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JDN_NEWSLETTER_JULY_AUGUST_2024<\/a><\/p>\n

ABOUT US. 1
\nJUL- AUG
\nI S S U E 2 9 T H
\nJUNIOR DOCTORS LEADERSHIP JUNIO 2023-2024 2
\nEDITORIAL TEAM 2023 – 2024 3
\nTEAM OF OFFICIALS\u2019 CONTRIBUTIONS, AND STATEMENTS. 4
\nWORDS FROM THE JDN CHAIRPERSON 5
\nWORDS FROM THE PUBLICATIONS DIRECTOR 6
\nUNIVERSAL HEALTH COVERAGE AND ANTIMICROBIAL 7
\nBUILDING A HEALTHIER FUTURE: DR. ROOPA DHATT 9
\nCONFERENCES, MEETINGS, CONTRIBUTIONS & TESTIMONIES 17
\n154TH WORLD HEALTH ORGANIZATION, EXECUTIVE BOARD 19
\nCOMMITMENT AND CHALLENGES OF YOUNG DOCTORS: 28
\nARTICLES BY JDN MEMBERS 30
\nTHE RISING THREAT: ANTIMICROBIAL RESISTANCE AND ITS I 32
\nHEALTH AS A RIGHT: CHALLENGES AND OPPORTUNITIES FOR 37
\nANTIMICROBIAL RESISTANCE IN INDIA 46
\nNAVIGATING THE ANTIMICROBIAL RESISTANCE LANDSCAPE IN 40
\nBREAKING BARRIERS: NETWORK AT THE FOREFRONT OF CND67 25
\nANTIMICROBIAL RESISTANCE (AMR): A SIGNIFICANT PUBLIC 51
\nTABLE OF CONTENTS
\nAbout Us.
\nWhat is the JDN?
\nThe Junior Doctors Network (JDN) serves as an international platform for junior doctors to facilitate an open dialogue
\nof global events and activities that are relevant to their postgraduate training and the World Medical Association
\n(WMA).
\nIt was created at the 61st WMA General Assembly (October 2010) in Vancouver, Canada and the inaugural JDN
\nmeeting was held at the 62nd WMA General Assembly (October 2011) in Montevideo, Uruguay. The network, which
\nstarted from a few motivated junior doctors, now has a total of over 500 members from more than 90 countries from
\nall regions of the world.
\nJunior doctors are defined as physicians, within 10 years after their medical graduation or who are still in an ongoing
\npostgraduate medical education program.
\nWhat is the mission?
\nThe purpose of the JDN is to empower young physicians to work together towards a healthier world through
\nadvocacy, education, and international collaboration.
\nWhat do we do?
\nNetworking:
\nDuring the regular JDN meetings, members get to know each other, discuss global health issues, share challenges,
\nand start collaborations on global health issues. The JDN meets on several occasions during the year, both in-
\nperson and via online teleconferences:
\nBiannual meetings in conjunction with the Council Meeting and the General Assembly of the WMA (April &
\nOctober).
\nMonthly general membership and management team teleconferences
\nAd-hoc online and webinars organized by the JDN
\n1
\nDR. MARIE-CLAIRE WANGARI
\nCHAIR PERSON
\nDR. BALKISS ABDELMOULA
\nDEPUTY CHAIR PERSON
\nDR. DEENA MARIYAM
\nSECRETARY
\nDR. FRANCISCO FRANCO P\u00caGO
\nSOCIO-MEDICAL AFFAIRS OFFICER
\nDR. MERLINDA SHAZELLENNE
\nMEDICAL EDUCATION DIRECTOR
\nDR.SHIV JOSHI
\nMEDICAL ETHICS DIRECTOR
\nDR. PABLO ESTRELLA
\nMEMBERSHIP DIRECTOR
\nDR. JEAZUL PONCE H.
\nPUBLICATIONS DIRECTOR
\nDR. SAZI NZAMA
\nCOMMUNICATIONS DIRECTOR
\nDR. UCHECHUKWU ARUM
\nIMMIEDIATE PAST CHAIR
\nDR. LWANDO MAKI
\nIMMIDIATE PAST DEPUTY CHAIR
\n2
\nDR.DOUAA ROUFIA ATTABI DR. ARSALAN NADEEM DR. CAROL KANGETHE DR. SHRAVAN R. DAVE
\nDR. AMANUEL Y. NEGASH DR. JAMIE COLLOTY DR. MAYMONA CHOUDRY DR. MICHAEL JOHNSON
\nMAHA AWAN DR. JEANETTE GODINEZ YAHAYA DR. AQSA SHAFIQUE
\nDR. LUIS MIGUEL ALFONSO
\nFERN\u00c1NDEZ GUTI\u00c9RREZ
\n3
\nTEAM OF
\nCONTRIBUTIONS,
\nAND
\nSTATEMENTS.
\n4
\nOFFICIALS\u2019
\nBY MARIE-CLAIRE WANGARI (MBCHB),
\nJDN CHAIRPERSON
\nTERM 2023-2024
\nKENYA
\nJUNIOR DOCTORS NETWORK
\nWORLD MEDICAL ASSOCIATION
\nWORDS FROM THE JDN CHAIRPERSON
\nDear Reader,
\nIt is with immense pleasure and honour that I extend a warm welcome to you all to the 29th
\nedition of the World Medical Association Junior Doctors Network Newsletter. As the Chair of
\nthe JDN, it brings me great joy to introduce you to this second newsletter for 2024.
\nThe JDN newsletter continues to be a platform that serves as a beacon of knowledge,
\ncollaboration, and inspiration for junior doctors across the globe. In this edition, we have
\ncurated a diverse range of articles that largely build up from our first newsletter of 2024 and
\nreflect the multifaceted nature of the medical profession. We are particularly excited to
\nhighlight stories of resilience and innovation from our colleagues who are making significant
\nstrides in their fields.
\nI would like to express my deepest gratitude to the contributors and editorial team who have
\ndedicated their time and expertise to making this newsletter possible. Your unwavering
\ncommitment to the sustainability of the JDN newsletter is truly commendable.
\nI encourage you all to explore the rich content of this newsletter and to engage actively with
\nour contributors and editorial team.I also remain available for feedback on the content of this
\nnewsletter on chair.jdn@wma.net
\nThank you for your continued support and participation.
\nMarie-Claire Wangari (MBChB)
\nChairperson (2023\/2024)
\nWorld Medical Association Junior Doctors Network (WMA JDN)
\n5
\nWORDS FROM THE PUBLICATIONS
\nDIRECTOR
\nI am pleased to share with you the activities of junior doctors around the world. It is important
\nto mention that your contributions are very valuable, not only to our community but also to
\nyoung people around the world who work in various forms of public health, global health,
\nclinical research and clinical medicine.
\nI encourage you to continue working, creating, and promoting health and well-being,
\ncooperating and strengthening health systems. Additionally, I invite you not to fear making
\nmistakes, as it is part of being human. Making mistakes can lead us to have interesting
\nconversations with people who have different skills and perspectives. It also reminds us that
\nadvancing in the field of public health and global health is a shared task.
\nIt is crucial to recognize the dedication and effort that each of you puts into your daily work.
\nYour innovations and fresh approaches are driving positive and sustainable changes in
\ncommunities around the world. From the implementation of prevention programs to
\nimprovements in medical care, each initiative is a step towards a healthier future.
\nWe cannot underestimate the power of collaboration. Working together allows us to learn from
\neach other, share resources, and maximize our impact. I encourage you to continue building
\nstrong networks and fostering strategic partnerships. Global health cannot advance without a
\ncollective effort and the integration of multiple disciplines and experiences.
\nFurthermore, I want to highlight the importance of resilience and adaptation in our profession.
\nThe challenges we face are complex and constantly evolving. Being open to new ideas and
\napproaches is essential to overcoming these challenges. The recent pandemic has
\ndemonstrated the need for flexibility and the ability to quickly adapt to changing
\ncircumstances.
\nThank you for your dedication and commitment. Let us move forward with the conviction that
\ntogether we can build a healthier and more equitable world for all.
\nJeazul Ponce (MD. MSc. MPH)
\nPublications Director(2023\/24)
\nWorld Medical Association Junior Doctors Network (WMA JDN)
\nBY DR. JEAZUL PONCE HERNANDEZ, MD
\nMSC. MPH.
\nPUBLICATIONS DIRECTOR
\nTERM 2023\u22122024
\nMEXICO-SPAIN
\nJUNIOR DOCTORS NETWORK
\nWORLD MEDICAL ASSOCIATION
\n6
\n‘
\nUNIVERSAL
\nHEALTH COVERAGE AND
\nANTIMICROBIAL RESITANCE
\nSPECIAL SECTION.
\nINTERVIEW
\n7
\nROOPA
\nDHATT
\nF
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\nW O M E N I N G L O B A L H E A L T H
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\n8
\ndisparities in leadership in global health. She is also a practicing Internal Medicine physician at
\nGeorgetown University Hospital in Washington, D.C. and has faculty appointments as an Assistant
\nProfessor at Georgetown University. Dr. Dhatt’s unwavering commitment extends to confronting the
\nissues of power dynamics, privilege, and intersectionality that hinder numerous women from accessing
\npositions of global health leadership. She endeavors tirelessly to create inclusive spaces where the
\nvoices of these women can resound. Determined to build a movement to transform women\u2019s leadership
\nopportunities in health, Dr. Dhatt co-founded Women in Global Health in 2015. Today, Women in Global
\nHealth boasts 51 chapters in 47 countries with continued demand to expand. Through collective action,
\nDr. Dhatt, the global team, and the Chapter network drive change by mobilizing a diverse movement of
\nemerging women health leaders, generating evidence and thought leadership for informed policy change,
\npressing governments and global health leaders to fulfill their commitments, and holding them
\naccountable. Accumulating nearly 15 years of experience in global health, she has engaged with over 120
\ncountries and assumed numerous advisory and board roles. She advises global health institutions on
\nissues concerning the health workforce, gender equity, and universal health coverage. She earned
\nrecognition in the Gender Equality Top 100 as one of the most influential figures in global policy and
\nserved on the Lancet COVID-19 Commission. Additionally, she acted as a former W7 Germany Advisor
\nand presently serves as a W7 Japan Advisor, advocating for feminist agendas before G7 governments in
\n2023. Dr. Dhatt contributes her expertise as a member of the Economist Impact Health Inclusivity Index
\nExpert Advisory Committee and the Global Council on SDG3.
\nROOPA DHATT, M.D., M.P.A.
\nFORMER EXECUTIVE DIRECTOR &
\nCO-FOUNDER
\nWOMEN IN GLOBAL HEALTH
\nBUILDING A HEALTHIER FUTURE: DR. ROOPA DHATT ON GLOBAL
\nTwitter: https:\/\/www.linkedin.com\/in\/roopadhatt\/ | @RoopaDhatt
\nLinkedin: https:\/\/www.linkedin.com\/in\/roopadhatt\/ | Roopa Dhatt
\nInstagram: https:\/\/www.instagram.com\/roopadhatt\/ | @roopadhatt
\nFurthermore, she holds a position on the U.S. President\u2019s Emergency Plan
\nfor AIDS Relief (PEPFAR) Scientific Advisory Board, serves on the Virchow
\nPrize Committee, and is designated as a World Economic Forum Young
\nGlobal Leader (YGL). In March 2021, she was invited as a public delegate to
\nthe historic U.S. Delegation to the United Nations 65th Commission of Status
\nof Women Meeting, led by Vice President Kamala Harris. Dr. Dhatt’s
\ncontributions to academic discourse have resulted in publications in
\nrenowned journals such as the Lancet, British Medical Journal (BMJ), Devex,
\nand Forbes. Furthermore, she has been featured in interviews by National
\nGeographic, Nature, NPR, BBC, EuroNews, and numerous other prominent
\nmedia channels.
