title: Access to effective antimicrobials: a worldwide challenge.
abstract: Recent years have seen substantial improvements in life expectancy and access to antimicrobials, especially in low-income and lower-middle-income countries, but increasing pathogen resistance to antimicrobials threatens to roll back this progress. Resistant organisms in health-care and community settings pose a threat to survival rates from serious infections, including neonatal sepsis and health-care-associated infections, and limit the potential health benefits from surgeries, transplants, and cancer treatment. The challenge of simultaneously expanding appropriate access to antimicrobials, while restricting inappropriate access, particularly to expensive, newer generation antimicrobials, is unique in global health and requires new approaches to financing and delivering health care and a one-health perspective on the connections between pathogen transmission in animals and humans. Here, we describe the importance of effective antimicrobials. We assess the disease burden caused by limited access to antimicrobials, attributable to resistance to antimicrobials, and the potential effect of vaccines in restricting the need for antibiotics.
authors.affiliation: Princeton Environmental Institute, Princeton, NJ, USA; Public Health Foundation of India, New Delhi, India. Electronic address: ramanan@cddep.org.
authors.forename: Ramanan
authors.initials: R
authors.lastname: Laxminarayan
authors.affiliation: Directorate of Health, Pretoria, South Africa.
authors.forename: Precious
authors.initials: P
authors.lastname: Matsoso
authors.affiliation: Center for Disease Dynamics, Economics & Policy, Washington, DC, USA.
authors.forename: Suraj
authors.initials: S
authors.lastname: Pant
authors.affiliation: Center for Disease Dynamics, Economics & Policy, Washington, DC, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Brower
authors.affiliation: Norwegian Institute of Public Health, and Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA.
authors.forename: John-Arne
authors.initials: JA
authors.lastname: Røttingen
authors.affiliation: Bill & Melinda Gates Foundation, Seattle, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Klugman
authors.affiliation: Department of Health, UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Davies
mesh_terms: D000822:Animal Husbandry; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019049:Developed Countries; D003906:Developing Countries; D004352:Drug Resistance, Microbial; D014943:Global Health; D006297:Health Services Accessibility; D006801:Humans; D008460:Meat; D022242:Pneumococcal Vaccines; D011014:Pneumonia / Q000401:mortality; D018805:Sepsis / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines