| Potentially divisive arguments of human versus animal use |
Develop joint National AMR Strategy with input from all sectors. Restrict use of antimicrobials in agriculture to those with limited cross-over resistance. Companion animals to have the same access as humans.
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| Companion animals are excluded from agriculture and health portfolios |
Provide a ‘home’ for companion animal health within the Commonwealth government structures. Provide AMR prescribing guidelines for companion animals, including antimicrobial stewardship programmes and improved infection control.
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| Problem of attribution |
Elucidate sources of AMR organisms including in humans (hospital vs community), animals (companion vs livestock vs wildlife) and environment (eg, water or soil). Provide research funding for negative impacts on ecosystems and animal health, irrespective of human health.
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| Limited funding for multidisciplinary research |
Provide funding avenues for multidisciplinary research, especially those combining human, animal and environmental health. Consider dedicated funding provision from the new MRFF.
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| Global/regional rather than a national problem |
Focus on AMR (including growing drug resistance in tuberculosis and malaria) as part of the DFAT regional Health Security agenda. Strengthened international/regional AMR legislation, improved governance and stewardship should be key international development outcomes. WHO to develop better global AMR accountability measures.
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| Spread of mobile resistance elements |
Understand and monitor the mobile genetic pool, including spread by wild animals and bird populations. Support regional/global strategies.
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| Antimicrobials are cheap and easily available |
Restrict prescribing of certain antimicrobials. Consider deferred prescribing if uncertain diagnosis and not acutely ill. Consider ways to make antimicrobials more expensive,* without restricting access for people who need them.
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| Unnecessary supply and perceived public demand |
Educate children and the public about responsible antimicrobial use. Institute effective antimicrobial stewardship programmes. Make institutional antimicrobial use and drug resistance profiles public.
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| Inadequate infection control leading to transmission of AMR organisms |
Improved sanitation and environmental hygiene. Better infection control practice in hospitals and other healthcare settings. Better infection control awareness in the general community and targeted measures in congregate settings.
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| Poor communication and collaboration between states |
Standard approach taken across states and territories. Standardise susceptibility testing, surveillance, governance and antimicrobial stewardship procedures. Consider routine reporting of drug-resistant infections as good clinical practice (laboratory accreditation requirement).
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| Antimicrobial development deliver poor return on investment |
Recognise the failure of standard market mechanisms Advocate for the development of alternative funding models, including consideration of public–private partnerships or a health insurance model. Develop less expensive adaptive trial strategies.
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