The International Centre for Antimicrobial Solutions (ICARS) and the International Development Research Centre (IDRC) are leading a project, working with local stakeholders and using a One Health approach, to assess opportunities for preventing and controlling antimicrobial resistance (AMR) across the Caribbean. The project is supported by funding from the UK Department of Health and Social Care’s Fleming Fund programme. Although the project will benefit the region as a whole, the initiative will primarily focus on 10 ODA-eligible countries and territories in the Caribbean, including Dominica, Haiti, St Lucia, Belize, Jamaica, Suriname, Guyana, St Vincent and the Grenadines, Montserrat, and Grenada.
Context
Antimicrobial resistance (AMR) is an ever-present and growing problem for public health globally. In 2019, it was estimated that between 1.27 million and 4.95 million people died because of bacterial antimicrobial resistance[1]. The estimates for the same year in the Caribbean region is between 7,627 and 30,688 deaths because of AMR[2]. The Caribbean faces a growing risk of antimicrobial resistance (AMR) due to several factors, including limited surveillance systems across human, animal, and environmental sectors, insufficient regulation of antimicrobial use, and a high burden of infectious diseases. The interconnected nature of the islands through tourism and the food industries, alongside vulnerability to climate change, further exacerbates the spread of AMR.
While regional initiatives, including those by the Caribbean Community (CARICOM), Pan American Health Organization (PAHO), Food and Agriculture Organisation (FAO), and the Caribbean Public Health Agency (CARPHA) are working to strengthen AMR surveillance and coordination, significant gaps remain. Only a few Caribbean countries have developed National Action Plans (NAPs) on AMR, with most lacking comprehensive data on AMR prevalence and antimicrobial use. Moreover, there is limited evidence about AMR in the region, particularly from low- and middle-income countries. The response is hindered by poor infrastructure for microbiological testing and a lack of evidence-based interventions to address AMR across sectors, including the impacts of climate change. A One Health approach is needed to better understand and address the drivers of AMR, particularly in vulnerable populations and sectors.
Project Overview
The ‘People-Centred AMR Research and Innovation’ project responds to commitments in the Political Declaration of the High-Level Meeting on AMR (September 2024) to strengthen international cooperation including support for research, development, and innovation. This 14-month project aims to lay the foundations for targeted and impactful investments in the region.
The project will focus on the need to reduce AMR transmission and burden within the human population (infection prevention and control, AMR prevention, antibiotic and diagnostic stewardship), while taking a One Health lens including other sectors that have a direct impact on AMR transmission to humans (i.e. food safety and food production systems).
Scoping studies
The following commissioned studies will kick-start consultations to identify priority topics:
- Assessment of the AMR research and scientific ecosystem (IDRC)
- Review public engagement strategies, interventions, and public health measures aimed at identifying, preventing, and controlling AMR (ICARS)
- Assessment of the AMR policy and regulatory frameworks (IDRC)
Capacity strengthening
ICARS, with support from Radboud University Medical College, will lead activities aiming to strengthen the necessary capacity to develop and test antimicrobial stewardship (AMS) and infection prevention and control interventions, based on the ‘data-driven implementation of behaviour change in Antimicrobial Stewardship in Low- and Middle-Income Countries’ (drive-AMS LMICs) model.
Iterative stakeholder analysis
ICARS and IDRC will organise a series of virtual and in-person workshops, building on initial consultation with regional public health agencies and research organisations (including CARPHA, PAHO, UWI) to:
- Share and validate the results from the scoping studies and capacity-strengthening activities
- Identify the interests and contributions of national and regional AMR stakeholders
- Prioritise research, training and policy directions and actionable projects that could be advanced with future funding
Design and implement baseline studies
Furthermore, ICARS will support the co-development and implementation of AMR mitigation efforts across high-priority areas identified by different countries in the region. The results from these studies will be used to address existing data gaps and capacity limitations and to inform National Action Plans, surveillance strategies, and future research priorities.
Project development of priority topics
IDRC will support the development of research, public health, and policy and regulatory projects on priority topics, identified through scoping studies and in consultation with local and regional stakeholders. In addition, an international conference on AMR will be held in the region to foster learning and collaboration between AMR researchers.
Outcomes
The findings from this project will provide a comprehensive overview of current AMR prevention and control efforts, highlighting strategies, gaps, and opportunities for future research and innovation in the region. The insights will assist with prioritizing and developing an agenda for improving AMR policies, practices, and research with a human health focus and connections to other One Health sectors (e.g. agriculture and agri-food) across the Caribbean.
[1] Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022 Feb 12;399(10325):629-655. doi: 10.1016/S0140-6736(21)02724-0.
[2] Measuring Infectious Causes and Resistance Outcomes for Burden Estimation, Vizhub-MICROBE
Photo credit: Blue Mountain, Jamaica – Yves Alarie, Unsplash