In November 2024, ICARS and its TANDEM-ABX team conducted stakeholder consultations at the national level in Kenya and the state level in India. The consultations provided a platform to discuss the development of a sustainable use framework for a new reserve class of antibiotics, by focusing on strengthening antimicrobial stewardship (AMS).
The consultations are a critical part of a collaborative planning grant, funded by the Novo Nordisk Foundation, called TANDEM- ABX: Towards an antibiotic roadmap for the sustainable entry and management of Antibiotic X (an exemplar reserve antibiotic) This one-year project aims to design a framework that closely links access and stewardship to ensure the sustainable and responsible use of new last-resort antibiotics in low- and middle-income countries. Initially, ICARS started working with the Global Antibiotic Research & Development Partnership (GARDP) and the ReAct Africa Network (RAN) to strengthen networks in Sub-Saharan Africa and Asia. Country-level partnerships were established with Aga Khan University Hospital Nairobi (AKUHN) in Kenya, the Indian School of Business (ISB), and the Christian Medical College Vellore (CMC) in India.
Nairobi, Kenya
The TANDEM-ABX Kenya team has been reviewing published evidence and conducting exploratory discussions with key antimicrobial resistance (AMR) stakeholders to understand the current AMR context in Kenya. Following this, on 4th November 2024, AKUHN and ICARS hosted the national-level TANDEM-ABX stakeholder consultation in Nairobi. The event brought together multiple stakeholders from the health sector including clinicians, microbiologists, pharmacists, hospital administrators within the government and private health facilities, civil society and patient groups, academics, researchers, representatives from the pharma and diagnostic sector as well as policymakers from the Ministry of Health in Kenya. The event was inaugurated by Dr Charles Kandie, Director of Health Standards at the Ministry for Health in Kenya.
During the meeting, the TANDEM-ABX team highlighted learnings from the introduction and scale-up of exemplar medicines such as Bedaquiline (for TB) and other reserve antibiotics in Kenya and reflected on how the learnings from these experiences can be extrapolated to develop a sustainable use framework for reserve antibiotics. The team proposed a theoretical framework that utilises elements from previous successful public health programmes in the country, making evident the need for balance between the supply and demand side levers to create an enabling AMS ecosystem in the long term. Furthermore, participants discussed aspects where the framework synergises with local priorities and programme structures to understand the barriers and enablers to implementation. This was followed by further panel discussions on the TANDEM-ABX framework focused on:
- policy leadership and necessary support for implementation
- channelling guidance from stewardship experts to implementors
- the importance of information technology in monitoring implementation
- defining inclusive and sustainable stewardship for reserve antibiotics
Punjab, India
In India, the TANDEM-ABX team conducted discussions with key stakeholders at the state level where health sits. The first TANDEM-ABX consultation was in Mohali, Punjab on 13th November 2024 at the ISB Max Institute of Healthcare Management campus with approximately 30 participants. Attended by policymakers, state experts, practitioners, researchers, IT companies, and Industry representatives, the event was inaugurated by Shri Ghanshyam Thori, IAS Mission Director, National Health Mission – Punjab.
After an overview of the TANDEM-ABX project by ICARS, case study presentations by state AMR experts including Dr Nusrat Shafiq from the Postgraduate Institute of Medical Education and Research (PGIMER), highlighted the experiences of other miscellaneous exemplars such as antivirals during H1N1 and reactive scaling up of antibiotic stewardship during public health crises such as COVID-19 and other pandemics. In addition, experts from Dayanand Medical College, Government Medical College, Mohali, Fortis Chandigarh, and the National Institute of Pharmaceutical Education & Research (NIPER) participated in a panel discussion on the critical perspectives of policymakers, clinicians, AMS experts, hospital administrators and IT developers, for implementing such a framework. This was followed by break-out group discussions where participants developed a collective pathway for introducing and using Antibiotic X (reserve class antibiotic) in the state within the current field realities.
Telangana, India
Another state-level consultation was held on 20th November, in Hyderabad, Telangana at the ISB Hyderabad campus. It was attended by almost 50 participants ranging from state policymakers, AMR researchers, clinicians, microbiologists, healthcare administrators from the public sector, corporate hospitals, bio innovators, health start-ups, IT companies, and pharma industry representatives. The meeting was inaugurated by Shri R.V Karnan, Mission Director, Health Commissionerate, Government of Telangana. The consultation followed a similar agenda as the Mohali meeting with presentations by Dr Sumalatha (epidemiologist State TB Program) and Dr Suneetha Nareddy (ID physician Apollo Hyderabad)
These consultations use an intervention and implementation research (IIR) approach to co-develop the TANDEM-ABX framework in India and Kenya with local stakeholders. The overwhelming feedback from these meetings has reinforced the belief that it is time for bold approaches like TANDEM-ABX to build a sustainable use framework for reserve antibiotics to address the complex AMR problem. This will require close collaboration between hospitals in the private and public sectors, researchers, civil society organisations and policymakers to test IIR outcomes including economic and behavioural aspects through a field pilot.
Reflecting on the consultation process, Dr Jyoti Joshi, Senior Science Advisor at ICARS, and project lead of the TANDEM ABX project said:
“This has been a valuable experience to listen directly from field-level stakeholders in India and Kenya and we are excited because the learnings from these countries can be useful for other LMICS working to mitigate AMR. Proactive planning to establish antimicrobial stewardship enabling systems will promote health preparedness and responsive policies that can help the right patient get the right antibiotic while preserving reserve antibiotics as a precious global good.”
Next steps
Following the enthusiastic response to the TANDEM-ABX consultations in India, a third consultation is being organised in Thiruvananthapuram, Kerala on 18th Dec, co-hosted by the Kerala state government together with ISB, CMC Vellore and ICARS.
The rich insights generated from the consultations will be consolidated into meeting reports and shared as policy briefs by the teams in India and Kenya. They will also be shared as a pre-read ahead of the global stakeholder consultation in Copenhagen, Denmark on the 10th and 11th of February 2025.