\n9
\nis a leading voice in the movement to advance gender equality and redress gender
\nHEALTH CHALLENGES OF UHC, GENDER EQUITY AND AMR
\nDr. Roopa Dhatt
\nSOCIAL MEDIA
\nWomen in Global Health (WGH) is an organization built on a global movement with the largest network of
\nwomen and allies challenging power and privilege for gender equity in health. It is a US 501(c)(3) started
\nin 2015, which has grown to 51 official chapters in 47 countries. Through collective action, Dr. Dhatt, the
\nglobal team, and the Chapter network drive change by mobilizing a diverse movement of emerging
\nwomen health leaders, generating evidence and thought leadership for informed policy change, pressing
\ngovernments and global health leaders to fulfill their commitments, and holding them accountable. With
\nmore than 50 chapters in all regions, WGH works tirelessly to champion gender equity and create a new
\nsocial contract for women health workers at global, national, and local levels to improve health outcomes
\nand deliver better health for all. Together with the World Health Organization, WGH jointly co-chairs the
\nGender Equity Hub for the Global Health Workforce Network, working with partners to catalyze gender
\nequity and gender transformative change in the health workforce.
\nWGH chapters are active in Argentina, Australia, Bangladesh, Benin, Bolivia, Brazil, Burkina Faso,
\nBurundi, Cameroon, Canada, Chile, China, C\u00f4te d\u2019 Ivoire, Egypt, Finland, Germany, Denmark, Guinea,
\nIndia, Ireland, Senegal, Mali, Kenya, the Lusophone Community, Malawi, Niger, Nigeria, Rwanda,
\nNorway, Pakistan, Iraq, Mexico, United Arab Emirates, Austria, Philippines, Portugal, Singapore, Somalia,
\nSouth Africa, Spain, Sweden, Switzerland, Togo, Uganda, UK, USA (Seattle, Georgia, DC, Midwest),
\nFrancophone West Africa, Zambia, and Zimbabwe. WGH is honing its focus on five major policy priorities
\nfor the year 2023: equity in leadership for women in global health, a new social contract for women health
\nand care workers, Gender-Responsive Universal Health Coverage (UHC), gender equity in health
\nemergency preparedness and response, and movement and alliance building.
\nBUILDING A HEALTHIER FUTURE: DR. ROOPA DHATT ON GLOBAL
\nROOPA DHATT, M.D., M.P.A.
\nEXECUTIVE DIRECTOR &
\nCO-FOUNDER
\nWOMEN IN GLOBAL HEALTH
\nROOPADHATT@GMAIL.COM
\n10
\nHEALTH CHALLENGES OF UHC, GENDER EQUITY AND AMR
\nIn the 21st century, the landscape of global health faces increasingly complex and diverse challenges.
\nFrom the constant threat of pandemics to the growing shortage of healthcare workers, and the ongoing
\nstruggle for women’s sexual and reproductive rights, the current scenario demands decisive and
\ncoordinated action. In this interview, we explore the challenges of Universal Health Coverage (UHC) and
\nhow they affect healthcare providers, particularly junior doctors. Additionally, we address the critical issue
\nof antimicrobial resistance (AMR) and the fundamental role that healthcare professionals, especially junior
\ndoctors, play in.
\nThe interviewee highlights the importance of addressing health challenges in the 21st century, focusing on
\nthree main areas: pandemic preparedness and response, healthcare worker shortages, and the fight for
\nwomen’s sexual and reproductive rights. Subsequently, the need for gender-sensitive Universal Health
\nCoverage (UHC) is discussed, recognizing the importance of addressing gender inequalities both in the
\nhealthcare workforce and in access to healthcare services. The crucial role of junior doctors in promoting
\nUHC through their participation in professional associations and global campaigns is emphasized.
\nis underscored, as well as the need for a comprehensive approach to ensure accessibility and equity in
\nhealthcare delivery. Additionally, the direct impact of UHC’s absence on the daily work of junior doctors is
\nBUILDING A HEALTHIER FUTURE: DR. ROOPA DHATT ON GLOBAL
\nROOPA DHATT, M.D., M.P.A.
\nEXECUTIVE DIRECTOR &
\nWOMEN IN GLOBAL HEALTH
\nROOPADHATT@GMAIL.COM
\nThe interview also addresses the issue of antimicrobial resistance (AMR),
\nhighlighting the crucial role of junior doctors in responsible antibiotic
\nprescribing and patient education on proper antibiotic use. The need for a
\ncomprehensive approach addressing factors contributing to AMR is
\nemphasized, including improving hygiene and infection control in healthcare
\nfacilities, as well as raising awareness about the importance of preserving
\nantibiotics.
\nPrologue by Delta Jeazul Ponce Hernandez. Publications director,
\nInterviewer.
\n11
\nHEALTH CHALLENGES OF UHC, GENDER EQUITY AND AMR
\nRegarding UHC, the importance of addressing the multiple injustices affecting women healthcare workers
\nCO-FOUNDER
\nhighlighted, as they often face the consequences of healthcare system deficiencies.
\nWhat are the health challenges in the 21st century?
\nUnfortunately our world is spoilt for choice when it comes to systemic threats for health. PostCOVID-19,
\nwe can\u2019t be complacent about the likelihood or the potential impact of a future pandemic. We know it\u2019s not
\na question of if but rather when. We learned some hard lessons from COVID-19, not least that women
\nhealth workers, who made up 90% of the frontline workforce, kept us safe by working overtime,
\nunremunerated, unprotected by inadequate or sometimes altogether missing PPE. All of this needs to
\nchange for us to withstand future threats, as our policy brief of Gender-Responsive Pandemic
\nPreparedness, Prevention, Response and Recovery (PPRR) shows.
\nThe other big threat to health systems is very much related to what I have just mentioned. The WHO
\npredicts a global health worker shortage of 10 million workers by 2030 \u2013 and we know women are leaving
\nthe profession in unprecedented high numbers. This Great Resignation and Great Migration of women
\nhealth workers can only be stopped with meaningful action to redress the multitude of injustices that are
\ndemanded of women health workers, from unpaid or underpaid work, to the leadership gap, violence,
\nabuse and harassment and so on. We ignore these trends at our peril.
\nLastly, let\u2019s be clear, the rising backlash against women\u2019s sexual and reproductive health and rights is a
\ndanger not only to women, but also to the (largely female) workforce that has to deal with the
\nconsequences of the loss of rights and services. This puts health workers in unthinkable situations where
\nthey risk prosecution for providing vital healthcare. It\u2019s not something I thought I would see happen in my
\nlifetime. We must take it very seriously indeed.
\nBUILDING A HEALTHIER FUTURE: DR. ROOPA DHATT ON GLOBAL
\nROOPA DHATT, M.D., M.P.A.
\nEXECUTIVE DIRECTOR &
\nCO-FOUNDER
\nWOMEN IN GLOBAL HEALTH
\nROOPADHATT@GMAIL.COM
\n12
\nHEALTH CHALLENGES OF UHC, GENDER EQUITY AND AMR
\nWhat are the health challenges in the 21st century?
\nGovernments and other stakeholders have to invest in making health coverage universally available. This
\nmeans coverage that is there for everyone, everywhere. From my perspective as the co-founder of a
\nglobal movement of women in health, I can tell you with certainty that making our health systems gender-
\nresponsive is an indispensable step on our way to UHC. You will not be surprised to hear me say that
\nUHC without gender-responsive health systems will be very difficult to achieve. Gender is a crucial social
\ndeterminant of health. This means that patriarchal norms, power structures, control over resources can
\nprevent women and girls from accessing the healthcare they need. At the health workforce end of the
\nspectrum, we know that the women who make up 70% of the workforce are expected to tolerate gender
\ninequities on everything from pay to leadership and violence, harassment and abuse \u2013 and leaving the
\nprofession as a result. Making health systems gender-responsive at both the workforce and service user
\nend is an imperative. Without this, UHC risks remaining a distant dream.
\nCould you share your thoughts on why Universal Health Coverage is important from a healthcare
\nprovider’s (HCP) perspective? Health is a human right, which means it\u2019s universal and based on non-
\ndiscrimination. Now, we know that different countries have different ways in which they approach this,
\nwhether it\u2019s insurance-based schemes or cover through taxation, whether or not there\u2019s a public-private
\nmix, etc. What\u2019s important to know is what happens when coverage is not available, not accessible, not
\naffordable. We only have to look as far back as the COVID-19 pandemic to understand that even when we
\ndon\u2019t take a normative, rights-based approach to UHC, the whole of society pays the price of UHC not
\nbeing achieved.
\n.
\nBUILDING A HEALTHIER FUTURE: DR. ROOPA DHATT ON GLOBAL
\nROOPA DHATT, M.D., M.P.A.
\nEXECUTIVE DIRECTOR &
\nCO-FOUNDER
\nWOMEN IN GLOBAL HEALTH
\nROOPADHATT@GMAIL.COM
\nWe need strong healthcare systems and we need health to be accessible to all,
\nwithout exception. HCPs understand that better than anyone else, because they
\ndeal with the consequences of system deficiencies when the worst happens.
\n13
\nHEALTH CHALLENGES OF UHC, GENDER EQUITY AND AMR
\nHow can junior doctors actively contribute to the advancement of Universal Health Coverage?
\nJunior doctors have an important voice through our professional associations, whether it\u2019s organisations
\nsuch as IFMSA during our training or the Junior Doctor Network of the World Medical Association. I
\nbenefited hugely from engaging with global networks early in my career and encourage others to do the
\nsame. Our voices make a difference. At Women in Global Health, we have many junior doctors in our
\nnational chapters who join our global campaigns on leadership, pay, protection, vaccine equity, mental
\nhealth, PSEAH. They campaign in their national context, join our delegations at global level eg to UHC
\nHLM and WHA contribute country perspectives and are part of our evidence gathering and policy
\nresearch.
\nHow do you think Universal Health Coverage impacts the daily work and experiences of junior
\ndoctors?
\nMost of us become doctors because we want to keep people and societies well. When UHC is absent,
\nsocieties suffer the consequences of multiple overlapping injustices including poverty and ill-health.
\nJunior doctors are on the frontline, responding to the consequences of these systemic deficiencies. Take
\nthe example of the US, which saw nearly 60,000 excess deaths from COVID-19, over 220,000 additional
\nhospitalizations, and 2.9 million additional cases, all associated with lack of medical insurance.
\nBUILDING A HEALTHIER FUTURE: DR. ROOPA DHATT ON GLOBAL
\nROOPA DHATT, M.D., M.P.A.
\nEXECUTIVE DIRECTOR &
\nCO-FOUNDER
\nWOMEN IN GLOBAL HEALTH
\nROOPADHATT@GMAIL.COM
\nWhen UHC is absent, the whole of society pays the price, and junior doctors
\nare sadly among the first line responders who get to deal with the aftermath.
\nHealthcare should be affordable and accessible to all. Doctors should have the
\nprofessional satisfaction of knowing patients are being treated for their health
\nneeds, not their ability to pay and that the most vulnerable populations are
\nbeing reached. Doctors should therefore see fewer preventable and premature
\n14
\nHEALTH CHALLENGES OF UHC, GENDER EQUITY AND AMR
\ndeaths, e.g. in childbirth and infancy and far less avoidable suffering.
\nCould you share your perspectives on why Antimicrobial Resistance is a significant concern,
\nespecially in the context of the roles of junior doctors?
\nImagine a world where antibiotics, drugs that revolutionized infection treatment, no longer work. This will
\nhave an enormous impact on so many aspects of our lives, from medical treatment and prevention to
\nglobal socioeconomic burden. We simply cannot let this happen. Junior doctors play a significant role in
\nthis. I know very well that we may feel the pressure from patients to prescribe antibiotics, even when
\nunnecessary. I have had many patients come with an expectation that every infection should be treated
\nwith antibiotics, less willing to trust younger doctors with their therapeutic choices. It puts extra pressure
\non a junior professional, with time constraints and limited access to diagnostic tools adding to the burden.
