BSAC: The evidence tells us that young children are disproportionately affected by superbugs. Why is that?

Alex: Children are not small adults. For example, their immune systems are not fully developed, making them more vulnerable to infections. Infectious diseases, including pneumonia and sepsis, are a leading cause of death and disability in children under the age of five. Sepsis, bloodstream infections, is the major cause of death in newborns and up to 40% of bacterial infections in newborns are resistant to standard antibiotic treatments. Another example of why children are not small adults is that children’s bodies also respond differently to treatment. Unfortunately, antibiotics to treat drug-resistant infections in children are very limited, particularly in LMICs. Thus, this increased vulnerability to infections and limited options to treat these infections make children more vulnerable to superbugs.

BSAC: How is your assessment in Time is Running Out likely to change UNICEF’s operational priorities over the coming years?

Alex: UNICEF is a multisectoral organization and the report highlights many ongoing efforts that have a direct or indirect impact on AMR across the organization. The report also identifies areas where UNICEF’s has a comparative advantage and could significantly contribute even further to the global response to AMR, such as communications, advocacy, behavioral change, market shaping of antibiotics, increased access to antibiotics in LMICs through pool procurement. Altogether, this assessment has introduced an AMR lens to multiple sectors within UNICEF which are already engaged in activities that impact AMR, which will give us a better understanding of the impact of AMR on our programmes as well as the impact of our work on AMR. It is this understanding that will guide our priorities over the coming years.

BSAC: In your opinion, does the funding model that supports organisations such as UNICEF adequately prioritise projects focused on tackling superbugs? If not, what needs to change?

Alex: A lot more can be done within the existing health and sustainable development architecture to review development priorities and programmes using an AMR lens. Because AMR is a multisectoral issue, it is very important to apply an AMR lens to domestic budgets and current sources of international health and development funding to identify opportunities that can have a direct and indirect impact on AMR. These include donors and financing mechanisms for human, animal and plant health, food production and the environment, which need to give AMR greater priority in their resource allocations based not only on the threat it represents to global health, but also the economic and security threat which AMR represents, and which cannot be contained without additional resources.

BSAC: Time is Running Out was published just weeks before the emergence of COVID-19. What impact is COVID-19 likely to have on UNICEF’s ability to protect children from superbugs?

Alex: COVID-19 is shifting priorities and resources across the globe and we are all in the process of adjusting to this new reality. I am particularly concerned about the widespread and often incorrect use of antibiotics during the COVID-19 pandemic which will likely exacerbate the pre-existing pandemic of antibiotic resistance. Severe COVID-19 cases are also driving an increase in hospitalizations, which will likely correlate with an increase in hospital acquired infections, many of which will be drug-resistant. COVID-19 is also causing service disruptions, such as diagnosis and access to drugs to treat HIV, TB and other diseases, which may lead to the emergence and spread of drug resistance. Finally, COVID-19 has caused a worldwide drop in vaccination among children which will likely contribute to an increase in the incidence of preventable diseases and the use of antimicrobial drugs. Together, these factors will likely contribute to an increase in AMR in the months ahead and post-COVID phase.

BSAC: Can you describe the practical actions UNICEF will take to “reduce the incidence of infection, promote access to, and optimal use of, antimicrobial agents, and increase the awareness and understanding of AMR”?

Alex: This is a very broad question and I strongly recommend that readers download UNICEF’s technical note on AMR for a detailed answer and list of activities related to this question. I will try to summarize very briefly: On Reducing the incidence of infections, UNICEF works in improving WASH in healthcare facilities, promoting behavioural change in preventative practices, and improving access to vaccination and nutritional supplementation through stronger community health systems.  On Promoting access to, and optimal use of antimicrobials, UNICEF works on supplying quality assured diagnostics and antimicrobials, pooled procurement, market shaping and scale up of new products. On Increasing awareness and understanding of AMR, UNICEF is planning activities at both global and national levels, including the development of an advocacy and communication strategy on AMR, building national advocacy capacity, and the publication of national policy briefs, guidance documents, and communications assets on AMR.

BSAC: How can UNICEF, and other similar organisations, better harness the support of civil society organisations that stand ready to help the global effort to stop superbugs?

Alex: Civil society organizations and networks have critical roles to play. Resource mobilization, such as pressuring donors, aid agencies, financial institutions and governments to adopt an AMR lens on resource allocation. Advocacy with decision makers to drive policy change and hold them accountable. Raise awareness of AMR at the community level and promote behavior change, such as the rational use of antibiotics. Evidence generation. It is incredibly important for evidence to be compiled along with any recommendations that can ensure that interventions at the community level can be culturally sensitive, practical and effective. Finally, coordination is key! One of the biggest challenges for an effective response to AMR is coordination among stakeholders representing the many sectors involved in the AMR response, including governments, industry, donors, aid agencies, international financial institutions, implementing partners, professional associations, academic and research institutions, non-governmental organizations, and civil society organizations. With so many players involved, coordination is essential to generate an effective and sustainable response.