Issue 29-2024

ABOUT US. 1
JUL- AUG
I S S U E 2 9 T H
JUNIOR DOCTORS LEADERSHIP JUNIO 2023-2024 2
EDITORIAL TEAM 2023 – 2024 3
TEAM OF OFFICIALS’ CONTRIBUTIONS, AND STATEMENTS. 4
WORDS FROM THE JDN CHAIRPERSON 5
WORDS FROM THE PUBLICATIONS DIRECTOR 6
UNIVERSAL HEALTH COVERAGE AND ANTIMICROBIAL 7
BUILDING A HEALTHIER FUTURE: DR. ROOPA DHATT 9
CONFERENCES, MEETINGS, CONTRIBUTIONS & TESTIMONIES 17
154TH WORLD HEALTH ORGANIZATION, EXECUTIVE BOARD 19
COMMITMENT AND CHALLENGES OF YOUNG DOCTORS: 28
ARTICLES BY JDN MEMBERS 30
THE RISING THREAT: ANTIMICROBIAL RESISTANCE AND ITS I 32
HEALTH AS A RIGHT: CHALLENGES AND OPPORTUNITIES FOR 37
ANTIMICROBIAL RESISTANCE IN INDIA 46
NAVIGATING THE ANTIMICROBIAL RESISTANCE LANDSCAPE IN 40
BREAKING BARRIERS: NETWORK AT THE FOREFRONT OF CND67 25
ANTIMICROBIAL RESISTANCE (AMR): A SIGNIFICANT PUBLIC 51
TABLE OF CONTENTS
About Us.
What is the JDN?
The Junior Doctors Network (JDN) serves as an international platform for junior doctors to facilitate an open dialogue
of global events and activities that are relevant to their postgraduate training and the World Medical Association
(WMA).
It was created at the 61st WMA General Assembly (October 2010) in Vancouver, Canada and the inaugural JDN
meeting was held at the 62nd WMA General Assembly (October 2011) in Montevideo, Uruguay. The network, which
started from a few motivated junior doctors, now has a total of over 500 members from more than 90 countries from
all regions of the world.
Junior doctors are defined as physicians, within 10 years after their medical graduation or who are still in an ongoing
postgraduate medical education program.
What is the mission?
The purpose of the JDN is to empower young physicians to work together towards a healthier world through
advocacy, education, and international collaboration.
What do we do?
Networking:
During the regular JDN meetings, members get to know each other, discuss global health issues, share challenges,
and start collaborations on global health issues. The JDN meets on several occasions during the year, both in-
person and via online teleconferences:
Biannual meetings in conjunction with the Council Meeting and the General Assembly of the WMA (April &
October).
Monthly general membership and management team teleconferences
Ad-hoc online and webinars organized by the JDN
1
DR. MARIE-CLAIRE WANGARI
CHAIR PERSON
DR. BALKISS ABDELMOULA
DEPUTY CHAIR PERSON
DR. DEENA MARIYAM
SECRETARY
DR. FRANCISCO FRANCO PÊGO
SOCIO-MEDICAL AFFAIRS OFFICER
DR. MERLINDA SHAZELLENNE
MEDICAL EDUCATION DIRECTOR
DR.SHIV JOSHI
MEDICAL ETHICS DIRECTOR
DR. PABLO ESTRELLA
MEMBERSHIP DIRECTOR
DR. JEAZUL PONCE H.
PUBLICATIONS DIRECTOR
DR. SAZI NZAMA
COMMUNICATIONS DIRECTOR
DR. UCHECHUKWU ARUM
IMMIEDIATE PAST CHAIR
DR. LWANDO MAKI
IMMIDIATE PAST DEPUTY CHAIR
2
DR.DOUAA ROUFIA ATTABI DR. ARSALAN NADEEM DR. CAROL KANGETHE DR. SHRAVAN R. DAVE
DR. AMANUEL Y. NEGASH DR. JAMIE COLLOTY DR. MAYMONA CHOUDRY DR. MICHAEL JOHNSON
MAHA AWAN DR. JEANETTE GODINEZ YAHAYA DR. AQSA SHAFIQUE
DR. LUIS MIGUEL ALFONSO
FERNÁNDEZ GUTIÉRREZ
3
TEAM OF
CONTRIBUTIONS,
AND
STATEMENTS.
4
OFFICIALS’
BY MARIE-CLAIRE WANGARI (MBCHB),
JDN CHAIRPERSON
TERM 2023-2024
KENYA
JUNIOR DOCTORS NETWORK
WORLD MEDICAL ASSOCIATION
WORDS FROM THE JDN CHAIRPERSON
Dear Reader,
It is with immense pleasure and honour that I extend a warm welcome to you all to the 29th
edition of the World Medical Association Junior Doctors Network Newsletter. As the Chair of
the JDN, it brings me great joy to introduce you to this second newsletter for 2024.
The JDN newsletter continues to be a platform that serves as a beacon of knowledge,
collaboration, and inspiration for junior doctors across the globe. In this edition, we have
curated a diverse range of articles that largely build up from our first newsletter of 2024 and
reflect the multifaceted nature of the medical profession. We are particularly excited to
highlight stories of resilience and innovation from our colleagues who are making significant
strides in their fields.
I would like to express my deepest gratitude to the contributors and editorial team who have
dedicated their time and expertise to making this newsletter possible. Your unwavering
commitment to the sustainability of the JDN newsletter is truly commendable.
I encourage you all to explore the rich content of this newsletter and to engage actively with
our contributors and editorial team.I also remain available for feedback on the content of this
newsletter on chair.jdn@wma.net
Thank you for your continued support and participation.
Marie-Claire Wangari (MBChB)
Chairperson (2023/2024)
World Medical Association Junior Doctors Network (WMA JDN)
5
WORDS FROM THE PUBLICATIONS
DIRECTOR
I am pleased to share with you the activities of junior doctors around the world. It is important
to mention that your contributions are very valuable, not only to our community but also to
young people around the world who work in various forms of public health, global health,
clinical research and clinical medicine.
I encourage you to continue working, creating, and promoting health and well-being,
cooperating and strengthening health systems. Additionally, I invite you not to fear making
mistakes, as it is part of being human. Making mistakes can lead us to have interesting
conversations with people who have different skills and perspectives. It also reminds us that
advancing in the field of public health and global health is a shared task.
It is crucial to recognize the dedication and effort that each of you puts into your daily work.
Your innovations and fresh approaches are driving positive and sustainable changes in
communities around the world. From the implementation of prevention programs to
improvements in medical care, each initiative is a step towards a healthier future.
We cannot underestimate the power of collaboration. Working together allows us to learn from
each other, share resources, and maximize our impact. I encourage you to continue building
strong networks and fostering strategic partnerships. Global health cannot advance without a
collective effort and the integration of multiple disciplines and experiences.
Furthermore, I want to highlight the importance of resilience and adaptation in our profession.
The challenges we face are complex and constantly evolving. Being open to new ideas and
approaches is essential to overcoming these challenges. The recent pandemic has
demonstrated the need for flexibility and the ability to quickly adapt to changing
circumstances.
Thank you for your dedication and commitment. Let us move forward with the conviction that
together we can build a healthier and more equitable world for all.
Jeazul Ponce (MD. MSc. MPH)
Publications Director(2023/24)
World Medical Association Junior Doctors Network (WMA JDN)
BY DR. JEAZUL PONCE HERNANDEZ, MD
MSC. MPH.
PUBLICATIONS DIRECTOR
TERM 2023−2024
MEXICO-SPAIN
JUNIOR DOCTORS NETWORK
WORLD MEDICAL ASSOCIATION
6
‘
UNIVERSAL
HEALTH COVERAGE AND
ANTIMICROBIAL RESITANCE
SPECIAL SECTION.