\nYoung doctors are key actors in the AMR battle, as the management of resistant infections and growing
\nlimits on treatment options is a looming threat for modernmedicine.
\nHow do you think awareness and education can play a role in addressing Antimicrobial
\nResistance?
\nEducation is key to overcoming the dangers posed by AMR. This matters everywhere, and is particularly
\nthe case in parts of the world where gaps in healthcare coverage lead to inadequate antibiotic prescribing
\npractice, by providers lacking sufficient training. In some countries with vulnerable health systems
\nantibiotics are still unregulated and available over the counter. Since there are so few new antibiotics
\nbeing developed it is critical we do not lose the effectiveness of the ones we have through misuse. That
\nmeans strengthening health systems everywhere.
\nBUILDING A HEALTHIER FUTURE: DR. ROOPA DHATT ON GLOBAL
\nROOPA DHATT, M.D., M.P.A.
\nEXECUTIVE DIRECTOR &
\nCO-FOUNDER
\nWOMEN IN GLOBAL HEALTH
\nROOPADHATT@GMAIL.COM
\nIt\u2019s worth remembering that AMR does not respect national borders. Drug
\nresistant TB is also seen in HICs with better controls. This has to be a
\nnational and global effort. There is an important hygiene angle too. We need
\na strong emphasis on hygiene and infection prevention and control in all
\nhealth facilities to stop patients and health workers acquiring and spreading
\ninfections that may be resistant e.g. MRSA and C Difficile. Hand hygiene,
\ninfection control in surgery are essential, but in LMICs a large proportion of
\nhospitals and clinics have no clean water supply. Huge investment is needed
\nin water supply, soap and clean toilets in health care facilities. This is actually
\nanother part of UHC. .
\n15
\nHEALTH CHALLENGES OF UHC, GENDER EQUITY AND AMR
\nOne Health is also a key consideration in this, as animal health service provision can also be inadequate
\nand under-resourced. At the patient end, awareness and knowledge are crucial in shaping expectations in
\na way that is constructive.
\nWhen patients understand that antibiotic use should be sparing and avoided unless strictly necessary, the
\npressure on both human and animal healthcare providers will be lowered, and responsible antibiotic use
\nwill be easier to achieve.
\nInterviewer: Dr. Dhatt, I want to personally thank you for taking the time to share your invaluable insights
\nand expertise on pressing healthcare challenges. Your contributions have provided valuable illumination
\non critical issues impacting our global community.
\nBUILDING A HEALTHIER FUTURE: DR. ROOPA DHATT ON GLOBAL
\nROOPA DHATT, M.D., M.P.A.
\nEXECUTIVE DIRECTOR &
\nCO-FOUNDER
\nWOMEN IN GLOBAL HEALTH
\nROOPADHATT@GMAIL.COM
\n16
\nHEALTH CHALLENGES OF UHC, GENDER EQUITY AND AMR
\nCONFERENCES, MEETINGS,
\nCONTRIBUTIONS &
\nTESTIMONIES
\n17
\nFRANCISCO P\u00caGO
\nDEENA MARYIAM
\nMUHA HASSAN
\n154TH WORLD HEALTH ORGANIZATION, EXECUTIVE
\nBOARD MEETING
\n18
\nKUAN YU CHIANG
\nEB154 \u2013 which sets the agenda for the forthcoming World Health Assembly (WHA) in May \u2013 convened in
\nGeneva in January. It’s the place where crucial decisions about World Health Organisation (WHO)
\npolicies, programs and elections are made. Non-state actors (NSA) also have a significant role,
\nexpressing their concerns and viewpoints.
\nWe advocated for decisive action on climate and health, strengthening of the universal health coverage
\nprogram, prioritising mental health in primary healthcare, and adherence to INB and international health
\nregulations at the upcoming WHA. Being young physicians, we not only possess the qualities and
\nexpertise of a doctor but also the zeal and enthusiasm found in youth. As healthcare providers and future
\nleaders, we have involved ourselves deeply in the process of WHO with the support of WMA. Besides the
\nstatements, which can be read using the links above, we\u2019d like to give you some key takeaways from the
\nrecent WHO activity:
\nFigure 1 – Our team in Geneva – from left to right, Christina, Francisco and Kuan Yu
\n19
\n154TH WORLD HEALTH ORGANIZATION, EXECUTIVE BOARD MEETING
\nThis year’s meeting involved discussions on the intergovernmental negotiating body (INB) process, the Climate
\nand Health declaration and Antimicrobial Resistance (AMR). Non-state actors, such as the World Medical
\nAssociation (WMA), actively participated. Pre-WHA JDN Organizing Committee (OC), along with JDN and WMA
\ncollaborated on and delivered 6 interventions – Universal Health Coverage (UHC), Non-Communicable Diseases (NCD),
\nAntimicrobial Resistance (AMR), Social Determinants of Health (SDH), Climate Change and Health (CCH), and Health
\n,
\nEmergencies (HE), the latter held as a constituency jointly with the remaining health professionals.
\nof climate change, which included strengthening the implementation of WHO Global Strategy on Health,
\nEnvironment and Climate Change and adopting a health-in-all policies approach. Our intervention on the
\nclimate change agenda supported the WHO report on climate crisis action. We pressed for carbon
\nneutrality by 2030 and emphasised the need to formally state fossil fuels as the main source of
\ngreenhouse gas emissions in the resolution in order to drive an impactful change in future policies and
\nthis document. We are still unsure about how ground-breaking it will be as negotiations will happen until
\nMay this year, with WMA trying to intervene whenever allowed. Although its most recent draft already
\naddresses the safety of the workforce during emergencies, the toll on workers is not only physical nor
\nimmediate and we must include the prevention and recovery from the mental health burden and
\nexhaustion of health personnel. Additionally, young, or in-training healthcare workers should be provided
\na clear set of competencies and adequate supervision to guarantee their continued learning, safety, and
\nresponsibilities proportional to theirlevel of proficiency.
\nand treatment, and promoting strategic information and innovation. A Japanese representative noted that
\nmany nations lack adequate budgets for implementation despite having national plans. This highlights the
\nsignificant costs of precise laboratorymonitoring and developing accurate screening tools.
\nneed for emergency health responses that are both \u201cconflict-sensitive\u201d and \u201cpeace-responsive. The
\ninitiative progresses through six work-streams, commencing with evidence generation through research
\nand analysis. GHPI acknowledges inequalities are exacerbated in conflict zones and
\n154TH WORLD HEALTH ORGANIZATION, EXECUTIVE BOARD MEETING
\n20
\nCLIMATE CHANGE: The resolution called upon member states to take relevant steps to tackle health impacts
\nactions.Member states (MS) will formally present the resolution for decision at WHA77.
\nINB: EB154 was used as the last open meeting for MS and NSA to comment on the developments of
\nAMR:The WHO’s approach to AMR includes prevention of infections, ensuring access to quality diagnosis
\nGHPI: WHO\u2019s Global Health and Peace Initiative (GHPI) was formally adopted at EB154. It emphasises the
\noffers a mechanism to tackle these issues, fostering trust through multilateral efforts.
\nOn social media communication
\nExperimenting with Instagram Reels yielded increased engagement from followers and non-followers, but
\ncreating short videos proved time-consuming and challenging without user-friendly tools. With limited
\nhuman resources for the task, we took turns to share highlights on social media. This approach was
\nlabour-intensive, but we learnt how to best manage the workflow, and studied how to implement AI tools
\nfor live recording, transcription, translation, and summarization to ease this burden going forward.
\nFigure 2 – Delivering one of our 5 statements in the floor of the EB meeting room
\n154TH WORLD HEALTH ORGANIZATION, EXECUTIVE BOARD MEETING
\n21
\nIndividual reflections
\nFrancisco: Leading JDN on such a stage was a first for me, but the degree of trust invested in us by the
\nWMA and the diligence of fellow delegates made managing the delegation a really rewarding experience. I
\nthink that there are many things to improve in this work of ours and that this event was the perfect trial run
\nfor an improvement already at the WHA77. The things at which you should expect to see us raise the bar
\nsoon are social networks presence and engagement, statement writing proficiency, and side events
\nparticipation.
\nKuan Yu: This was a pivotal moment in my life, witnessing that direction emerges through interaction,
\ncorroborating the idea that \u00ab\u00a0leadership arises through interaction\u00a0\u00bb. This included calls from numerous
\nothers to not overlook youth\u2019s contribution and to respect the needs of women and children.
\nMuha: Attending online was convenient and accessible, allowing me to easily follow the discussions live. I
\nfound the experience valuable, especially as I was able to also follow the discussions of my colleagues
\nattending in person.
\nDeena: The Pre-WHA OC Team was a delight to work with, the diversity we brought to the table made the
\noverall experience memorable. Even though I attended online, I was kept up to date with all proceedings
\nand was able to follow up at every step of the way. Hoping to be part of this team again next year and join
\nin person.
\n154TH WORLD HEALTH ORGANIZATION, EXECUTIVE BOARD MEETING
\nWhat\u2019s next?
\nTo follow-up on EB154, we will be sending delegates to the WHA77, which will be
\nheld in Geneva from 27th May 2024 to 1st June 2024. Two days prior to this, we will
\nhold a pre-WHA JDN meeting, which will consist of networking and capacity building
\nsessions to which every Junior Doctor in the Network is invited! At all times, we are
\nopenly accepting suggestions on the ways to improve our effectiveness at such
\nhigh-level representation.
\n22
\nAcknowledgements:The full PreWHA Organising Committee, both the ones in the
\nofficial delegation but also the ones following the action online.
\n154TH WORLD HEALTH ORGANIZATION, EXECUTIVE BOARD MEETING
\nAUTHORS:
\nFRANCISCO P\u00caGO
\nMD. IN THE PUBLIC HEALTH RESIDENCY
\nFACULTY OF MEDICINE OF THE UNIVERSITY OF PORTO, ALMADA-SEIXAL
\nLOCAL HEALTH UNIT
\nLISBOA, PORTUGAL
\nDEENA MARYIAM
\nMBBS
\nGENERAL PRACTIONER
\nDUBAI, UAE
\nMUHA HASSAN
\nMBCHB, BSC (HONS)
\nINTERNAL MEDICINE RESIDENT, NATIONAL HEALTH SERVICE
\nCOVENTRY, ENGLAND
\nKUAN YU, CHIANG
\nMD, AND EMHA (EXECUTIVE MASTER OF HEALTH ADMINISTRATION)
\nPERUSING
\nATTENDING PHYSICIAN, HOSPITALIST
\nTAIPEI CITY HOSPITAL
\n23
\nTAIPEI CITY, TAIWAN
\nPABLO
\nESTRELLA
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\n24
\nThe Junior Doctors Network (JDN) of the World Medical Association (WMA) marked a significant
\nmilestone by participating in the 67th Commission on Narcotic Drugs (CND67) at the United Nations
\nOffice on Drugs and Crime (UNODC) in Vienna on March 18 and 19, 2024. This involvement
\nunderscores the key role of young doctors in shaping global medication policy, especially in ensuring
\naccess to controlled medicines for medical and scientific purposes.
\nThe CND67 concentrated on improving access to and the availability of controlled substances for
\nmedical and scientific purposes. This was encapsulated in the resolution \u201cPromoting awareness-
\nraising, education and training as part of a comprehensive approach to ensuring access to and the
\navailability of internationally controlled substances for medical and scientific purposes and improving
\ntheir rational use\u201d\u200b
\n\u200b
\n. This resolution reflects the global commitment to the rational and equitable use of
\ncontrolled medicines.
