How could the marketplace attract (a) developing country researchers, (b) developed country researchers, and (c) donors, investors, and late-stage developers? 

Recommendation #5:  Establish systematic resistance‐specific training and education for pharmacy workers.

1. How can global, sustained, and systematic education and training be made available to pharmacy workers? Which organizations could develop and update resistance-specific materials suitable in different countries and regions?
2. What would education and training cost for start-up and maintenance? Who might provide short-term and longer-term funding?
3. What is the potential for using web-based training methods?

Recommendation #6:  Scale up accreditation of drug dispensers and provide incentives for high quality dispensing practices.

1. What tools (checklists, guidelines, etc.) and incentives are effective mechanisms to improve rational drug dispensing and use? 
2. What minimum basic services and standards are needed in a “core drug dispensing model” for accreditation, and how could this model be sustainably implemented in developing countries? 
3. How much do existing accreditation programs cost?  Who might fund their expansion?

Recommendation #7:  Hold an international drug‐resistance and development conference (IDRDC) to catalyze institutional communities against resistance.

1. Who should participate in the IDRDC conference?
2. What should an IDRDC conference accomplish?
3. How frequently should an IDRDC be held and how should it be linked to other global medicine and infectious disease events?

Recommendation #8: Strengthen the International Health Regulations (IHR) in language and practice as they apply to drug resistance.

• What are the existing barriers to using the IHRs to combat drug resistance?
• What steps would better enable the WHO to act against drug resistance?