INTERVIEW
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ROOPA
DHATT
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disparities in leadership in global health. She is also a practicing Internal Medicine physician at
Georgetown University Hospital in Washington, D.C. and has faculty appointments as an Assistant
Professor at Georgetown University. Dr. Dhatt’s unwavering commitment extends to confronting the
issues of power dynamics, privilege, and intersectionality that hinder numerous women from accessing
positions of global health leadership. She endeavors tirelessly to create inclusive spaces where the
voices of these women can resound. Determined to build a movement to transform women’s leadership
opportunities in health, Dr. Dhatt co-founded Women in Global Health in 2015. Today, Women in Global
Health boasts 51 chapters in 47 countries with continued demand to expand. Through collective action,
Dr. Dhatt, the global team, and the Chapter network drive change by mobilizing a diverse movement of
emerging women health leaders, generating evidence and thought leadership for informed policy change,
pressing governments and global health leaders to fulfill their commitments, and holding them
accountable. Accumulating nearly 15 years of experience in global health, she has engaged with over 120
countries and assumed numerous advisory and board roles. She advises global health institutions on
issues concerning the health workforce, gender equity, and universal health coverage. She earned
recognition in the Gender Equality Top 100 as one of the most influential figures in global policy and
served on the Lancet COVID-19 Commission. Additionally, she acted as a former W7 Germany Advisor
and presently serves as a W7 Japan Advisor, advocating for feminist agendas before G7 governments in
2023. Dr. Dhatt contributes her expertise as a member of the Economist Impact Health Inclusivity Index
Expert Advisory Committee and the Global Council on SDG3.
ROOPA DHATT, M.D., M.P.A.
FORMER EXECUTIVE DIRECTOR &
CO-FOUNDER
WOMEN IN GLOBAL HEALTH
BUILDING A HEALTHIER FUTURE: DR. ROOPA DHATT ON GLOBAL
Twitter: https://www.linkedin.com/in/roopadhatt/ | @RoopaDhatt
Linkedin: https://www.linkedin.com/in/roopadhatt/ | Roopa Dhatt
Instagram: https://www.instagram.com/roopadhatt/ | @roopadhatt
Furthermore, she holds a position on the U.S. President’s Emergency Plan
for AIDS Relief (PEPFAR) Scientific Advisory Board, serves on the Virchow
Prize Committee, and is designated as a World Economic Forum Young
Global Leader (YGL). In March 2021, she was invited as a public delegate to
the historic U.S. Delegation to the United Nations 65th Commission of Status
of Women Meeting, led by Vice President Kamala Harris. Dr. Dhatt’s
contributions to academic discourse have resulted in publications in
renowned journals such as the Lancet, British Medical Journal (BMJ), Devex,
and Forbes. Furthermore, she has been featured in interviews by National
Geographic, Nature, NPR, BBC, EuroNews, and numerous other prominent
media channels.
9
is a leading voice in the movement to advance gender equality and redress gender
HEALTH CHALLENGES OF UHC, GENDER EQUITY AND AMR
Dr. Roopa Dhatt
SOCIAL MEDIA
Women in Global Health (WGH) is an organization built on a global movement with the largest network of
women and allies challenging power and privilege for gender equity in health. It is a US 501(c)(3) started
in 2015, which has grown to 51 official chapters in 47 countries. Through collective action, Dr. Dhatt, the
global team, and the Chapter network drive change by mobilizing a diverse movement of emerging
women health leaders, generating evidence and thought leadership for informed policy change, pressing
governments and global health leaders to fulfill their commitments, and holding them accountable. With
more than 50 chapters in all regions, WGH works tirelessly to champion gender equity and create a new
social contract for women health workers at global, national, and local levels to improve health outcomes
and deliver better health for all. Together with the World Health Organization, WGH jointly co-chairs the
Gender Equity Hub for the Global Health Workforce Network, working with partners to catalyze gender
equity and gender transformative change in the health workforce.
WGH chapters are active in Argentina, Australia, Bangladesh, Benin, Bolivia, Brazil, Burkina Faso,
Burundi, Cameroon, Canada, Chile, China, Côte d’ Ivoire, Egypt, Finland, Germany, Denmark, Guinea,
India, Ireland, Senegal, Mali, Kenya, the Lusophone Community, Malawi, Niger, Nigeria, Rwanda,
Norway, Pakistan, Iraq, Mexico, United Arab Emirates, Austria, Philippines, Portugal, Singapore, Somalia,
South Africa, Spain, Sweden, Switzerland, Togo, Uganda, UK, USA (Seattle, Georgia, DC, Midwest),
Francophone West Africa, Zambia, and Zimbabwe. WGH is honing its focus on five major policy priorities
for the year 2023: equity in leadership for women in global health, a new social contract for women health
and care workers, Gender-Responsive Universal Health Coverage (UHC), gender equity in health
emergency preparedness and response, and movement and alliance building.
BUILDING A HEALTHIER FUTURE: DR. ROOPA DHATT ON GLOBAL
ROOPA DHATT, M.D., M.P.A.
EXECUTIVE DIRECTOR &
CO-FOUNDER
WOMEN IN GLOBAL HEALTH
ROOPADHATT@GMAIL.COM
10
HEALTH CHALLENGES OF UHC, GENDER EQUITY AND AMR
In the 21st century, the landscape of global health faces increasingly complex and diverse challenges.
From the constant threat of pandemics to the growing shortage of healthcare workers, and the ongoing
struggle for women’s sexual and reproductive rights, the current scenario demands decisive and
coordinated action. In this interview, we explore the challenges of Universal Health Coverage (UHC) and
how they affect healthcare providers, particularly junior doctors. Additionally, we address the critical issue
of antimicrobial resistance (AMR) and the fundamental role that healthcare professionals, especially junior
doctors, play in.
The interviewee highlights the importance of addressing health challenges in the 21st century, focusing on
three main areas: pandemic preparedness and response, healthcare worker shortages, and the fight for
women’s sexual and reproductive rights. Subsequently, the need for gender-sensitive Universal Health
Coverage (UHC) is discussed, recognizing the importance of addressing gender inequalities both in the
healthcare workforce and in access to healthcare services. The crucial role of junior doctors in promoting
UHC through their participation in professional associations and global campaigns is emphasized.
is underscored, as well as the need for a comprehensive approach to ensure accessibility and equity in
healthcare delivery. Additionally, the direct impact of UHC’s absence on the daily work of junior doctors is
BUILDING A HEALTHIER FUTURE: DR. ROOPA DHATT ON GLOBAL
ROOPA DHATT, M.D., M.P.A.
EXECUTIVE DIRECTOR &
WOMEN IN GLOBAL HEALTH
ROOPADHATT@GMAIL.COM
The interview also addresses the issue of antimicrobial resistance (AMR),
highlighting the crucial role of junior doctors in responsible antibiotic
prescribing and patient education on proper antibiotic use. The need for a
comprehensive approach addressing factors contributing to AMR is
emphasized, including improving hygiene and infection control in healthcare
facilities, as well as raising awareness about the importance of preserving
antibiotics.
Prologue by Delta Jeazul Ponce Hernandez. Publications director,
Interviewer.
11
HEALTH CHALLENGES OF UHC, GENDER EQUITY AND AMR
Regarding UHC, the importance of addressing the multiple injustices affecting women healthcare workers
CO-FOUNDER
highlighted, as they often face the consequences of healthcare system deficiencies.
What are the health challenges in the 21st century?
Unfortunately our world is spoilt for choice when it comes to systemic threats for health. PostCOVID-19,
we can’t be complacent about the likelihood or the potential impact of a future pandemic. We know it’s not
a question of if but rather when. We learned some hard lessons from COVID-19, not least that women
health workers, who made up 90% of the frontline workforce, kept us safe by working overtime,
unremunerated, unprotected by inadequate or sometimes altogether missing PPE. All of this needs to
change for us to withstand future threats, as our policy brief of Gender-Responsive Pandemic
Preparedness, Prevention, Response and Recovery (PPRR) shows.