\nDuring the event plenary, the JDN, represented by Dr. Pablo Estrella Porter, delivered a compelling
\nstatement prepared by the newly established Young Doctors Network within UNODC. This statement
\nhighlighted the challenges in accessing controlled medicines and emphasized the need for integrated
\nmedical education, sufficient resources, collaborative regulatory frameworks, and the reduction of
\nstigma associated with controlled medicines. The advocacy of the JDN was crucial in bringing the
\nperspective of young doctors to the forefront of the global discourse on drug control and patient
\ncare.
\nIn her address at the CND67 on March 14, 2024, Ms. Ghada Waly, Director-General and Executive
\nDirector of UNODC, noted the establishment of a network of young doctors from around the world to
\ndiscuss sustainable solutions for barriers to access.
\nThis initiative is part of the broader UNODC programming aimed at building connections in the
\nmedical field and fostering collaborative efforts to enhance access to controlled medicines\u200b
\n\u200b
\n.
\nPABLO ESTRELLA PORTER (MD, MPH), PUBLIC
\nHEALTH RESIDENT AND JUNIOR
\nDOCTORS NETWORK – WMA MEMBERSHIP
\nDIRECTOR (VALENCIA, SPAIN).
\nBREAKING BARRIERS: THE JUNIOR DOCTORS NETWORK AT THE FOREFRONT OF CND67
\nThe JDN also participated in a side event titled "Taking
\nthe Pledge4Action to ensure adequate availability of
\ninternationally controlled essential medicines" This event,
\nco-sponsored by UNODC, showcased global commitments to
\nimproving access to essential medicines. Discussions featured
\nrepresentatives from various countries and organizations,
\nincluding Belgium, Brazil, Ghana, INCB, CAPSA Canada, and
\nthe International Association for Hospice and Palliative Care
\n(IAHPC).
\nThe involvement of young doctors in these forums is critical for
\ndriving the conversation toward practical and innovative
\nsolutions for medication accessibility and healthcare
\nimprovement\u200b
\n\u200b
\n.
\n25
\nRecommendations from the Young Doctors Network
\nAt the plenary session of CND67, the Young Doctors Network presented the following
\nrecommendations:
\n1. Strengthen education and training in the rational prescribing of controlled substances.
\n2. Foster global partnerships to share best practices and innovations.
\n3. Advocate for policy reforms to balance access to controlled medicines and prevent misuse.
\n4. Support research and data sharing to inform evidence-based policymaking.
\n5. Address stigma around controlled medicines and ensure equitable access, particularly in low- and
\nThe participation of the JDN at CND67 represents a landmark event, signifying the growing influence
\nand responsibility of young doctors in the global health landscape.
\nTheir involvement in UNODC initiatives, particularly in the accessibility of controlled medicines, sets
\na precedent for future engagements and policy developments. This event not only highlighted the
\nchallenges but also paved the way for actionable solutions, aligning with the Sustainable
\nDevelopment Goals and ensuring that no one is left behind in accessing essential healthcare
\nservices.
\nPABLO ESTRELLA PORTER (MD, MPH), PUBLIC
\nHEALTH RESIDENT AND JUNIOR
\nDOCTORS NETWORK – WMA MEMBERSHIP
\nDIRECTOR (VALENCIA, SPAIN).
\nBREAKING BARRIERS: THE JUNIOR DOCTORS NETWORK AT THE FOREFRONT OF CND67
\n26
\nmiddle-income countries.
\nJEAZUL
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\nThe European Junior Doctors (EJD) is an organization that represents young and resident doctors in
\nEurope. Its mission is to defend the interests and rights of these professionals, promoting better
\nworking conditions, high-quality medical education, and workplace well-being.
\nThe European Junior Doctors Spring General Assembly took place on May 3-4, 2024, in the historic
\nbuildings of the University of Medicine in Montpellier, France. This event, filled with significant
\ndiscussions and decisions, focused on the mobility of healthcare workers and how current policies
\naffect doctors in training. Additionally, other crucial issues for young doctors were addressed,
\nincluding climate emergency policies and working conditions.
\nChallenges of Junior Doctors in Europe: Climate Emergency
\nOne of the main topics discussed during the recent Spring Assembly was the climate emergency
\npolicy. The European Junior Doctors (EJD) has made progress in developing a policy that aligns with
\nother medical organizations and the European Union’s political agenda. This policy highlights the
\ncommitment of young doctors to tackle climate change, emphasizing the interconnectedness of
\npublic health and sustainability.
\nImpact of Climate Change on Public Health: Climate change significantly impacts public health by
\nincreasing disease burden and mortality rates. Collective actions from governments, healthcare
\nsystems, professionals, and citizens are essential to avert the worst outcomes.
\nContribution of the Health Sector to Carbon Emissions: The healthcare sector is a notable contributor
\nto carbon emissions, highlighting the need for mitigation efforts within healthcare operations.
\nJEAZUL PONCE HERNANDEZ, MD. MPH. MSC.
\nPUBLICATIONS DIRECTOR
\nJUNIOR DOCTORS NETWORK – WMA
\nStrategies Advocated by EJD:
\nAdvancing the European Green Deal: Integrate a \u00ab\u00a0One Health\u00a0\u00bb
\napproach across all policies to ensure cohesive health and climate
\nactions.
\nMedical Education: Incorporate global health and climate change
\ntopics into medical education at all levels.
\nPreparation of the Health Workforce: Enhance funding, planning,
\nand capacity to prepare healthcare workers for the pressures of
\nclimate change.
\nSustainability and Efficiency in Healthcare Systems: Allocate
\nresources to implement measures that improve the sustainability
\nand efficiency of healthcare systems.
\nCOMMITMENT AND CHALLENGES OF YOUNG DOCTORS: CLIMATE EMERGENCY AND
\nWORKING CONDITIONS FOR DOCTORS IN SPECIALTY TRAINING; EJD SPRING ASSEMBLY
\n2024, MONTPELLIER, FRANCE
\n28
\nJunior Doctors Network (JDN) Intervention
\nDuring the assembly in Montpellier, the Junior Doctors Network (JDN) was introduced to the European Junior
\nDoctors. The emphasis was on the importance of collaboration to promote policies benefiting young doctors
\nworldwide.
\nActive participation from all JDN members was encouraged, highlighting that the network relies on the
\ncommitment and collaboration of young doctors from diverse regions. The invitation was extended to European
\nJunior Doctors to contribute to the JDN newsletter and join as active members, providing opportunities to
\nengage in activities offered by the World Medical Associations, including meetings in April and October.
\nIn summary, addressing critical issues like climate change, working conditions, and promoting active member
\nparticipation strengthens the JDN’s mission and contributes positively to global health. By aligning with EJD,
\nUEMO, and through JDN and WMA, there is a collective effort to demand better working conditions and
\nstrategies to address the shortage of human resources in many European countries. This concerted effort aims
\nto improve the lives and careers of junior doctors, ultimately enhancing healthcare delivery across Europe.
\nJEAZUL PONCE HERNANDEZ, MD. MPH. MSC.
\nPUBLICATIONS DIRECTOR
\nJUNIOR DOCTORS NETWORK – WMA
\nCOMMITMENT AND CHALLENGES OF YOUNG DOCTORS: CLIMATE EMERGENCY AND
\nWORKING CONDITIONS FOR DOCTORS IN SPECIALTY TRAINING; EJD SPRING ASSEMBLY
\n2024, MONTPELLIER, FRANCE
\nThe Reality of Resident Doctors in Europe
\nCurrently, resident doctors in many European countries, including Spain, deal with long working hours that
\nexceed the 48-hour weekly limit stipulated by the European Working Time Directive. These extended working
\nhours not only affect the quality of life of young doctors but also the quality of care they can provide to their
\npatients.
\nThe EJD strongly opposes forced allocation and advocates for strategies that retain healthcare workers without
\nsuch measures. During postgraduate training, involuntary reallocation manifests through various forms, such
\nas allocation based on healthcare demand and mandatory placements in underserved areas. In the early
\nspecialization period, professionals face contractual obligations linking career advancement to service in
\nunderserved regions. These initiatives, while aiming to address medical personnel shortages, raise concerns
\nabout training quality, personal choices, and professional development.
\n29
\nARTICLES BY
\nJDN
\nMEMBERS
\n30
\nFATIMA
\nKHURSHID
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\n31
\nThe emergence of antimicrobial resistance has been attributed to many factors, including the overuse and
\nmisuse of antibiotics in human medicine, agriculture, and veterinary practices. Excessive use of antibiotics
\nin livestock farming has led to the development of antibiotic-resistant bacteria that can be transmitted to
\nhumans through food. Additionally, poor infection control in hospitals and clinics and lack of cle
\nan water and sanitation in some areas also contribute to the spread of resistant pathogens.
\nThe impact of antimicrobial drugs on global health is enormous. It causes the treatment of infectious
\ndiseases to be ineffective, increases morbidity, increases the risk of hospitalization and increases
\nmortality. The World Health Organization (WHO) estimates that AMR causes 700,000 deaths worldwide
\neach year, and if action is not taken, the number of deaths could rise to 10 million each year from 2050.
\nThe situation is particularly concerning in countries like Pakistan, where the weak health infrastructure
\nand limited access to quality healthcare services contribute to the problem. The country faces a dual
\nchallenge of addressing AMR while also improving access to essential healthcare services.
\n4.95 million people who died in 2019 suffered from drug-resistant infections. AMR directly caused 1.27
\nmillion of those deaths. 1 in 5 of those deaths occurred among children under 5 years old. In Pakistan in
\n2019, there were 59,200 deaths attributable to AMR and 221,300 deaths associated with AMR. Pakistan
\nhas the 176th highest age-standardized mortality rate per 100,000 population associated with AMR across
\n204 countries. In the GBD region of South Asia, Pakistan has the 5th highest age-standardized mortality
\nacross 5 countries. The number of AMR deaths in Pakistan is higher than deaths from neoplasms,
\nrespiratory infections and tuberculosis, enteric infections, diabetes and kidneyAntimicrobial resistance
\n(AMR) is a major threat to global health. This occurs when organisms such as bacteria, viruses, parasites,
\nand parasites change their response to the drug, making the drug ineffective. This phenomenon is
\nspreading rapidly and, if left unchecked, will lead to an epidemic, increasing disease and mortality rates
\nworldwide.
\nTHE RISING THREAT: ANTIMICROBIAL RESISTANCE
\nAND ITS IMPACT ON GLOBAL HEALTH
\nThere are five pathogens to be aware of in Pakistan (number of deaths
\nassociated with AMR in parenthesis): Klebsiella pneumoniae (34,400),
\nEscherichia coli (31,300), Staphylococcus aureus (28,600), Salmonella Typhi
\n(23,300), and Streptococcus pneumoniae (20,300). These commonly cause
\nbloodstream infections, lower respiratory infections and all related infections
\nin the thorax, peritoneal and intra-abdominal infections, and bloodstream
\ninfections.
\n32
\nDR. FATIMA KHURSHID MBBS, REGISTERED
\nMEDICAL PRACTITIONER (PMDC), MEDICAL
\nDOCTOR, PAKISTAN JUNIOR DOCTORS
\nNETWORK, WORLD MEDICAL ASSOCIATION
\nTackling this growing threat requires a multifaceted approach
\ninvolving government, medical professionals and the public.
\nSome of the key strategies are to promote the effective use of
\nantibiotics, invest in research and development of new drugs
\nand diagnostic tools, support surveillance systems, and
\npromote public awareness of the importance of appropriate
\nantibiotic use.
\nTHE RISING THREAT: ANTIMICROBIAL RESISTANCE
\nAND ITS IMPACT ON GLOBAL HEALTH
\nThe Role of Junior Doctors in Addressing Antimicrobial Resistance
\nJunior Doctors are in a unique position as future healthcare leaders, and their engagement is critical in
\neffectively combating antimicrobial resistance (AMR). We look at how younger physicians might influence
\nand enhance the proper use of antimicrobials, emphasizing the need of education, awareness, and
\nresponsible prescribing behaviors among them.
