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The Importance of Public Administration Principles to Global Public Health Risk Assessments and National Health Action Plans

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Nathan Myers
March 22, 2024

Individual countries and the world community must be more vigilant in assessing risks for the next major public health crisis. One potential instigator which has been on the global health community’s radar for some time is antimicrobial resistant bacteria (AMR). As stated by the World Health Organization, “[a]ntimicrobial resistance threatens the very core of modern medicine…” requiring the ability to mount a “global health response to the enduring threat from infectious disease.” Before the world was forced to respond to the threat of COVID-19, the World Health Assembly announced the five objectives for their global action plan on antimicrobial resistance in 2015. These objectives expressed the need to leverage tools such as communication, education, training, surveillance, research, sanitation and hygiene. The plan also called for making the economic case for the development of new vaccines and diagnostics, as well as improving antibiotic use among humans and animals.

This last element, focused on the connection between humans and animals, is indicative of the One Health approach that has increasingly been adopted when addressing public health risks. Countries like Canada quickly expressed their support for the global plan, as well as adopting their own plan. While there are many important elements to these plans, this column will present a preliminary review focused on surveillance efforts and how that they incorporated a One Health approach that was inclusive of environmental factors, as well as humans and animals.

Ethiopia’s updated plan, published in 2022, articulated a One Health surveillance approach when they wrote that they intended to  “[e]stablish and strengthen surveillance of antimicrobial resistance priority pathogens in human and animal health, feed and food safety, plants and the environment.” Saudi Arabia’s description of this approach in 2023 was more specific when they discussed “enhancing surveillance in humans, and particularly in animals and the environment, expanding AMR stewardship programs in hospitals; consumption of antimicrobials in humans and animals; and ensuring robust monitoring of AMR activities.” Ireland planned to address this issue of concern for general contamination of antimicrobial resistance in the environment, as reported in their 2022 plan, through surveillance for residues indicating resistance from various point source risks, including hospitals, septic tanks, agriculture and the biopharmaceutical industry.

The need to better monitor the consumption of antimicrobial agents among people, animals and the environment was noted in Tanzania’s 2017 plan as well. Tanzania’s updated 2022 action plan included a number of initiatives to engage the public in AMR responses, including workshops to develop standard procedures for AMR surveillance, conducting field visits for AMR sample collection and conducting sensitization meetings for stakeholders in areas such as agriculture and food safety.

Tanzania’s 2022 plan also outlined a number of steps to better equip laboratories to participate in AMR surveillance, which was emphasized in Ethiopia’s 2022 plan as well. Ethiopia’s 2022 plan discussed the need for “[a]n effective [laboratory] network that generates and collates data on surveillance of antimicrobial use, consumption and resistance across the human, animal and environmental interface…” for the purposes of “strengthening and standardizing surveillance and research through the One Health approach…Hence, information and evidence will be generated for decision-making.” The importance of an integrated laboratory network for AMR surveillance is also discussed in Ireland’s 2017 plan and Canada’s plan from 2023. In the updated 2022 U.S. plan, there was discussion of the need to “establish an accelerator program to advance implementation of whole-genome sequencing, metagenomics and other molecular testing for antibiotic-resistant pathogens in humans, animals, plants and the environment and to coordinate training guidance across agencies [including CDC and the Department of Defense] and among public and private organizations.”     

From a public administration standpoint, all of this will, of course, require funding. This is explicitly addressed in Ireland’s 2017 plan, which notes the importance of “[c]ontinued funding of research focusing on assessing the potential environmental impact of AMR and antimicrobial use, with the ultimate aim of…informing policy and developing solutions…” as well as funding that “will characterise hotspots… and facilitate “for example removal of antimicrobials in conventional and advanced wastewater treatment…” The need to develop policy solutions regarding the AMR issue also speaks to other key public administration themes noted above, including community engagement, evidence-based decision making, interdepartmental collaboration and coordination and public-private partnerships.

These themes are also important for public health risk assessment generally, whether at the local or international level. Governments in all countries and at all levels will need to make hard decisions on how they will prioritize the various health threats confronting them in the wake of the COVID-19 pandemic. These priorities should be set based on the best available data, data which is collected at the community level by those regularly engaged with agriculture and wildlife and then analyzed by collaborative laboratory networks with the best technology available. However, whether such plans are truly operationalized, as with most policy initiatives, depends on the foresight and attention of policy makers. Governments must devote resources toward recognizing the potential magnitude of a risk like antimicrobial resistance before it has already reached the tipping point and employ a One Health-based framework to stop it. 

Author: Nathan Myers, Ph.D. is a Professor in the Department of Political Science and Director of the Master of Public Administration at Indiana State University. His areas of research include public policy, public health emergency preparedness, and the governance of biotechnology. He is the author of Pandemics and Polarization: Implications of Partisan Budgeting for Responding to Public Health Emergencies and numerous related articles. Myers is a graduate of Knox College (BA), University of Illinois at Springfield (MPA), and University of Nevada, Las Vegas (Ph.D.)

Email: [email protected]; Twitter: nagremye1980

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