The other big threat to health systems is very much related to what I have just mentioned. The WHO
predicts a global health worker shortage of 10 million workers by 2030 – and we know women are leaving
the profession in unprecedented high numbers. This Great Resignation and Great Migration of women
health workers can only be stopped with meaningful action to redress the multitude of injustices that are
demanded of women health workers, from unpaid or underpaid work, to the leadership gap, violence,
abuse and harassment and so on. We ignore these trends at our peril.
Lastly, let’s be clear, the rising backlash against women’s sexual and reproductive health and rights is a
danger not only to women, but also to the (largely female) workforce that has to deal with the
consequences of the loss of rights and services. This puts health workers in unthinkable situations where
they risk prosecution for providing vital healthcare. It’s not something I thought I would see happen in my
lifetime. We must take it very seriously indeed.
BUILDING A HEALTHIER FUTURE: DR. ROOPA DHATT ON GLOBAL
ROOPA DHATT, M.D., M.P.A.
EXECUTIVE DIRECTOR &
CO-FOUNDER
WOMEN IN GLOBAL HEALTH
ROOPADHATT@GMAIL.COM
12
HEALTH CHALLENGES OF UHC, GENDER EQUITY AND AMR
What are the health challenges in the 21st century?
Governments and other stakeholders have to invest in making health coverage universally available. This
means coverage that is there for everyone, everywhere. From my perspective as the co-founder of a
global movement of women in health, I can tell you with certainty that making our health systems gender-
responsive is an indispensable step on our way to UHC. You will not be surprised to hear me say that
UHC without gender-responsive health systems will be very difficult to achieve. Gender is a crucial social
determinant of health. This means that patriarchal norms, power structures, control over resources can
prevent women and girls from accessing the healthcare they need. At the health workforce end of the
spectrum, we know that the women who make up 70% of the workforce are expected to tolerate gender
inequities on everything from pay to leadership and violence, harassment and abuse – and leaving the
profession as a result. Making health systems gender-responsive at both the workforce and service user
end is an imperative. Without this, UHC risks remaining a distant dream.
Could you share your thoughts on why Universal Health Coverage is important from a healthcare
provider’s (HCP) perspective? Health is a human right, which means it’s universal and based on non-
discrimination. Now, we know that different countries have different ways in which they approach this,
whether it’s insurance-based schemes or cover through taxation, whether or not there’s a public-private
mix, etc. What’s important to know is what happens when coverage is not available, not accessible, not
affordable. We only have to look as far back as the COVID-19 pandemic to understand that even when we
don’t take a normative, rights-based approach to UHC, the whole of society pays the price of UHC not
being achieved.
.
BUILDING A HEALTHIER FUTURE: DR. ROOPA DHATT ON GLOBAL
ROOPA DHATT, M.D., M.P.A.
EXECUTIVE DIRECTOR &
CO-FOUNDER
WOMEN IN GLOBAL HEALTH
ROOPADHATT@GMAIL.COM
We need strong healthcare systems and we need health to be accessible to all,
without exception. HCPs understand that better than anyone else, because they
deal with the consequences of system deficiencies when the worst happens.
13
HEALTH CHALLENGES OF UHC, GENDER EQUITY AND AMR
How can junior doctors actively contribute to the advancement of Universal Health Coverage?
Junior doctors have an important voice through our professional associations, whether it’s organisations
such as IFMSA during our training or the Junior Doctor Network of the World Medical Association. I
benefited hugely from engaging with global networks early in my career and encourage others to do the
same. Our voices make a difference. At Women in Global Health, we have many junior doctors in our
national chapters who join our global campaigns on leadership, pay, protection, vaccine equity, mental
health, PSEAH. They campaign in their national context, join our delegations at global level eg to UHC
HLM and WHA contribute country perspectives and are part of our evidence gathering and policy
research.
How do you think Universal Health Coverage impacts the daily work and experiences of junior
doctors?
Most of us become doctors because we want to keep people and societies well. When UHC is absent,
societies suffer the consequences of multiple overlapping injustices including poverty and ill-health.
Junior doctors are on the frontline, responding to the consequences of these systemic deficiencies. Take
the example of the US, which saw nearly 60,000 excess deaths from COVID-19, over 220,000 additional
hospitalizations, and 2.9 million additional cases, all associated with lack of medical insurance.
BUILDING A HEALTHIER FUTURE: DR. ROOPA DHATT ON GLOBAL
ROOPA DHATT, M.D., M.P.A.
EXECUTIVE DIRECTOR &
CO-FOUNDER
WOMEN IN GLOBAL HEALTH
ROOPADHATT@GMAIL.COM
When UHC is absent, the whole of society pays the price, and junior doctors
are sadly among the first line responders who get to deal with the aftermath.
Healthcare should be affordable and accessible to all. Doctors should have the
professional satisfaction of knowing patients are being treated for their health
needs, not their ability to pay and that the most vulnerable populations are
being reached. Doctors should therefore see fewer preventable and premature
14
HEALTH CHALLENGES OF UHC, GENDER EQUITY AND AMR
deaths, e.g. in childbirth and infancy and far less avoidable suffering.
Could you share your perspectives on why Antimicrobial Resistance is a significant concern,
especially in the context of the roles of junior doctors?
Imagine a world where antibiotics, drugs that revolutionized infection treatment, no longer work. This will
have an enormous impact on so many aspects of our lives, from medical treatment and prevention to
global socioeconomic burden. We simply cannot let this happen. Junior doctors play a significant role in
this. I know very well that we may feel the pressure from patients to prescribe antibiotics, even when
unnecessary. I have had many patients come with an expectation that every infection should be treated
with antibiotics, less willing to trust younger doctors with their therapeutic choices. It puts extra pressure
on a junior professional, with time constraints and limited access to diagnostic tools adding to the burden.
Young doctors are key actors in the AMR battle, as the management of resistant infections and growing
limits on treatment options is a looming threat for modernmedicine.
How do you think awareness and education can play a role in addressing Antimicrobial
Resistance?
Education is key to overcoming the dangers posed by AMR. This matters everywhere, and is particularly
the case in parts of the world where gaps in healthcare coverage lead to inadequate antibiotic prescribing
practice, by providers lacking sufficient training. In some countries with vulnerable health systems
antibiotics are still unregulated and available over the counter. Since there are so few new antibiotics
being developed it is critical we do not lose the effectiveness of the ones we have through misuse. That
means strengthening health systems everywhere.
BUILDING A HEALTHIER FUTURE: DR. ROOPA DHATT ON GLOBAL
ROOPA DHATT, M.D., M.P.A.
EXECUTIVE DIRECTOR &
CO-FOUNDER
WOMEN IN GLOBAL HEALTH
ROOPADHATT@GMAIL.COM
It’s worth remembering that AMR does not respect national borders. Drug
resistant TB is also seen in HICs with better controls. This has to be a
national and global effort. There is an important hygiene angle too. We need
a strong emphasis on hygiene and infection prevention and control in all
health facilities to stop patients and health workers acquiring and spreading
infections that may be resistant e.g. MRSA and C Difficile. Hand hygiene,
infection control in surgery are essential, but in LMICs a large proportion of
hospitals and clinics have no clean water supply. Huge investment is needed
in water supply, soap and clean toilets in health care facilities. This is actually
another part of UHC. .
15
HEALTH CHALLENGES OF UHC, GENDER EQUITY AND AMR
One Health is also a key consideration in this, as animal health service provision can also be inadequate
and under-resourced. At the patient end, awareness and knowledge are crucial in shaping expectations in
a way that is constructive.
When patients understand that antibiotic use should be sparing and avoided unless strictly necessary, the
pressure on both human and animal healthcare providers will be lowered, and responsible antibiotic use
will be easier to achieve.
Interviewer: Dr. Dhatt, I want to personally thank you for taking the time to share your invaluable insights
and expertise on pressing healthcare challenges. Your contributions have provided valuable illumination
on critical issues impacting our global community.
BUILDING A HEALTHIER FUTURE: DR. ROOPA DHATT ON GLOBAL
ROOPA DHATT, M.D., M.P.A.