\nJunior doctors have a tremendous influence on patient care, making their involvement critical in combating
\nAMR. By encouraging effective antimicrobial stewardship and adherence to recommendations, you may
\nhelp to reduce the development and spread of antibiotic resistance. This involves administering antibiotics
\nonly when absolutely required, selecting the best antibiotic based on local resistance trends, and ensuring
\nthe proper dosage and duration of therapy.
\n1.- Education and Training: Junior doctors must pursue ongoing
\neducation and training in AMR-related areas. Staying current on the
\nnewest research, guidelines, and best practices allows them to deliver
\nevidence-based care and make educated antimicrobial decisions.
\nContinuous education enables junior physicians to advocate for
\nappropriate prescription practices and urge their colleagues to do the
\nsame.
\n2.- Research and Innovation: Participating in research and monitoring
\nprograms enables student doctors to track AMR trends and contribute to
\nthe collection of useful data. By actively participating in research, people
\nmay assist in identifying local resistance patterns, detecting emerging
\nresistance, and informing policy choices. Junior doctors can work with
\nexperienced healthcare professionals, microbiologists, and
\nepidemiologists to develop surveillance systems and understand AMR
\ndynamics.
\n33
\nDR. FATIMA KHURSHID MBBS, REGISTERED
\nMEDICAL PRACTITIONER (PMDC), MEDICAL
\nDOCTOR, PAKISTAN JUNIOR DOCTORS
\nNETWORK, WORLD MEDICAL ASSOCIATION
\nTHE RISING THREAT: ANTIMICROBIAL RESISTANCE
\nAND ITS IMPACT ON GLOBAL HEALTH
\nDR. FATIMA KHURSHID MBBS\/ REGISTERED
\nMEDICAL PRACTITIONER (PMDC) MEDICAL
\n3.- Education and Training: Junior doctors must pursue ongoing education and training in AMR-related
\nareas. Staying current on the newest research, guidelines, and best practices allows them to deliver
\nevidence-based care and make educated antimicrobial decisions. Continuous education enables junior
\nphysicians to advocate for appropriate prescription practices and urge their colleagues to do the same.
\n4.-Research and Innovation: Participating in research and monitoring programs enables student doctors
\nto track AMR trends and contribute to the collection of useful data. By actively participating in research,
\npeople may assist in identifying local resistance patterns, detecting emerging resistance, and informing
\npolicy choices. Junior doctors can work with experienced healthcare professionals, microbiologists, and
\nepidemiologists to develop surveillance systems and understand AMR dynamics.
\n5.-Patient Education: Patient and public education is another critical component in addressing AMR.
\nJunior doctors can educate patients on the proper use of antimicrobials, highlighting the dangers of AMR
\nand the significance of completing required training. They can also encourage preventative measures,
\nsuch as immunization and proper cleanliness, to lessen the need for antimicrobial therapy.
\n6.- Collaboration and Interdisciplinary Approach: Collaborative efforts between junior doctors, senior
\nhealthcare professionals, policymakers, and other stakeholders are critical for effectively combatting AMR.
\nMultidisciplinary collaboration enables the interchange of knowledge, ideas, and best practices. It permits
\nthe creation of complete plans that include antimicrobial stewardship, infection prevention, and control
\ntechniques.
\n7.- Leadership and Advocacy: Junior doctors can take on leadership positions and advocate for AMR
\nawareness and action in their own healthcare institutions and professional communities. They can join
\ngroups or organizations dedicated to antimicrobial stewardship and AMR, and actively shape policies and
\nstandards.
\n8.- Infection Prevention and Control: Junior doctors have an important
\nrole in advocating and executing infection prevention and control
\ntechniques that minimize the spread of resistant illnesses. They can
\nactively engage in infection control committees, teach healthcare
\npersonnel about good hygiene techniques, and help design protocols
\nand recommendations.
\n9.- Community Engagement: By interacting with the local community,
\njunior doctors can expand their impact outside the hospital. They can
\ncreate awareness campaigns, deliver speeches in schools or community
\ncenters, and work with public health groups to educate the public about
\nAMR, antimicrobial usage, and preventative measures.
\n34
\nDOCTOR, PAKISTAN JUNIOR DOCTORS
\nNETWORK, WORLD MEDICAL ASSOCIATION
\nTHE RISING THREAT: ANTIMICROBIAL RESISTANCE
\nAND ITS IMPACT ON GLOBAL HEALTH
\nDR. FATIMA KHURSHID MBBS\/ REGISTERED
\nMEDICAL PRACTITIONER (PMDC) MEDICAL
\n10.- Research and Quality Improvement: Junior doctors can contribute to AMR-related research
\nprojects and quality improvement activities. They can conduct research to assess the efficacy of
\nantimicrobial stewardship programs, look into local resistance patterns, and assess the effects of
\nmeasures targeted at reducing antibiotic usage.
\n11.- Lifelong Learning and Professional Development: Junior doctors should be committed to lifetime
\nlearning and ongoing professional development in the field of AMR. They can attend conferences,
\nworkshops, and seminars about AMR, join relevant professional groups, and remain up to speed on the
\nnewest research and guidelines.
\nPakistan, in collaboration with the World Health Organization (WHO), acknowledges the critical need to
\nfight antimicrobial resistance (AMR). The Pakistani government has committed to addressing this issue as
\na priority, acknowledging AMR as a severe health catastrophe impacting the country. The Ministry of
\nNational Health Services Regulations and Coordination collaborates with provinces, the veterinary
\nindustry, and health development partners to improve national capability in a variety of sectors.
\nEfforts are being undertaken to increase surveillance and laboratory diagnoses, promote the rational use
\nof antimicrobials, improve infection prevention and control procedures, and educate people about AMR
\nprevention and control. These activities are intended to address AMR holistically and strategically.
\nTo lead these efforts, Pakistan collaborated with WHO to create a national action plan. This action plan
\nwill be converted into province operational plans, ensuring that the strategies and interventions are
\nsuccessful and targeted.
\nThese initiatives indicate Pakistan’s commitment to combating AMR and emphasize the necessity of
\ncross-sectoral coordination among government agencies, healthcare providers, and the public. Pakistan
\nhopes to increase its capacity to fight AMR and ensure the efficacy of antimicrobial medications for future
\ngenerations through coordinated efforts and WHO cooperation.
\nReferences:
\nWorld Health Organization (WHO). TrACSS 2021-2022 [Internet]. [cited 2023 Feb 16].
\nAvailable from: https:\/\/amrcountryprogress.org\/download\/AMR-self-assessment-
\nsurveyresponses-2020-2021.xlsx
\n1.
\nThe burden of antimicrobial resistance (AMR) in Pakistan. Global Bacterial Antimicrobial
\nResistance Burden Estimates 2019. Institute for Health Metrics and Evaluation. Oct 19,
\n2022. https:\/\/www.healthdata.org\/sites\/default\/files\/files\/Projects\/GRAM\/Pakistan_0.pdf
\n2.
\nAntimicrobial resistance. Pakistan. World Health Organization. Eastern Mediterranean
\nRegion. https:\/\/www.emro.who.int\/pak\/programmes\/antimicrobial-resistance.html
\n3.
\nCenters for Disease Control and Prevention, National Center for Emerging and Zoonotic
\nInfectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP).
\nhttps:\/\/www.cdc.gov\/drugresistance\/index.html`
\n4.
\n35
\nDOCTOR, PAKISTAN JUNIOR DOCTORS
\nNETWORK, WORLD MEDICAL ASSOCIATION
\nLUIS MIGUEL
\nALFONSO
\nJ
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\n36
\nHEALTH AS A RIGHT: CHALLENGES AND OPPORTUNITIES FOR THE MEXICAN
\nHEALTH SYSTEM FROM THE PERSPECTIVE OF A YOUNG DOCTOR
\nLUIS MIGUEL ALFONSO, MD ANAHUAC
\nASSOCIATION
\nAbstract:
\nThis essay explores the challenges and opportunities faced by young doctors in Mexico within the context
\nof the country’s health system. It discusses the fragmentation, low coverage, and insufficient financing that
\ncharacterize the system, emphasizing the disparities between the public and private sectors. The essay
\nreflects on the author’s role as a young doctor and proposes actions to contribute to positive change. The
\ngoal is to shed light on the complexities of Mexico’s health system and encourage fellowyoung doctors to
\nactively participate in its transformation.
\nIntroduction:
\nThe health system of Mexico consists of two sectors: public and private. The public sector is integrated by
\nvarious institutions that provide health services to different groups of the population according to their
\nwork status and social security. These institutions include the Mexican Social Security Institute (IMSS),
\nthe Institute of Security and Social Services for State Workers (ISSSTE), Petr\u00f3leos Mexicanos (PEMEX),
\nthe Armed Forces, the Navy Secretariat, and other state services, as well as the Health Secretariat (SSA)
\nand programs that serve the population without social security. On the other hand, the private health
\nsystem is financed by the payments made by patients when they are treated, either by out-of-
\npocketspending or through private health insurance. [1,2].
\nMethods:
\nAs a young doctor, I face the challenges of this system with concern but also
\nhope. I believe there is much to do to improve Mexico’s health system and
\nmake the right to health effective for all Mexicans. I recognize my social
\nresponsibility to contribute to this purpose, armed with the tools and skills
\nnecessary. Some proposed actions include promoting comprehensive reform
\nof the health system for universality, equity, quality, and efficiency.
\nAdditionally, active participation in preventing and controlling non-
\ncommunicable chronic diseases is crucial, focusing on education, early
\ndiagnosis, and timely treatment. Fostering citizen participation and
\naccountability in the health sector is another key aspect, allowing users to
\nexpress their needs, demand their rights, and evaluate service quality. Lastly,
\na commitment to constantly updating my knowledge and professional skills is
\nessential to providing excellent care based on scientific evidence and respect
\nfor human dignity. [1-3].
\n37
\nUNIVERSITY, REGISTERED PHYSICIAN, MEXICO
\nJUNIOR DOCTORS NETWORK, WORLD MEDICAL
\nMENTAL HEALTH AND WELL-BEING OF JUNIOR
\nDOCTORS: RECOGNIZING AND MANAGING BURNOUT
\nASSOCIATION
\nResults:
\nThe potential results of implementing these proposed actions are promising. Comprehensive reform could
\nlead to increased universality, equity, quality, and efficiency of health services. Active participation in
\ndisease prevention might contribute to a reduction in the prevalence and impact of chronic diseases.
\nFostering citizen engagement can empower users to express their needs, demand their rights, and
\nevaluate service quality. Continuous professional development ensures that doctors provide excellent care
\nbased on scientific evidence and respect for human dignity.
\nDiscussion:
\nImplementing the proposed actions for health system reform in Mexico faces challenges such as
\nbureaucratic hurdles, resource constraints, and potential resistance within the healthcare system.
\nAchieving comprehensive reform requires strategic planning and political will. Disease prevention efforts
\nneed to navigate cultural and socioeconomic disparities. Fostering citizen engagement demands effective
\ncommunication channels, education programs, and overcoming potential resistance. Continuous
\nprofessional development, vital for maintaining high standards, may face integration challenges due to
\ntime constraints. Despite these challenges, a collective and holistic approach by young doctors can
\ncontribute to a more just, humane, and effective health system that upholds the right to health for all
\ncitizens.
