Table 1.

Summary of key issues relating to AMR in PICTs

Issue related to AMR in PICTs	Strengths/achievements	Weaknesses/limitations
National Action Plans (NAPs) for AMR	NAPs approved by government in Fiji and Cook Islands	Many PICTs remain without well-developed NAPs
Laboratory surveillance capacity	Long-standing Neisseria gonorrhoeae surveillance in select PICTs	Antimicrobial susceptibility testing typically only available in large centres WHO GLASS report contains no data from PICTs
Surveillance of antimicrobial consumption (human)	Extensive use of mSupply in Pacific holds potential for real-time monitoring of consumption	WHO report on Surveillance of Antimicrobial Consumption contains no data from PICTs
Standard treatment guidelines (STGs)	Antimicrobial STGs available in at least eight PICTs Fiji and Solomon Islands STGs freely available via smartphone app	Presence of STGs doesn’t guarantee adherence—adherence to STGs in Solomon Islands has improved but remains at 44%50
Community education	Most PICTs participate in ‘Antibiotic Awareness Week’ each November	No assessment of effectiveness of these campaigns
Surveillance of antimicrobial consumption (animal)	Fiji alone reports collecting data on antimicrobial use in animals down to farm and species level	Paucity of reported data
Animal health	Presence of Food and Agriculture Organisation of the United Nations, with subregional office in Samoa since 1996	Lack of government regulation restricting antimicrobial use in animals

AMR, antimicrobial resistance; GLASS, Global Antimicrobial Resistance Surveillance System; PICTs, Pacific Island countries and territories.