EXECUTIVE DIRECTOR &
CO-FOUNDER
WOMEN IN GLOBAL HEALTH
ROOPADHATT@GMAIL.COM
16
HEALTH CHALLENGES OF UHC, GENDER EQUITY AND AMR
CONFERENCES, MEETINGS,
CONTRIBUTIONS &
TESTIMONIES
17
FRANCISCO PÊGO
DEENA MARYIAM
MUHA HASSAN
154TH WORLD HEALTH ORGANIZATION, EXECUTIVE
BOARD MEETING
18
KUAN YU CHIANG
EB154 – which sets the agenda for the forthcoming World Health Assembly (WHA) in May – convened in
Geneva in January. It’s the place where crucial decisions about World Health Organisation (WHO)
policies, programs and elections are made. Non-state actors (NSA) also have a significant role,
expressing their concerns and viewpoints.
We advocated for decisive action on climate and health, strengthening of the universal health coverage
program, prioritising mental health in primary healthcare, and adherence to INB and international health
regulations at the upcoming WHA. Being young physicians, we not only possess the qualities and
expertise of a doctor but also the zeal and enthusiasm found in youth. As healthcare providers and future
leaders, we have involved ourselves deeply in the process of WHO with the support of WMA. Besides the
statements, which can be read using the links above, we’d like to give you some key takeaways from the
recent WHO activity:
Figure 1 – Our team in Geneva – from left to right, Christina, Francisco and Kuan Yu
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154TH WORLD HEALTH ORGANIZATION, EXECUTIVE BOARD MEETING
This year’s meeting involved discussions on the intergovernmental negotiating body (INB) process, the Climate
and Health declaration and Antimicrobial Resistance (AMR). Non-state actors, such as the World Medical
Association (WMA), actively participated. Pre-WHA JDN Organizing Committee (OC), along with JDN and WMA
collaborated on and delivered 6 interventions – Universal Health Coverage (UHC), Non-Communicable Diseases (NCD),
Antimicrobial Resistance (AMR), Social Determinants of Health (SDH), Climate Change and Health (CCH), and Health
,
Emergencies (HE), the latter held as a constituency jointly with the remaining health professionals.
of climate change, which included strengthening the implementation of WHO Global Strategy on Health,
Environment and Climate Change and adopting a health-in-all policies approach. Our intervention on the
climate change agenda supported the WHO report on climate crisis action. We pressed for carbon
neutrality by 2030 and emphasised the need to formally state fossil fuels as the main source of
greenhouse gas emissions in the resolution in order to drive an impactful change in future policies and
this document. We are still unsure about how ground-breaking it will be as negotiations will happen until
May this year, with WMA trying to intervene whenever allowed. Although its most recent draft already
addresses the safety of the workforce during emergencies, the toll on workers is not only physical nor
immediate and we must include the prevention and recovery from the mental health burden and
exhaustion of health personnel. Additionally, young, or in-training healthcare workers should be provided
a clear set of competencies and adequate supervision to guarantee their continued learning, safety, and
responsibilities proportional to theirlevel of proficiency.
and treatment, and promoting strategic information and innovation. A Japanese representative noted that
many nations lack adequate budgets for implementation despite having national plans. This highlights the
significant costs of precise laboratorymonitoring and developing accurate screening tools.
need for emergency health responses that are both “conflict-sensitive” and “peace-responsive. The
initiative progresses through six work-streams, commencing with evidence generation through research
and analysis. GHPI acknowledges inequalities are exacerbated in conflict zones and
154TH WORLD HEALTH ORGANIZATION, EXECUTIVE BOARD MEETING
20
CLIMATE CHANGE: The resolution called upon member states to take relevant steps to tackle health impacts
actions.Member states (MS) will formally present the resolution for decision at WHA77.
INB: EB154 was used as the last open meeting for MS and NSA to comment on the developments of
AMR:The WHO’s approach to AMR includes prevention of infections, ensuring access to quality diagnosis
GHPI: WHO’s Global Health and Peace Initiative (GHPI) was formally adopted at EB154. It emphasises the
offers a mechanism to tackle these issues, fostering trust through multilateral efforts.
On social media communication
Experimenting with Instagram Reels yielded increased engagement from followers and non-followers, but
creating short videos proved time-consuming and challenging without user-friendly tools. With limited
human resources for the task, we took turns to share highlights on social media. This approach was
labour-intensive, but we learnt how to best manage the workflow, and studied how to implement AI tools
for live recording, transcription, translation, and summarization to ease this burden going forward.
Figure 2 – Delivering one of our 5 statements in the floor of the EB meeting room
154TH WORLD HEALTH ORGANIZATION, EXECUTIVE BOARD MEETING
21
Individual reflections
Francisco: Leading JDN on such a stage was a first for me, but the degree of trust invested in us by the
WMA and the diligence of fellow delegates made managing the delegation a really rewarding experience. I
think that there are many things to improve in this work of ours and that this event was the perfect trial run
for an improvement already at the WHA77. The things at which you should expect to see us raise the bar
soon are social networks presence and engagement, statement writing proficiency, and side events
participation.
Kuan Yu: This was a pivotal moment in my life, witnessing that direction emerges through interaction,
corroborating the idea that “leadership arises through interaction”. This included calls from numerous
others to not overlook youth’s contribution and to respect the needs of women and children.
Muha: Attending online was convenient and accessible, allowing me to easily follow the discussions live. I
found the experience valuable, especially as I was able to also follow the discussions of my colleagues
attending in person.
Deena: The Pre-WHA OC Team was a delight to work with, the diversity we brought to the table made the
overall experience memorable. Even though I attended online, I was kept up to date with all proceedings
and was able to follow up at every step of the way. Hoping to be part of this team again next year and join
in person.
154TH WORLD HEALTH ORGANIZATION, EXECUTIVE BOARD MEETING
What’s next?
To follow-up on EB154, we will be sending delegates to the WHA77, which will be
held in Geneva from 27th May 2024 to 1st June 2024. Two days prior to this, we will
hold a pre-WHA JDN meeting, which will consist of networking and capacity building
sessions to which every Junior Doctor in the Network is invited! At all times, we are
openly accepting suggestions on the ways to improve our effectiveness at such
high-level representation.
22
Acknowledgements:The full PreWHA Organising Committee, both the ones in the
official delegation but also the ones following the action online.
154TH WORLD HEALTH ORGANIZATION, EXECUTIVE BOARD MEETING
AUTHORS:
FRANCISCO PÊGO
MD. IN THE PUBLIC HEALTH RESIDENCY
FACULTY OF MEDICINE OF THE UNIVERSITY OF PORTO, ALMADA-SEIXAL
LOCAL HEALTH UNIT
LISBOA, PORTUGAL
DEENA MARYIAM
MBBS
GENERAL PRACTIONER
DUBAI, UAE
MUHA HASSAN
MBCHB, BSC (HONS)
INTERNAL MEDICINE RESIDENT, NATIONAL HEALTH SERVICE
COVENTRY, ENGLAND
KUAN YU, CHIANG
MD, AND EMHA (EXECUTIVE MASTER OF HEALTH ADMINISTRATION)
PERUSING
ATTENDING PHYSICIAN, HOSPITALIST
TAIPEI CITY HOSPITAL
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TAIPEI CITY, TAIWAN
PABLO
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The Junior Doctors Network (JDN) of the World Medical Association (WMA) marked a significant
milestone by participating in the 67th Commission on Narcotic Drugs (CND67) at the United Nations
Office on Drugs and Crime (UNODC) in Vienna on March 18 and 19, 2024. This involvement
underscores the key role of young doctors in shaping global medication policy, especially in ensuring
access to controlled medicines for medical and scientific purposes.
The CND67 concentrated on improving access to and the availability of controlled substances for
medical and scientific purposes. This was encapsulated in the resolution “Promoting awareness-
raising, education and training as part of a comprehensive approach to ensuring access to and the
availability of internationally controlled substances for medical and scientific purposes and improving
their rational use”​
​
. This resolution reflects the global commitment to the rational and equitable use of
controlled medicines.