\nReferences:
\n1. Juan Mercedes, Moguel Ancheita Alba, Vald\u00e9s Olmedo Cuauht\u00e9moc,
\nGonz\u00e1lez Pier Eduardo, Mart\u00ednez Gonz\u00e1lez Gabriel, Barraza Llorens Mariana,
\net al. Universalidad de los servicios de salud en M\u00e9xico. Salud p\u00fablica M\u00e9x
\n[Internet]. 2013 [cited 2024 Jan 29];55(spe):1-64. Available from:
\nhttp:\/\/www.scielo.org.mx\/scielo.php?script=sci_arttext&pid=S0036-
\n36342013000600001&lng=es.
\n2. G\u00f3mez-Dant\u00e9s O, Sesma S, Becerril VM, Knaul FM, Arreola H, Frenk J.
\nSistema de salud de M\u00e9xico. Salud Publica [Internet]. 2011 [cited 2024
\nJan];53(Suppl 2):S220-S232. Available from: [Link not available].
\n3. Organizaci\u00f3n para la Cooperaci\u00f3n y el Desarrollo Econ\u00f3micos. Panorama
\nde la Salud 2021: Indicadores de la OCDE. Par\u00eds: OCDE; 2021. Available
\nfrom: https:\/\/www.oecd.org\/health\/Panorama-de-la-Salud-2021-OCDE.pdf.
\n38
\nLUIS MIGUEL ALFONSO, MD ANAHUAC
\nUNIVERSITY, REGISTERED PHYSICIAN, MEXICO
\nJUNIOR DOCTORS NETWORK, WORLD MEDICAL
\nCHIANG
\nKUAN YU
\nD
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\nD R . M D , H O S P I T A L M E D I C I N E , T A I W A N ,
\nP U R S U I N G M A S T E R
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\nY
\n39
\nIntroduction
\nIn the realm of public health, antimicrobial resistance (AMR) poses a formidable challenge, one that
\nTaiwan has been actively confronting. This article delves into the multifaceted aspects of AMR in Taiwan,
\nencompassing antibiotic usage patterns, the impact of the COVID-19 pandemic, and the nation’s strategic
\nresponses.
\nAntibiotic Usage and AMR inTaiwan Antibiotic Consumption Patterns:
\nTaiwan, like many countries worldwide, has seen a significant rise in antibiotic use over recent years. This
\nincrease is not without consequence. The correlation between high antibiotic consumption and the
\nemergence of AMR is a growing concern. In Taiwan, the trend of antibiotic use reflects a complex
\ninterplay of healthcare practices, patient expectations, and prescription policies. Studies indicate a
\nnotable reliance on antibiotics for respiratory and other common infections, often leading to over-
\nprescription. The consequent impact on AMR is evident from the rising rates of drug-resistant strains of
\nbacteria, such as MRSA (Methicillin-resistant Staphylococcus aureus).
\nThe correlation between antibiotic usage and AMR:
\nThis increase in antibiotic consumption directly correlates with a rise in AMR. The emergence of
\nmultidrug-resistant organisms (MDROs) has become a significant public health concern. For instance, the
\nprevalence of extended-spectrum \u03b2-lactamase (ESBL)-producing Enterobacteriaceae has dramatically
\nincreased in Taiwan’s hospitals and communities. This trend highlights the urgent need for strategic
\ninterventions in antibiotic prescription practices.
\nNAVIGATING THE ANTIMICROBIAL RESISTANCE
\nLANDSCAPE IN TAIWAN: CHALLENGES AND INNOVATIONS
\nDR. CHIANG KUAN YU, MD, HOSPITAL
\nMEDICINE, TAIWAN, PURSUING MASTER
\nDEGREE OF HEALTH POLICY AND
\nMANAGEMENT IN NATIONAL TAIWAN
\nUNIVERSITY
\nThe government and healthcare organizations have begun addressing this
\nthrough stricter prescription guidelines and public awareness campaigns. These
\nefforts aim to educate both medical professionals and the public about the
\njudicious use of antibiotics. Section 2: Impact ofCOVID-19 on AMR Patterns
\nAMR Patterns During the Pandemic: The COVID-19 pandemic has had a
\nprofound impact on healthcare systems globally, and Taiwan is no exception.
\nDuring this period, there was a noticeable shift in the patterns of antimicrobial
\nresistance. The heightened use of antibiotics as a precautionary measure
\nagainst secondary bacterial infections in COVID-19 patients has led to an
\naltered antimicrobial landscape. The research indicates a rise in resistant
\nstrains, particularly in hospital settings. This scenario underscores the
\nchallenge of balancing immediate patient care needs with long-term public
\nhealth objectives in crisis situations.
\n40
\nComparative Analysis of AMRPre and Post COVID-19:
\nA comparative analysis of AMR data before and during the pandemic reveals significant shifts. For
\ninstance, the usage of certain antibiotics increased markedly during the pandemic, and correspondingly,
\ncertain bacteria showed elevated resistance levels. This comparison is crucial for understanding how the
\npandemic has necessitated a re-evaluation of antibiotic use protocols. The increased resistance to
\ncommonly used antibiotics during the pandemic period is a call to action for healthcare providers to adapt
\nand innovate in their approach to antibiotic prescription. A comprehensive assessment of antibiotic
\nresistance (AMR) patterns in Central Taiwan during the COVID-19 pandemic conducted a retrospective
\nanalysis of clinical samples collected before and after the pandemic, identifying six prevalent bacteria and
\ntheir resistance patterns. The prevalence of resistant bacteria, such as vancomycin-resistant
\nEnterococcus and carbapenem-resistant Acinetobacter baumannii, increased during the pandemic,
\nhighlighting the impact of COVID-19 on AMR. The study underscores the critical importance of
\nunderstanding AMR prevalence for infection prevention and policy formulation. Further research is
\nneeded to explore the relationship between AMR and infection severity inCOVID-19 patients. The
\nprevalence rates of vancomycin-resistant Enterococcus (VRE) and carbapenem-resistant Acinetobacter
\nbaumannii (CRAB) before and after the COVID-19 pandemic show a notable increase during the
\npandemic period. Prior to the COVID-19 pandemic, the overall prevalence rate of VRE was 59%, and it
\nincreased to 69% during the pandemic. Similarly, for CRAB, the prevalence rate was 46% before the
\nCOVID-19 pandemic and rose to 65% during the pandemic. This data indicates a significant rise in the
\nprevalence of both VRE and CRAB during the COVID-19 pandemic. The increased prevalence of resistant
\nbacteria during the COVID-19 pandemic in Central Taiwan has significant implications for public health
\nand the management of infections. The findings reveal a concerning rise in antimicrobial resistance
\n(AMR) among common bacterial pathogens, including Acinetobacter baumannii (CRAB), vancomycin-
\nresistant Enterococcus (VRE), Klebsiella pneumoniae (CRKP), and Escherichia coli (CREco), with
\nrespective increases of 19%, 10%, 2%, and 1% in their resistance . The prevalence of resistant strains of
\nStaphylococcus aureus and Pseudomonas aeruginosa, however,showed a decrease of 6% each.
\nNAVIGATING THE ANTIMICROBIAL
\nRESISTANCE LANDSCAPE IN TAIWAN:
\nCHALLENGES AND INNOVATIONS
\n41
\nNAVIGATING THE ANTIMICROBIAL
\nRESISTANCE LANDSCAPE IN TAIWAN:
\nCHALLENGES AND INNOVATIONS
\nThese shifts suggest that the COVID-19 pandemic has exacerbated the challenge of AMR in the region. A
\nprimary concern is the potential for these resistant bacteria to complicate the treatment of COVID-19
\npatients, especially those with bacterial coinfections, which have been documented both in Taiwan and
\nglobally . High levels of antibiotic prescribing during the pandemic, despite a low prevalence of bacterial
\ncoinfections in COVID-19 patients, have been observed and could contribute to further escalation of AMR.
\nThis situation underscores the critical need for judicious antibiotic use and the implementation of effective
\nantimicrobialstewardship programs. Moreover, the rise in AMR compromises patient outcomes, potentially
\nleading to increased morbidity, mortality, longer hospital stays, and higher healthcare costs . Treating
\ninfections caused by resistant bacteria often requires the use of last-resort or more potent antibiotics,
\nwhich may have more significantside effects and are typically more costly. From a broader perspective, the
\nincrease in AMR during the COVID-19 pandemic stresses the importance of integrating AMR surveillance
\nand management into pandemic preparedness and response plans. It highlights the need for robust
\ninfection control measures, not only to manage viral pandemics but also to prevent the spread of bacterial
\npathogens and contain AMR. To address these challenges, further research is warranted to explore the
\ncorrelation between AMR and the severity of infections in COVID-19 patients, aiming to develop targeted
\nstrategies to mitigate the impact of resistant infections. Healthcare providers in Central Taiwan and similar
\nregions should be aware of these trends to adapt treatment protocols appropriately and consider AMR
\npatterns in their clinical decision-making processes.
\nThe Need for a National AMRAction Plan:
\nThere is a pressing need for a strategic framework that encompasses surveillance, prevention, and control
\nof AMR. Such a plan should incorporate robust measures for monitoring, rapid response to AMR threats,
\nand public awareness campaigns. Collaboration across various sectors, including healthcare, agriculture,
\nand education, is vital. The plan should also align with global health initiatives, reflecting a commitment to
\nreducing AMR both locally and internationally.
\nRole and Functionality of Taiwan Antimicrobial Resistance Network (TARN):
\nThe Taiwan Antimicrobial Resistance Network plays a pivotal role in consolidating and disseminating
\ninformation related to AMR. Its comprehensive database aids in tracking resistance patterns, guiding
\npolicy decisions, and fostering research collaborations. TARN’s functionality extends beyond data
\ncollection; it serves as a crucial platform for a hub for collaboration and strategy development in the fight
\nagainst AMR. By providing real-time data and analysis, it empowers healthcare professionals and
\npolicymakersto make informed decisions.
\n42
\nNAVIGATING THE ANTIMICROBIAL
\nRESISTANCE LANDSCAPE IN TAIWAN:
\nCHALLENGES AND INNOVATIONS
\nDescription of the Taiwan Hospital InfectionControl and AMR Monitoring System (THAS)
\nThe Taiwan Hospital Infection Control and AMR Monitoring System (THAS) is a critical tool in
\nmanaging hospital infections and antimicrobial resistance. This system offers a comprehensive
\nplatform for tracking and analyzing infection rates and antimicrobial resistance patterns in hospitals.
\nIt enables healthcare providers to effectively monitor infection control measures and adjust strategies
\nas needed. The integration of THAS into the healthcare system represents a significant step in
\nenhancing Taiwan’s ability to manage and mitigate the risks associated with AMR.
\nConclusion
\nIn conclusion, Taiwan’s multifaceted approach to combating antimicrobial resistance showcases a
\nblend of innovation, public health policy, and global collaboration. The challenges are significant, but
\nthe strategies and systems like TARN and THAS highlight the nation’s commitment to addressing this
\nglobal health crisis. Continuous efforts in research, policy development, and public education are
\nessential to sustain progress and improve health outcomes both within Taiwan and in the broader
\ninternational community.
\n43
\nReferences:
\n1.Shio-Shin Jean, Po-Ren Hsueh. Antimicrobial Drug Resistance in Taiwan. Journal
\nof the Formosan Medical Association.
\n2011;110(1):4-13. ISSN 0929-6646. https:\/\/doi.org\/10.1016\/S0929-6646(11)60002-
\n8.
\n2. Yu-Wei Tseng, Chien-Wen Huang, Chih-Chieh Chen, Tze-Kiong Er. Assessment
\nof antibiotic resistance patterns in Central Taiwan
\nduring the COVID-19 pandemic: A retrospective study. Journal of Infection and
\nPublic Health. 2024;17(2):229-235. ISSN 1876-0341.
\nhttps:\/\/doi.org\/10.1016\/j.jiph.2023.11.026.
