A MULTIDISCIPLINARY APPROACH TO MITIGATING ANTIMICROBIAL RESISTANCE INSTRUCTORS' NOTESq

CASE DESCRIPTION This case presents a scenario of a local public health challenge relating to the global threat of antimicrobial resistance. It is caused and driven by complex factors and a solution is required to contain and prevent it. To holistically address this problem requires a multidisciplinary approach to accurately analyze the problem, identify its drivers and create innovative solutions that are effective, feasible and sustainable. There are many possible solutions to the problem, but all would require a judicious recognition and balance of public and private health care rights, responsibilities, and values. The case description is adapted from real occurrences and can represent real life situations. Fictitious characters and plots that bear no direct relation to any existing individuals or locations are used. CASE SYNOPSIS The President of the Democratic Republic of Mullenia (a fictional state) convened an emergency meeting of the Disaster Management Taskforce (DMT) under the Office of the Prime Minister responsible for coordinating all aspects of disaster management in mainland Mullenia. The taskforce comprising the heads of several ministries was called in order to address a recently identified public health crisis stemming from increased antimicrobial drug resistance (AMR). The most affected areas in the country are rural, which typically lack adequate medical resources, but the AMR is rapidly spreading into urban areas as well. A preliminary survey shows that this trend correlates with the indiscriminate sale and use of antimicrobials from unregulated markets and private drugstores that do not require prescriptions. Challenged with poor medical infrastructure and shortage of trained personnel, the country is determined to tackle the issue holistically. This means that, at the least, expertise in medicine, business/economics, sociology/anthropology and public policy is required. You (or your team) have been hired by the Government of Mullenia to offer both short and long term solutions to address these issues. DISCUSSION QUESTIONS Here are some questions to guide class discussions: 1. What is antimicrobial resistance (AMR)? 2. Why and to what extent is AMR a global threat? 3. What immediate, medium and long term measures will you employ to deal with the problem in Tilman and nationally? 4. Is there a role for anthropological or cultural solutions to antimicrobial resistance? Discuss. 5. Why is it important to not only focus on the medical solution to antimicrobial resistance? 6. Is business regulation an approach that will be effective and sustainable? 7. What business or economic factors may contribute to the emergence of AMR? 8. What other factors promulgate antimicrobial resistance? 9. What are the options for effectively communicating the nature of the problem at the community level? RESPONSES TO DISCUSSION QUESTIONS 1. Antimicrobial resistance is a phenomenon that bacteria use to protect themselves against the antimicrobials used to kill them. 2. It is a global threat because once a microorganism develops resistance in a human or animal population; it can possibly transfer and maintain resistance to other human or animal populations. WHO, CDC reports that antimicrobial resistance is now a major global threat. 3. Students are to create innovative strategies that address the identified cause and drivers of the problem. They need to also involve other non-medical stakeholders that are crucial to a successful intervention campaign and provide a time line for executing the goals. Some criteria for strategy evaluation should also be provided. 4. There is a role for anthropological and cultural studies. Students should explain their perspectives on how this applies. 5. The spread of antimicrobial resistance is due to the interplay of diverse factors not limited to diagnosis and prescription. …