During the event plenary, the JDN, represented by Dr. Pablo Estrella Porter, delivered a compelling
statement prepared by the newly established Young Doctors Network within UNODC. This statement
highlighted the challenges in accessing controlled medicines and emphasized the need for integrated
medical education, sufficient resources, collaborative regulatory frameworks, and the reduction of
stigma associated with controlled medicines. The advocacy of the JDN was crucial in bringing the
perspective of young doctors to the forefront of the global discourse on drug control and patient
care.
In her address at the CND67 on March 14, 2024, Ms. Ghada Waly, Director-General and Executive
Director of UNODC, noted the establishment of a network of young doctors from around the world to
discuss sustainable solutions for barriers to access.
This initiative is part of the broader UNODC programming aimed at building connections in the
medical field and fostering collaborative efforts to enhance access to controlled medicines​
​
.
PABLO ESTRELLA PORTER (MD, MPH), PUBLIC
HEALTH RESIDENT AND JUNIOR
DOCTORS NETWORK – WMA MEMBERSHIP
DIRECTOR (VALENCIA, SPAIN).
BREAKING BARRIERS: THE JUNIOR DOCTORS NETWORK AT THE FOREFRONT OF CND67
The JDN also participated in a side event titled "Taking
the Pledge4Action to ensure adequate availability of
internationally controlled essential medicines" This event,
co-sponsored by UNODC, showcased global commitments to
improving access to essential medicines. Discussions featured
representatives from various countries and organizations,
including Belgium, Brazil, Ghana, INCB, CAPSA Canada, and
the International Association for Hospice and Palliative Care
(IAHPC).
The involvement of young doctors in these forums is critical for
driving the conversation toward practical and innovative
solutions for medication accessibility and healthcare
improvement​
​
.
25
Recommendations from the Young Doctors Network
At the plenary session of CND67, the Young Doctors Network presented the following
recommendations:
1. Strengthen education and training in the rational prescribing of controlled substances.
2. Foster global partnerships to share best practices and innovations.
3. Advocate for policy reforms to balance access to controlled medicines and prevent misuse.
4. Support research and data sharing to inform evidence-based policymaking.
5. Address stigma around controlled medicines and ensure equitable access, particularly in low- and
The participation of the JDN at CND67 represents a landmark event, signifying the growing influence
and responsibility of young doctors in the global health landscape.
Their involvement in UNODC initiatives, particularly in the accessibility of controlled medicines, sets
a precedent for future engagements and policy developments. This event not only highlighted the
challenges but also paved the way for actionable solutions, aligning with the Sustainable
Development Goals and ensuring that no one is left behind in accessing essential healthcare
services.
PABLO ESTRELLA PORTER (MD, MPH), PUBLIC
HEALTH RESIDENT AND JUNIOR
DOCTORS NETWORK – WMA MEMBERSHIP
DIRECTOR (VALENCIA, SPAIN).
BREAKING BARRIERS: THE JUNIOR DOCTORS NETWORK AT THE FOREFRONT OF CND67
26
middle-income countries.
JEAZUL
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The European Junior Doctors (EJD) is an organization that represents young and resident doctors in
Europe. Its mission is to defend the interests and rights of these professionals, promoting better
working conditions, high-quality medical education, and workplace well-being.
The European Junior Doctors Spring General Assembly took place on May 3-4, 2024, in the historic
buildings of the University of Medicine in Montpellier, France. This event, filled with significant
discussions and decisions, focused on the mobility of healthcare workers and how current policies
affect doctors in training. Additionally, other crucial issues for young doctors were addressed,
including climate emergency policies and working conditions.
Challenges of Junior Doctors in Europe: Climate Emergency
One of the main topics discussed during the recent Spring Assembly was the climate emergency
policy. The European Junior Doctors (EJD) has made progress in developing a policy that aligns with
other medical organizations and the European Union’s political agenda. This policy highlights the
commitment of young doctors to tackle climate change, emphasizing the interconnectedness of
public health and sustainability.
Impact of Climate Change on Public Health: Climate change significantly impacts public health by
increasing disease burden and mortality rates. Collective actions from governments, healthcare
systems, professionals, and citizens are essential to avert the worst outcomes.
Contribution of the Health Sector to Carbon Emissions: The healthcare sector is a notable contributor
to carbon emissions, highlighting the need for mitigation efforts within healthcare operations.
JEAZUL PONCE HERNANDEZ, MD. MPH. MSC.
PUBLICATIONS DIRECTOR
JUNIOR DOCTORS NETWORK – WMA
Strategies Advocated by EJD:
Advancing the European Green Deal: Integrate a “One Health”
approach across all policies to ensure cohesive health and climate
actions.
Medical Education: Incorporate global health and climate change
topics into medical education at all levels.
Preparation of the Health Workforce: Enhance funding, planning,
and capacity to prepare healthcare workers for the pressures of
climate change.
Sustainability and Efficiency in Healthcare Systems: Allocate
resources to implement measures that improve the sustainability
and efficiency of healthcare systems.
COMMITMENT AND CHALLENGES OF YOUNG DOCTORS: CLIMATE EMERGENCY AND
WORKING CONDITIONS FOR DOCTORS IN SPECIALTY TRAINING; EJD SPRING ASSEMBLY
2024, MONTPELLIER, FRANCE
28
Junior Doctors Network (JDN) Intervention
During the assembly in Montpellier, the Junior Doctors Network (JDN) was introduced to the European Junior
Doctors. The emphasis was on the importance of collaboration to promote policies benefiting young doctors
worldwide.
Active participation from all JDN members was encouraged, highlighting that the network relies on the
commitment and collaboration of young doctors from diverse regions. The invitation was extended to European
Junior Doctors to contribute to the JDN newsletter and join as active members, providing opportunities to
engage in activities offered by the World Medical Associations, including meetings in April and October.
In summary, addressing critical issues like climate change, working conditions, and promoting active member
participation strengthens the JDN’s mission and contributes positively to global health. By aligning with EJD,
UEMO, and through JDN and WMA, there is a collective effort to demand better working conditions and
strategies to address the shortage of human resources in many European countries. This concerted effort aims
to improve the lives and careers of junior doctors, ultimately enhancing healthcare delivery across Europe.
JEAZUL PONCE HERNANDEZ, MD. MPH. MSC.
PUBLICATIONS DIRECTOR
JUNIOR DOCTORS NETWORK – WMA
COMMITMENT AND CHALLENGES OF YOUNG DOCTORS: CLIMATE EMERGENCY AND
WORKING CONDITIONS FOR DOCTORS IN SPECIALTY TRAINING; EJD SPRING ASSEMBLY
2024, MONTPELLIER, FRANCE
The Reality of Resident Doctors in Europe
Currently, resident doctors in many European countries, including Spain, deal with long working hours that
exceed the 48-hour weekly limit stipulated by the European Working Time Directive. These extended working
hours not only affect the quality of life of young doctors but also the quality of care they can provide to their
patients.
The EJD strongly opposes forced allocation and advocates for strategies that retain healthcare workers without
such measures. During postgraduate training, involuntary reallocation manifests through various forms, such
as allocation based on healthcare demand and mandatory placements in underserved areas. In the early
specialization period, professionals face contractual obligations linking career advancement to service in
underserved regions. These initiatives, while aiming to address medical personnel shortages, raise concerns
about training quality, personal choices, and professional development.
29
ARTICLES BY
JDN
MEMBERS
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The emergence of antimicrobial resistance has been attributed to many factors, including the overuse and
misuse of antibiotics in human medicine, agriculture, and veterinary practices. Excessive use of antibiotics
in livestock farming has led to the development of antibiotic-resistant bacteria that can be transmitted to
humans through food. Additionally, poor infection control in hospitals and clinics and lack of cle
an water and sanitation in some areas also contribute to the spread of resistant pathogens.