\nNAVIGATING THE ANTIMICROBIAL
\nRESISTANCE LANDSCAPE IN TAIWAN:
\nCHALLENGES AND INNOVATIONS
\n44
\nAVINA KHARAT
\nNARLAPATI VIGNAN
\nRUCHI KUMARI
\nANTIMICROBIAL RESISTANCE IN INDIA
\n45
\nIntroduction:
\nAntimicrobial resistance (AMR) poses a significant public health challenge in India, where elevated rates
\nof resistance to antimicrobial agents in both humans and food animals have been observed [1]. The
\ncountry is experiencing a surge in infections caused by antibiotic-resistant Gram-positive and Gram-
\nnegative microbes, exemplified by Escherichia coli’s resistance rate surpassing 80% for specific antibiotic
\nclasses [2][3]. Notably, India reported the initial identification of the NDM-1 gene, a factor that swiftly
\nspread to other regions. The NDM-1 gene, also known as New Delhi metallo-beta-lactamase 1, confers
\nresistance to a broad range of antibiotics, including carbapenems, considered last-resort antibiotics for
\nmany infections. [4]. The widespread use of antibiotics, coupled with the prevalent use of fixed-dose
\ncombinations for example, combinations of amoxicillin with clavulanic acid, which are commonly used in
\nIndia, contributes significantly to the escalating problem of AMR [5]. Globally, the impact of AMR is
\nstaggering, with an estimated 4.95 million deaths in 2019 attributable to drug-resistant infections,
\nincluding 1.27 million directly linked to bacterial AMR [6]. In Indian healthcare settings, studies reveal a
\nprevalence of 59% of Gram-negative species infections, with Escherichia coli being the most frequently
\nisolated Gramnegative species [7]. Additionally, research in rural communities highlights limited
\nawareness about antimicrobial medicines and high instances of antibiotic purchase without prescriptions
\n[8]. Pilot studies underscore substantial antibiotic resistance among pathogens isolated from urine,
\nwound, and blood cultures conducted in India. [9]. Investigations into Vibrio cholerae in India indicate
\nincreasing resistance to older and newer antibiotics [10]. In India, the multifaceted issue of AMR is
\ninfluenced by several specific risk factors, encompassing poor prescription practices, selfmedication,
\nover-the-counter drug sales, and misuse of antibiotics in agriculture and livestock sectors [11][12]. The
\nsocio-economic and cultural context introduces unique challenges, such as using sludge in agriculture
\nand improper disposal of livestock animals, contributing to the spread of AMR [13].
\nDR. RUCHI KUMARI MBBS, MD PHARMACOLOGY
\nASSOCIATION
\nDR. AVINA KHARAT MBBS, MD PHARMACOLOGY
\nMGM MEDICAL COLLEGE AND MAHARAJA
\nASSOCIATION
\nDR. NARLAPATI VIGNAN MBBS, MD
\nPHARMACOLOGY MGM MEDICAL COLLEGE AND
\nMAHARAJA YASHWANT RAO HOSPITAL,
\nANTIMICROBIAL RESISTANCE IN INDIA
\n46
\nMGM MEDICAL COLLEGE AND MAHARAJA
\nYASHWANT RAO HOSPITAL, INDORE, INDIA
\nJUNIOR DOCTORS NETWORK, WORLD MEDICAL
\nYASHWANT RAO HOSPITAL, INDORE, INDIA
\nJUNIOR DOCTORS NETWORK, WORLD MEDICAL
\nINDORE, INDIA JUNIOR DOCTORS NETWORK,
\nWORLD MEDICAL ASSOCIATION
\nInitiatives taken:
\nIndia has undertaken multiple initiatives to combat AMR, notably the National Action Plan for Antimicrobial
\nResistance (NAP-AMR). This initiative aims to enhance the governance and operationalization of AMR
\nprograms by incorporating strategies such as resilient leadership, multistakeholder coordination, innovative
\nprogram design, and data-driven monitoring across various sectors, including plant\/agricultural, animal
\nhusbandry, human health, and pharmaceuticals [14]. Another significant effort is the National Policy for
\nContainment of Antimicrobial Resistance, which encompasses measures like the introduction of Schedule H1
\nfor prescription antibiotics, hospital-based surveillance systems, and color-coding of certain antibiotics for
\nrestricted access [15]. The Indian Council of Medical Research (ICMR) has launched the Antibiotic
\nStewardship, Prevention of Infection & Control (ASPIC) program, employing digital technology to identify
\nopportunities and challenges and promote antimicrobial stewardship practices in hospitals [16]. These
\ninitiatives align with national declarations such as the Jaipur Declaration and the Chennai Declaration,
\nemphasizing strategies like prohibiting over-the-counter antibiotic sales, monitoring in-hospital antibiotic
\nusage, and establishing national AMR surveillance systems in healthcare settings. The research
\nunderscores the importance of delving into the mechanisms of AMR, including rapid antimicrobial
\nsusceptibility diagnostics, to guide effective prescribing. Additionally, there is a call for incentivized
\npreclinical research and early clinical development to bolster the discovery of new antimicrobial agents [17].
\nDR. AVINA KHARAT MBBS, MD PHARMACOLOGY
\nMGM MEDICAL COLLEGE AND MAHARAJA
\nASSOCIATION
\nDR. NARLAPATI VIGNAN MBBS, MD
\nPHARMACOLOGY MGM MEDICAL COLLEGE AND
\nMAHARAJA YASHWANT RAO HOSPITAL,
\nWORLD MEDICAL ASSOCIATION
\nDR. RUCHI KUMARI MBBS, MD PHARMACOLOGY
\nMGM MEDICAL COLLEGE AND MAHARAJA
\nASSOCIATION
\nANTIMICROBIAL RESISTANCE IN INDIA
\n47
\nYASHWANT RAO HOSPITAL, INDORE, INDIA
\nJUNIOR DOCTORS NETWORK, WORLD MEDICAL
\nINDORE, INDIA JUNIOR DOCTORS NETWORK,
\nYASHWANT RAO HOSPITAL, INDORE, INDIA
\nJUNIOR DOCTORS NETWORK, WORLD MEDICAL
\nConclusion:
\nPhysicians must adopt a proactive approach to the escalating challenge of antimicrobial resistance
\n(AMR). This necessitates the promotion of responsible antibiotic prescribing practices, implementation of
\nantimicrobial stewardship programs, continuous engagement in education, and active support for national
\nand global initiatives. Adhering to evidence-based guidelines, exercising judicious use of antibiotics, and
\nraising awareness about the necessity of antibiotic prescriptions only when clinically warranted, are
\nimperative aspects of our commitment. Actively participating in initiatives like the Antibiotic Stewardship,
\nPrevention of Infection & Control (ASPIC) program is crucial to promoting the prudent use of
\nantimicrobials whilst ensuring optimal patient outcomes. Continuous education on AMR is vital for making
\nwell-informed decisions in clinical practice. Collaborative efforts, resilient leadership, and multi-
\nstakeholder coordination are integral to successful initiatives. Advocacy for increased research and
\ninnovation, including support for studies on mechanisms of resistance and rapid antimicrobial
\nsusceptibility diagnostics is paramount. As physicians, our commitment to addressing the formidable
\nchallenge of AMR in India, our region, and worldwide is pivotal. Proactive measures are required in light
\nof escalating resistance rates observed in humans and food animals resulting in infections caused by
\nantibioticresistant microbes. Patient education plays a crucial role in combating AMR, necessitating active
\nengagement in educating patients about completing prescribed antibiotic courses, avoiding
\nselfmedication, and understanding the consequences of antibioticmisuse in India.
\nDR. AVINA KHARAT MBBS, MD PHARMACOLOGY
\nMGM MEDICAL COLLEGE AND MAHARAJA
\nDR. NARLAPATI VIGNAN MBBS, MD
\nPHARMACOLOGY MGM MEDICAL COLLEGE AND
\nMAHARAJA YASHWANT RAO HOSPITAL,
\nWORLD MEDICAL ASSOCIATION
\nANTIMICROBIAL RESISTANCE IN INDIA
\n48
\nYASHWANT RAO HOSPITAL, INDORE, INDIA
\nJUNIOR DOCTORS NETWORK, WORLD MEDICAL
\nASSOCIATION
\nINDORE, INDIA JUNIOR DOCTORS NETWORK,
\nDR. RUCHI KUMARI MBBS, MD PHARMACOLOGY
\nMGM MEDICAL COLLEGE AND MAHARAJA
\nYASHWANT RAO HOSPITAL, INDORE, INDIA
\nJUNIOR DOCTORS NETWORK, WORLD MEDICAL
\nASSOCIATION
\nDR. AVINA KHARAT MBBS, MD PHARMACOLOGY
\nMGM MEDICAL COLLEGE AND MAHARAJA
\nASSOCIATION
\nDR. NARLAPATI VIGNAN MBBS, MD
\nPHARMACOLOGY MGM MEDICAL COLLEGE AND
\nMAHARAJA YASHWANT RAO HOSPITAL,
\nWORLD MEDICAL ASSOCIATION
\nDR. RUCHI KUMARI MBBS, MD PHARMACOLOGY
\nMGM MEDICAL COLLEGE AND MAHARAJA
\nASSOCIATION
\nANTIMICROBIAL RESISTANCE IN INDIA
\nReferences:
\n1. Neelam, Taneja., Megha, Sharma. Antimicrobial resistance in the environment: The Indian scenario. Indian Journal of Medical
\nResearch, (2019). doi: 10.4103\/IJMR.IJMR_331_18
\n2. Isha, Patel., Rabia, Hussain., Anam, Khan., Akram, Ahmad., Muhammad, U., Khan., Mohamed, Azmi, Ahmed, Hassalai.
