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8 February 2024
The responsible and prudent use of antimicrobials needs to be improved in all sectors - human, animal, plant/crop, and environment - to preserve their public health benefits. In particular, antimicrobials that are medically important for human medicine need to be preserved by reducing their use in the non-human sectors. The WHO list of medically important antimicrobials for human medicine (WHO MIA List) is a risk management tool that can be used to support decision-making to minimize the impact of antimicrobial use in non-human sectors on antimicrobial resistance (AMR) in humans. The WHO MIA List is created to guide international, national, and subnational (local, state, provincial) antimicrobial stewardship efforts. It complements the WHO AWaRe (Access, Watch, Reserve) framework and antibiotic book which provide guidance on appropriate use of essential antibiotics within the human health sector.
The list categorizes antimicrobial classes based on their importance for human medicine and according to the AMR risk and potential human health implications of their use in non-human sectors: critically important, highly important, and important to human medicine. The publication is intended to serve as a reference tool to support decision-making by national regulators and policymakers in ministries of health and agriculture, authorities responsible for regulating, monitoring, and assuring the responsible and prudent use of antimicrobials, and professional prescribers in different sectors.
The WHO MIA List was developed in close collaboration with the Food and Agriculture Organization (FAO), the United Nations Environmental Programme (UNEP) and the World Organisation for Animal Health (WOAH) as a joint effort to harmonize and align related guidance and lists developed by the four organizations. Best practice statements included in the document are aligned with the position of the Quadripartite organizations (FAO, UNEP, WHO, and WOAH) and are critical to preserving the effectiveness of the agents in the WHO MIA List. Further work is ongoing to harmonize guidance on the prudent use of antimicrobials across all four organizations and this WHO antimicrobial list and the WOAH List of antimicrobial agents of veterinary importance.
AMR remains one of the top global public health threats facing humanity and was associated with the death of close to 5 million people globally in 2019. AMR occurs when bacteria, viruses, fungi, and parasites change over time and no longer respond to antimicrobial medicines making infections harder to treat and increasing the risk of disease spread, severe illness, and death. As a result, antimicrobial medicines become ineffective and infections persist in the body, increasing the risk of transmission to others. The WHO MIA List supports the optimized use of antimicrobial medicines in human and animal health.
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COMMENT (NPW): The above is important, but even more basic - and not adequately addressed - is the fact that healthcare professionals worldwide, and especially in LMICs, continue to lack access to reliable, unbiased information on the selection and use of antibiotics for common (and less common) infections. WHO itself acknowledge that many if not most health professionals do not have access, and continue to rely on the information provided by big pharma. And the primary aim of big pharma is defintely not to provide unbiased guidance, it is to persuade healthcare professionals to prescribe their antibiotics rather thanthose of their competitors. The net result is irrational prescribing, over-use of 'blockbuster' antibiotics, massive antimicrobial resistance, and several million deaths per year (and rising).
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org