The impact of antimicrobial drugs on global health is enormous. It causes the treatment of infectious
diseases to be ineffective, increases morbidity, increases the risk of hospitalization and increases
mortality. The World Health Organization (WHO) estimates that AMR causes 700,000 deaths worldwide
each year, and if action is not taken, the number of deaths could rise to 10 million each year from 2050.
The situation is particularly concerning in countries like Pakistan, where the weak health infrastructure
and limited access to quality healthcare services contribute to the problem. The country faces a dual
challenge of addressing AMR while also improving access to essential healthcare services.
4.95 million people who died in 2019 suffered from drug-resistant infections. AMR directly caused 1.27
million of those deaths. 1 in 5 of those deaths occurred among children under 5 years old. In Pakistan in
2019, there were 59,200 deaths attributable to AMR and 221,300 deaths associated with AMR. Pakistan
has the 176th highest age-standardized mortality rate per 100,000 population associated with AMR across
204 countries. In the GBD region of South Asia, Pakistan has the 5th highest age-standardized mortality
across 5 countries. The number of AMR deaths in Pakistan is higher than deaths from neoplasms,
respiratory infections and tuberculosis, enteric infections, diabetes and kidneyAntimicrobial resistance
(AMR) is a major threat to global health. This occurs when organisms such as bacteria, viruses, parasites,
and parasites change their response to the drug, making the drug ineffective. This phenomenon is
spreading rapidly and, if left unchecked, will lead to an epidemic, increasing disease and mortality rates
worldwide.
THE RISING THREAT: ANTIMICROBIAL RESISTANCE
AND ITS IMPACT ON GLOBAL HEALTH
There are five pathogens to be aware of in Pakistan (number of deaths
associated with AMR in parenthesis): Klebsiella pneumoniae (34,400),
Escherichia coli (31,300), Staphylococcus aureus (28,600), Salmonella Typhi
(23,300), and Streptococcus pneumoniae (20,300). These commonly cause
bloodstream infections, lower respiratory infections and all related infections
in the thorax, peritoneal and intra-abdominal infections, and bloodstream
infections.
32
DR. FATIMA KHURSHID MBBS, REGISTERED
MEDICAL PRACTITIONER (PMDC), MEDICAL
DOCTOR, PAKISTAN JUNIOR DOCTORS
NETWORK, WORLD MEDICAL ASSOCIATION
Tackling this growing threat requires a multifaceted approach
involving government, medical professionals and the public.
Some of the key strategies are to promote the effective use of
antibiotics, invest in research and development of new drugs
and diagnostic tools, support surveillance systems, and
promote public awareness of the importance of appropriate
antibiotic use.
THE RISING THREAT: ANTIMICROBIAL RESISTANCE
AND ITS IMPACT ON GLOBAL HEALTH
The Role of Junior Doctors in Addressing Antimicrobial Resistance
Junior Doctors are in a unique position as future healthcare leaders, and their engagement is critical in
effectively combating antimicrobial resistance (AMR). We look at how younger physicians might influence
and enhance the proper use of antimicrobials, emphasizing the need of education, awareness, and
responsible prescribing behaviors among them.
Junior doctors have a tremendous influence on patient care, making their involvement critical in combating
AMR. By encouraging effective antimicrobial stewardship and adherence to recommendations, you may
help to reduce the development and spread of antibiotic resistance. This involves administering antibiotics
only when absolutely required, selecting the best antibiotic based on local resistance trends, and ensuring
the proper dosage and duration of therapy.
1.- Education and Training: Junior doctors must pursue ongoing
education and training in AMR-related areas. Staying current on the
newest research, guidelines, and best practices allows them to deliver
evidence-based care and make educated antimicrobial decisions.
Continuous education enables junior physicians to advocate for
appropriate prescription practices and urge their colleagues to do the
same.
2.- Research and Innovation: Participating in research and monitoring
programs enables student doctors to track AMR trends and contribute to
the collection of useful data. By actively participating in research, people
may assist in identifying local resistance patterns, detecting emerging
resistance, and informing policy choices. Junior doctors can work with
experienced healthcare professionals, microbiologists, and
epidemiologists to develop surveillance systems and understand AMR
dynamics.
33
DR. FATIMA KHURSHID MBBS, REGISTERED
MEDICAL PRACTITIONER (PMDC), MEDICAL
DOCTOR, PAKISTAN JUNIOR DOCTORS
NETWORK, WORLD MEDICAL ASSOCIATION
THE RISING THREAT: ANTIMICROBIAL RESISTANCE
AND ITS IMPACT ON GLOBAL HEALTH
DR. FATIMA KHURSHID MBBS/ REGISTERED
MEDICAL PRACTITIONER (PMDC) MEDICAL
3.- Education and Training: Junior doctors must pursue ongoing education and training in AMR-related
areas. Staying current on the newest research, guidelines, and best practices allows them to deliver
evidence-based care and make educated antimicrobial decisions. Continuous education enables junior
physicians to advocate for appropriate prescription practices and urge their colleagues to do the same.
4.-Research and Innovation: Participating in research and monitoring programs enables student doctors
to track AMR trends and contribute to the collection of useful data. By actively participating in research,
people may assist in identifying local resistance patterns, detecting emerging resistance, and informing
policy choices. Junior doctors can work with experienced healthcare professionals, microbiologists, and
epidemiologists to develop surveillance systems and understand AMR dynamics.
5.-Patient Education: Patient and public education is another critical component in addressing AMR.
Junior doctors can educate patients on the proper use of antimicrobials, highlighting the dangers of AMR
and the significance of completing required training. They can also encourage preventative measures,
such as immunization and proper cleanliness, to lessen the need for antimicrobial therapy.
6.- Collaboration and Interdisciplinary Approach: Collaborative efforts between junior doctors, senior
healthcare professionals, policymakers, and other stakeholders are critical for effectively combatting AMR.
Multidisciplinary collaboration enables the interchange of knowledge, ideas, and best practices. It permits
the creation of complete plans that include antimicrobial stewardship, infection prevention, and control
techniques.
7.- Leadership and Advocacy: Junior doctors can take on leadership positions and advocate for AMR
awareness and action in their own healthcare institutions and professional communities. They can join
groups or organizations dedicated to antimicrobial stewardship and AMR, and actively shape policies and
standards.
8.- Infection Prevention and Control: Junior doctors have an important
role in advocating and executing infection prevention and control
techniques that minimize the spread of resistant illnesses. They can
actively engage in infection control committees, teach healthcare
personnel about good hygiene techniques, and help design protocols
and recommendations.
9.- Community Engagement: By interacting with the local community,
junior doctors can expand their impact outside the hospital. They can
create awareness campaigns, deliver speeches in schools or community
centers, and work with public health groups to educate the public about
AMR, antimicrobial usage, and preventative measures.
34
DOCTOR, PAKISTAN JUNIOR DOCTORS
NETWORK, WORLD MEDICAL ASSOCIATION
THE RISING THREAT: ANTIMICROBIAL RESISTANCE
AND ITS IMPACT ON GLOBAL HEALTH
DR. FATIMA KHURSHID MBBS/ REGISTERED
MEDICAL PRACTITIONER (PMDC) MEDICAL
10.- Research and Quality Improvement: Junior doctors can contribute to AMR-related research
projects and quality improvement activities. They can conduct research to assess the efficacy of
antimicrobial stewardship programs, look into local resistance patterns, and assess the effects of
measures targeted at reducing antibiotic usage.
11.- Lifelong Learning and Professional Development: Junior doctors should be committed to lifetime
learning and ongoing professional development in the field of AMR. They can attend conferences,
workshops, and seminars about AMR, join relevant professional groups, and remain up to speed on the
newest research and guidelines.
Pakistan, in collaboration with the World Health Organization (WHO), acknowledges the critical need to
fight antimicrobial resistance (AMR). The Pakistani government has committed to addressing this issue as
a priority, acknowledging AMR as a severe health catastrophe impacting the country. The Ministry of
National Health Services Regulations and Coordination collaborates with provinces, the veterinary
industry, and health development partners to improve national capability in a variety of sectors.