\nAntimicrobial resistance in India.. Journal of Pharmaceutical Policy andPractice, (2017). doi: 10.1186\/S40545-017-0118-6
\n3. Avika, Dixit., Neeta, Kumar., Sanjiv, Kumar., Vidyasagar, Trigun. Antimicrobial resistance: Progress in the decade since
\nemergence of New Delhi metallo-\u03b2-lactamase in India. Indian Journal of Community Medicine, (2019). doi:
\n10.4103\/IJCM.IJCM_217_18
\n4. Vidya, Mave., Vidya, Mave., Ajay, Chandanwale., Ajay, Chandanwale., Anju, Kagal., Anju, Kagal., Sandhya, Khadse., Sandhya,
\nKhadse., Dileep, Kadam., Dileep, Kadam., Renu, Bharadwaj., Renu, Bharadwaj., Vaishali, Dohe., Vaishali, Dohe., Matthew, L,
\nRobinson., Aarti, Kinikar., Aarti, Kinikar., Samir, Joshi., Samir, Joshi., Priyanka, Raichur., Katie, McIntire., Savita, Kanade.,
\nJonathan, Sachs., Chhaya, Valvi., Usha, Balasubramanian., Vandana, Kulkarni., Aaron, M., Milstone., Ivan, Marbaniang., Jonathan,
\nM., Zenilman., Amita, Gupta., Amita, Gupta. High burden of antimicrobial resistance and mortality among adults and children with
\ncommunity-onset bacterial infections in India. The Journal of InfectiousDiseases, (2017). doi: 10.1093\/INFDIS\/JIX114
\n5. Frederik, Joelving. (2018). India’s antibiotic combinationsthwart effortsto curb drug resistance, say researchers.. BMJ, doi:
\n10.1136\/BMJ.K560
\n6. Yogendra, Kumar, Gupta., Subasree, Srinivasan. A Silent Pandemic of Antimicrobial Resistance: Challenges and Strategy for
\nPreparedness in India. Annals of the National Academy of Medical Sciences. India, (2022). doi: 10.1055\/s-0042-1756285
\n7. Jitendra, Vaghasiya. Susceptibility and resistance pattern of bacterial isolates and development of antibiogram in a tertiary care
\nhospital of western India. Journal of medical pharmaceutical and allied sciences, (2023). doi: 10.55522\/jmpas.v12i1.3987
\n8. Matrujyoti, Pattnaik., Ashish, Kumar, Nayak., S., L., Rajasekar, Karna., Subrat, K, Sahoo., Subrata, Kumar, Palo., Srikanta,
\nKanungo., Jaya, Singh, Kshatri., Debaprasad, Parai., Kamini, Walia., Taru, Singh., Hari, Ram, Choudhary., Sanghamitra, Pati.,
\nDebdutta, Bhattacharya. Perception and determinants leading to antimicrobial (mis)use: A knowledge, attitude, and practices study
\nin the rural communities of Odisha, India. Frontiersin Public Health, (2023). doi: 10.3389\/fpubh.2022.1074154
\n9. Sumana, Mahadevaiah., Gautam, Kalyatanda. Prevalence of antimicrobial resistance in urine, blood, and wound pathogens
\namong rural patients in Karnataka, India. Antimicrobialstewardship & healthcare epidemiology, (2023). doi: 10.1017\/ash.2023.162
\n10. Phenotypic and genotypic characterization of antimicrobial resistance in clinical isolates of Vibrio cholerae over a decade (2002-
\n2016). Indian Journal of Medical Microbiology, (2022). doi: 10.1016\/j.ijmmb.2021.11.008
\n11. Sinan, BARAN. Combating Antimicrobial Resistance in India: The RoadAhead. (2023). doi: 10.1007\/978-981-16-9723-4_1-1
\n12. Sumana, Mahadevaiah., Gautam, Kalyatanda. Prevalence of antimicrobial resistance in urine, blood, and wound pathogens
\namong rural patients in Karnataka, India. Antimicrobialstewardship & healthcare epidemiology, (2023). doi: 10.1017\/ash.2023.162
\n13. Kamini, Walia., VC, Ohri., Jayaprakasam, Madhumathi., V, Ramasubramanian. Policy document on antimicrobial stewardship
\npractices in India.. Indian Journal of Medical Research, (2019). doi: 10.4103\/IJMR.IJMR_147_18
\n14. Falguni, Debnath., Debjit, Chakraborty., Sandip, Giri., Shatabdi, Saha., S., Pyne., Raja, Chakraverty., Agniva, Majumdar., Alok,
\nKumar, Deb., Vishal, Diwan., Rajesh, Bhatia., Shanta, Dutta. Existing Policies\/Guidelines on the Environmental Dimension of
\nAntimicrobial Resistance in India: An Insight into the Key Facets through Review and SWOT Analysis. Tropical Medicine and
\nInfectious Disease, (2022). doi: 10.3390\/tropicalmed7110336
\n15. Jyoti, Joshi., Anita, Kotwani. Learnings from select Indian public welfare programsto catalyze the implementation of India\u2019s
\nnational actional plan on antimicrobial resistance. International Journal of Community Medicine and Public Health, (2021). doi:
\n10.18203\/2394- 6040.IJCMPH20213042
\n16. Yogita, Thakral. Social (In)equities and Ethical Challenges: Role of Information Practices in Antimicrobial Resistance in India.
\nHealth technology assessment in action,(2022). doi: 10.18502\/htaa.v5i4.10167
\n49
\nYASHWANT RAO HOSPITAL, INDORE, INDIA
\nJUNIOR DOCTORS NETWORK, WORLD MEDICAL
\nINDORE, INDIA JUNIOR DOCTORS NETWORK,
\nYASHWANT RAO HOSPITAL, INDORE, INDIA
\nJUNIOR DOCTORS NETWORK, WORLD MEDICAL
\nDOUAA ROUFIA
\nATTABI
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\n50
\nAntimicrobial resistance (AMR) is a significant public health challenge in Algeria. The Ministry of Health of
\nAlgeria has reported increasing rates of AMR due to the overuse and misuse of antibiotics in both human
\nmedicine and agriculture, along with increasing rates of methicillin-resistant Staphylococcus aureus
\n(MRSA) and multidrug-resistant (MDR) tuberculosis (TB). TB and its multidrug-resistant form (MDR-TB)
\nare significant health challenges in Algeria. A study covering the period from 2008 to 2017 reported
\n215,581 TB cases in Algeria, with an average annual rate of about 57 cases per 100,000 people. This
\nhigh incidence highlights the ongoing public health challenge posed by both TB and its drug-resistant
\nstrains in the country [1].
\nAdditionally, recent studies in Algeria highlight the growing challenge of antimicrobial resistance (AMR).
\nFor instance, a study utilizing whole-genome sequencing (WGS) to analyze Mycobacterium tuberculosis
\ncomplex (MTBC) stains revealed a concerning trend; 25.6% of the 82 isolates examined were drug-
\nresistant, encompassing both multidrug-resistant (MDR) and pre-extensively drug-resistant (XDR) TB
\nstrains. This finding emphasizes the gravity of the AMR crisis in Algeria, which is not limited to
\ntuberculosis but extends to various pathogens, posing a significant public health threat. The situation
\ndemands urgent attention and action to develop effective strategies for managing and mitigating AMR in
\nthe region.[2]
\nAlgeria has taken proactive steps to combat antimicrobial resistance (AMR) through various national
\nefforts and strategies:
\nANTIMICROBIAL RESISTANCE (AMR): A SIGNIFICANT
\nPUBLIC HEALTH CHALLENGE IN ALGERIA
\nJUNIOR DOCTORS NETWORK, ALGERIA.
\nSTUDENT SAN JOSE STATE UNIVERSITY
\nCALIFORNIA, USA
\nNational TB Program: One notable strategy includes the withdrawal of TB
\nmedications from private pharmacies and providing free diagnostics and
\ntreatment for TB patients. This is supported by the establishment of the
\nNational TB Laboratory, enhancing the national response to tuberculosis
\nand its drug-resistant forms [3].
\n1.
\nIdentification of Resistance Genes: Efforts have been made to identify
\nvarious resistance genes against plasmid cephalosporinases,
\ncarbapenems, aminoglycosides, and fluoroquinolones, thereby informing
\ntargeted treatment strategies [4].
\n2.
\n51
\nDOUAA ROUFIA ATTABI, ALGERIA. MEMBER,
\nAlgeria has initiated several steps to tackle AMR, as reported by the World Health Organization (WHO) and
\ndetailed in the 2021 TrAcss country report. The TrAcss 2021 Country Report on Algeria highlights the nation’s
\ncommendable efforts in combating AMR. It details Algeria’s successful development and implementation of a
\nNational Action Plan (NAP) on AMR, involving multisectoral collaboration across human, animal, and plant health
\nsectors. The country has established stringent regulatory frameworks to control the prescription and sale of
\nantimicrobials. Notably, Algeria uses AMR data effectively to inform its strategies, demonstrating a commitment
\nto evidence-based policymaking. The report offers a five-year assessment of Algeria\u2019s progress, emphasizing
\nimprovements in AMR governance, awareness, surveillance, and infection control. While acknowledging these
\nsuccesses, the report also suggests areas for further development, including enhancing AMR education and
\nmonitoring antimicrobial consumption. Overall, Algeria’s approach sets a positive example in the African region
\nfor managing AMR challenges [5]. In 2020, Algeria joined the Global Antimicrobial Resistance Surveillance
\nSystem (GLASS) for Antimicrobial Resistance (AMR) and\/or Antimicrobial Consumption (AMC), demonstrating its
\ncommitment to strengthening national surveillance systems for AMR [6].
\nANTIMICROBIAL RESISTANCE (AMR): A SIGNIFICANT
\nPUBLIC HEALTH CHALLENGE IN ALGERIA
\nGiven the challenges of AMR in Algeria there is a pressing need for enhanced efforts in both awareness and
\npolicy implementation. Medical student associations like IPSF Algeria and IFMSA Algeria play a pivotal role in
\nawareness campaigns. Their efforts include conducting educational sessions in schools, mosques and
\ncommunity centers, utilizing social media for campaigns, and organizing workshops and seminars for healthcare
\nworkers and students. In February 2018, the ARPEC association, a chapter of the International Pharmaceutical
\nStudents Federation, organized an awareness day on antimicrobial resistance at Batna airport, Algeria. This
\nevent sought to educate the public about the growing threat of antibiotic resistance and to promote the
\nresponsible use of antibiotics. Additionally, IFMSA Algeria organized a sensitivity campaign on the dangers of
\nrandom drug use during the same month under the name \u201c the drug is not sweet\u201d
\nDOUAA ROUFIA ATTABI, ALGERIA MEMBER,
\nJUNIOR DOCTORS NETWORK, ALGERIA.
\nSTUDENT SAN JOSE STATE UNIVERSITY
\nCALIFORNIA, USA
\n52
\nReferences
\n1. Selmane S. Forecasting the Incidence of Tuberculosis in Algeria. Int J Mycobacteriol. 2021 Jan
\n1;10(Suppl 1):S37. Available from:
\nhttps:\/\/journals.lww.com\/ijmy\/Abstract\/2021\/10001\/Forecasting_the_Incidence_of_Tuberculosis_in
\n.37.aspx
\n2. Benremila D, Djoudi F, Gharout-Sait A, Kheloufi S, Spitaleri A, Battaglia S, et al. Comprehensive Drug
\nResistance Characterization of Pulmonary Tuberculosis in Algeria: Insights on Mycobacterium
\ntuberculosis Strains by Whole-Genome Sequencing. Microb Drug Resist. 2023 Apr 28. Available from:
\nhttps:\/\/pubmed.ncbi.nlm.nih.gov\/37115530\/
\n3. Boulahbal F. Relationship between National TB program and prevalence of TB drug resistance in
\nAlgeria, 1965 to 2013. Int J Mycobacteriol. 2015 Mar 1;4:3. Available from:
\nhttps:\/\/www.sciencedirect.com\/science\/article\/pii\/S2212553114001484
\n4. Arlet G. News of antibiotic resistance among Gram-negative bacilli in Algeria. Pathol Biol (Paris). 2014
\nMay 10;62(3):169-78. Available from: https:\/\/europepmc.org\/article\/med\/24819127
\n5. World Health Organization. 2021 TrACSS Country Report on the Implementation of National Action
\nPlan on Antimicrobial Resistance (AMR) – Algeria [Internet]. Geneva: World Health Organization; 2021
\n[cited 2023 Nov 20]. Available from: https:\/\/cdn.who.int\/media\/docs\/defaultsource\/antimicrobial-
\nresistance\/amr-spc-npm\/tracss\/tracss-2021- algeria.pdf?sfvrsn=e0ff6b82_9&download=true
\n6. World Health Organization. Global Antimicrobial Resistance and Use Surveillance System (GLASS)
\nReport: 2021 [Internet]. Geneva: WHO; 2021 [cited 2023 Nov 20]. Available from:
\nhttps:\/\/iris.who.int\/bitstream\/handle\/10665\/341666\/9789240027336-eng.pdf
\nANTIMICROBIAL RESISTANCE (AMR): A SIGNIFICANT
\nPUBLIC HEALTH CHALLENGE IN ALGERIA
\nDOUAA ROUFIA ATTABI, ALGERIA MEMBER,
\nJUNIOR DOCTORS NETWORK, ALGERIA.
\nSTUDENT SAN JOSE STATE UNIVERSITY
\nCALIFORNIA, USA
\n53
\nWho can become a JDN member?
\nTo join the JDN you:
\nMust be within 10 years of graduation from medical school or registered in an
\nongoing postgraduate medical education program, until it is completed.
\nMust be an associate member of the WMA*
\nNote: Associate membership of the WMA is free for all doctors for the first five
\nyears after graduation.To join the JDN, please follow the links and complete:
\nHow to become a JDN member?
\n1. Associate Membership Registration (and select the Junior Doctor form):
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\nFor more information, please contact jdn@wma.net.<\/p>\n

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