Efforts are being undertaken to increase surveillance and laboratory diagnoses, promote the rational use
of antimicrobials, improve infection prevention and control procedures, and educate people about AMR
prevention and control. These activities are intended to address AMR holistically and strategically.
To lead these efforts, Pakistan collaborated with WHO to create a national action plan. This action plan
will be converted into province operational plans, ensuring that the strategies and interventions are
successful and targeted.
These initiatives indicate Pakistan’s commitment to combating AMR and emphasize the necessity of
cross-sectoral coordination among government agencies, healthcare providers, and the public. Pakistan
hopes to increase its capacity to fight AMR and ensure the efficacy of antimicrobial medications for future
generations through coordinated efforts and WHO cooperation.
References:
World Health Organization (WHO). TrACSS 2021-2022 [Internet]. [cited 2023 Feb 16].
Available from: https://amrcountryprogress.org/download/AMR-self-assessment-
surveyresponses-2020-2021.xlsx
1.
The burden of antimicrobial resistance (AMR) in Pakistan. Global Bacterial Antimicrobial
Resistance Burden Estimates 2019. Institute for Health Metrics and Evaluation. Oct 19,
2022. https://www.healthdata.org/sites/default/files/files/Projects/GRAM/Pakistan_0.pdf
2.
Antimicrobial resistance. Pakistan. World Health Organization. Eastern Mediterranean
Region. https://www.emro.who.int/pak/programmes/antimicrobial-resistance.html
3.
Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic
Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP).
https://www.cdc.gov/drugresistance/index.html`
4.
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DOCTOR, PAKISTAN JUNIOR DOCTORS
NETWORK, WORLD MEDICAL ASSOCIATION
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HEALTH AS A RIGHT: CHALLENGES AND OPPORTUNITIES FOR THE MEXICAN
HEALTH SYSTEM FROM THE PERSPECTIVE OF A YOUNG DOCTOR
LUIS MIGUEL ALFONSO, MD ANAHUAC
ASSOCIATION
Abstract:
This essay explores the challenges and opportunities faced by young doctors in Mexico within the context
of the country’s health system. It discusses the fragmentation, low coverage, and insufficient financing that
characterize the system, emphasizing the disparities between the public and private sectors. The essay
reflects on the author’s role as a young doctor and proposes actions to contribute to positive change. The
goal is to shed light on the complexities of Mexico’s health system and encourage fellowyoung doctors to
actively participate in its transformation.
Introduction:
The health system of Mexico consists of two sectors: public and private. The public sector is integrated by
various institutions that provide health services to different groups of the population according to their
work status and social security. These institutions include the Mexican Social Security Institute (IMSS),
the Institute of Security and Social Services for State Workers (ISSSTE), Petróleos Mexicanos (PEMEX),
the Armed Forces, the Navy Secretariat, and other state services, as well as the Health Secretariat (SSA)
and programs that serve the population without social security. On the other hand, the private health
system is financed by the payments made by patients when they are treated, either by out-of-
pocketspending or through private health insurance. [1,2].
Methods:
As a young doctor, I face the challenges of this system with concern but also
hope. I believe there is much to do to improve Mexico’s health system and
make the right to health effective for all Mexicans. I recognize my social
responsibility to contribute to this purpose, armed with the tools and skills
necessary. Some proposed actions include promoting comprehensive reform
of the health system for universality, equity, quality, and efficiency.
Additionally, active participation in preventing and controlling non-
communicable chronic diseases is crucial, focusing on education, early
diagnosis, and timely treatment. Fostering citizen participation and
accountability in the health sector is another key aspect, allowing users to
express their needs, demand their rights, and evaluate service quality. Lastly,
a commitment to constantly updating my knowledge and professional skills is
essential to providing excellent care based on scientific evidence and respect
for human dignity. [1-3].
37
UNIVERSITY, REGISTERED PHYSICIAN, MEXICO
JUNIOR DOCTORS NETWORK, WORLD MEDICAL
MENTAL HEALTH AND WELL-BEING OF JUNIOR
DOCTORS: RECOGNIZING AND MANAGING BURNOUT
ASSOCIATION
Results:
The potential results of implementing these proposed actions are promising. Comprehensive reform could
lead to increased universality, equity, quality, and efficiency of health services. Active participation in
disease prevention might contribute to a reduction in the prevalence and impact of chronic diseases.
Fostering citizen engagement can empower users to express their needs, demand their rights, and
evaluate service quality. Continuous professional development ensures that doctors provide excellent care
based on scientific evidence and respect for human dignity.
Discussion:
Implementing the proposed actions for health system reform in Mexico faces challenges such as
bureaucratic hurdles, resource constraints, and potential resistance within the healthcare system.
Achieving comprehensive reform requires strategic planning and political will. Disease prevention efforts
need to navigate cultural and socioeconomic disparities. Fostering citizen engagement demands effective
communication channels, education programs, and overcoming potential resistance. Continuous
professional development, vital for maintaining high standards, may face integration challenges due to
time constraints. Despite these challenges, a collective and holistic approach by young doctors can
contribute to a more just, humane, and effective health system that upholds the right to health for all
citizens.
References:
1. Juan Mercedes, Moguel Ancheita Alba, Valdés Olmedo Cuauhtémoc,
González Pier Eduardo, Martínez González Gabriel, Barraza Llorens Mariana,
et al. Universalidad de los servicios de salud en México. Salud pública Méx
[Internet]. 2013 [cited 2024 Jan 29];55(spe):1-64. Available from:
http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0036-
36342013000600001&lng=es.
2. Gómez-Dantés O, Sesma S, Becerril VM, Knaul FM, Arreola H, Frenk J.
Sistema de salud de México. Salud Publica [Internet]. 2011 [cited 2024
Jan];53(Suppl 2):S220-S232. Available from: [Link not available].
3. Organización para la Cooperación y el Desarrollo Económicos. Panorama
de la Salud 2021: Indicadores de la OCDE. París: OCDE; 2021. Available
from: https://www.oecd.org/health/Panorama-de-la-Salud-2021-OCDE.pdf.
38
LUIS MIGUEL ALFONSO, MD ANAHUAC
UNIVERSITY, REGISTERED PHYSICIAN, MEXICO
JUNIOR DOCTORS NETWORK, WORLD MEDICAL
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Introduction
In the realm of public health, antimicrobial resistance (AMR) poses a formidable challenge, one that
Taiwan has been actively confronting. This article delves into the multifaceted aspects of AMR in Taiwan,
encompassing antibiotic usage patterns, the impact of the COVID-19 pandemic, and the nation’s strategic
responses.
Antibiotic Usage and AMR inTaiwan Antibiotic Consumption Patterns:
Taiwan, like many countries worldwide, has seen a significant rise in antibiotic use over recent years. This
increase is not without consequence. The correlation between high antibiotic consumption and the
emergence of AMR is a growing concern. In Taiwan, the trend of antibiotic use reflects a complex
interplay of healthcare practices, patient expectations, and prescription policies. Studies indicate a
notable reliance on antibiotics for respiratory and other common infections, often leading to over-
prescription. The consequent impact on AMR is evident from the rising rates of drug-resistant strains of
bacteria, such as MRSA (Methicillin-resistant Staphylococcus aureus).
The correlation between antibiotic usage and AMR:
This increase in antibiotic consumption directly correlates with a rise in AMR. The emergence of
multidrug-resistant organisms (MDROs) has become a significant public health concern. For instance, the
prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae has dramatically
increased in Taiwan’s hospitals and communities. This trend highlights the urgent need for strategic
interventions in antibiotic prescription practices.
NAVIGATING THE ANTIMICROBIAL RESISTANCE
LANDSCAPE IN TAIWAN: CHALLENGES AND INNOVATIONS
DR. CHIANG KUAN YU, MD, HOSPITAL
MEDICINE, TAIWAN, PURSUING MASTER
DEGREE OF HEALTH POLICY AND
MANAGEMENT IN NATIONAL TAIWAN
UNIVERSITY
The government and healthcare organizations have begun addressing this
through stricter prescription guidelines and public awareness campaigns. These
efforts aim to educate both medical professionals and the public about the
judicious use of antibiotics. Section 2: Impact ofCOVID-19 on AMR Patterns
AMR Patterns During the Pandemic: The COVID-19 pandemic has had a
profound impact on healthcare systems globally, and Taiwan is no exception.
During this period, there was a noticeable shift in the patterns of antimicrobial
resistance. The heightened use of antibiotics as a precautionary measure
against secondary bacterial infections in COVID-19 patients has led to an
altered antimicrobial landscape. The research indicates a rise in resistant
strains, particularly in hospital settings. This scenario underscores the
challenge of balancing immediate patient care needs with long-term public
health objectives in crisis situations.
40
Comparative Analysis of AMRPre and Post COVID-19:
A comparative analysis of AMR data before and during the pandemic reveals significant shifts. For
instance, the usage of certain antibiotics increased markedly during the pandemic, and correspondingly,
certain bacteria showed elevated resistance levels. This comparison is crucial for understanding how the
pandemic has necessitated a re-evaluation of antibiotic use protocols. The increased resistance to
commonly used antibiotics during the pandemic period is a call to action for healthcare providers to adapt
and innovate in their approach to antibiotic prescription. A comprehensive assessment of antibiotic
resistance (AMR) patterns in Central Taiwan during the COVID-19 pandemic conducted a retrospective
analysis of clinical samples collected before and after the pandemic, identifying six prevalent bacteria and
their resistance patterns. The prevalence of resistant bacteria, such as vancomycin-resistant
Enterococcus and carbapenem-resistant Acinetobacter baumannii, increased during the pandemic,
highlighting the impact of COVID-19 on AMR. The study underscores the critical importance of
understanding AMR prevalence for infection prevention and policy formulation. Further research is
needed to explore the relationship between AMR and infection severity inCOVID-19 patients. The
prevalence rates of vancomycin-resistant Enterococcus (VRE) and carbapenem-resistant Acinetobacter
baumannii (CRAB) before and after the COVID-19 pandemic show a notable increase during the
pandemic period. Prior to the COVID-19 pandemic, the overall prevalence rate of VRE was 59%, and it
increased to 69% during the pandemic. Similarly, for CRAB, the prevalence rate was 46% before the
COVID-19 pandemic and rose to 65% during the pandemic. This data indicates a significant rise in the
prevalence of both VRE and CRAB during the COVID-19 pandemic. The increased prevalence of resistant
bacteria during the COVID-19 pandemic in Central Taiwan has significant implications for public health
and the management of infections. The findings reveal a concerning rise in antimicrobial resistance
(AMR) among common bacterial pathogens, including Acinetobacter baumannii (CRAB), vancomycin-
resistant Enterococcus (VRE), Klebsiella pneumoniae (CRKP), and Escherichia coli (CREco), with
respective increases of 19%, 10%, 2%, and 1% in their resistance . The prevalence of resistant strains of
Staphylococcus aureus and Pseudomonas aeruginosa, however,showed a decrease of 6% each.
NAVIGATING THE ANTIMICROBIAL
RESISTANCE LANDSCAPE IN TAIWAN:
CHALLENGES AND INNOVATIONS
41
NAVIGATING THE ANTIMICROBIAL
RESISTANCE LANDSCAPE IN TAIWAN:
CHALLENGES AND INNOVATIONS
These shifts suggest that the COVID-19 pandemic has exacerbated the challenge of AMR in the region. A
primary concern is the potential for these resistant bacteria to complicate the treatment of COVID-19
patients, especially those with bacterial coinfections, which have been documented both in Taiwan and
globally . High levels of antibiotic prescribing during the pandemic, despite a low prevalence of bacterial
coinfections in COVID-19 patients, have been observed and could contribute to further escalation of AMR.
This situation underscores the critical need for judicious antibiotic use and the implementation of effective
antimicrobialstewardship programs. Moreover, the rise in AMR compromises patient outcomes, potentially
leading to increased morbidity, mortality, longer hospital stays, and higher healthcare costs . Treating
infections caused by resistant bacteria often requires the use of last-resort or more potent antibiotics,
which may have more significantside effects and are typically more costly. From a broader perspective, the
increase in AMR during the COVID-19 pandemic stresses the importance of integrating AMR surveillance
and management into pandemic preparedness and response plans. It highlights the need for robust
infection control measures, not only to manage viral pandemics but also to prevent the spread of bacterial
pathogens and contain AMR. To address these challenges, further research is warranted to explore the
correlation between AMR and the severity of infections in COVID-19 patients, aiming to develop targeted
strategies to mitigate the impact of resistant infections. Healthcare providers in Central Taiwan and similar
regions should be aware of these trends to adapt treatment protocols appropriately and consider AMR
patterns in their clinical decision-making processes.
The Need for a National AMRAction Plan:
There is a pressing need for a strategic framework that encompasses surveillance, prevention, and control
of AMR. Such a plan should incorporate robust measures for monitoring, rapid response to AMR threats,
and public awareness campaigns. Collaboration across various sectors, including healthcare, agriculture,
and education, is vital. The plan should also align with global health initiatives, reflecting a commitment to
reducing AMR both locally and internationally.
Role and Functionality of Taiwan Antimicrobial Resistance Network (TARN):
The Taiwan Antimicrobial Resistance Network plays a pivotal role in consolidating and disseminating
information related to AMR. Its comprehensive database aids in tracking resistance patterns, guiding
policy decisions, and fostering research collaborations. TARN’s functionality extends beyond data
collection; it serves as a crucial platform for a hub for collaboration and strategy development in the fight
against AMR. By providing real-time data and analysis, it empowers healthcare professionals and
policymakersto make informed decisions.
42
NAVIGATING THE ANTIMICROBIAL
RESISTANCE LANDSCAPE IN TAIWAN:
CHALLENGES AND INNOVATIONS
Description of the Taiwan Hospital InfectionControl and AMR Monitoring System (THAS)
The Taiwan Hospital Infection Control and AMR Monitoring System (THAS) is a critical tool in
managing hospital infections and antimicrobial resistance. This system offers a comprehensive
platform for tracking and analyzing infection rates and antimicrobial resistance patterns in hospitals.
It enables healthcare providers to effectively monitor infection control measures and adjust strategies
as needed. The integration of THAS into the healthcare system represents a significant step in
enhancing Taiwan’s ability to manage and mitigate the risks associated with AMR.
Conclusion
In conclusion, Taiwan’s multifaceted approach to combating antimicrobial resistance showcases a
blend of innovation, public health policy, and global collaboration. The challenges are significant, but
the strategies and systems like TARN and THAS highlight the nation’s commitment to addressing this
global health crisis. Continuous efforts in research, policy development, and public education are
essential to sustain progress and improve health outcomes both within Taiwan and in the broader
international community.
43
References:
1.Shio-Shin Jean, Po-Ren Hsueh. Antimicrobial Drug Resistance in Taiwan. Journal
of the Formosan Medical Association.
2011;110(1):4-13. ISSN 0929-6646. https://doi.org/10.1016/S0929-6646(11)60002-
8.
2. Yu-Wei Tseng, Chien-Wen Huang, Chih-Chieh Chen, Tze-Kiong Er. Assessment
of antibiotic resistance patterns in Central Taiwan
during the COVID-19 pandemic: A retrospective study. Journal of Infection and
Public Health. 2024;17(2):229-235. ISSN 1876-0341.
https://doi.org/10.1016/j.jiph.2023.11.026.
NAVIGATING THE ANTIMICROBIAL
RESISTANCE LANDSCAPE IN TAIWAN:
CHALLENGES AND INNOVATIONS
44
AVINA KHARAT
NARLAPATI VIGNAN
RUCHI KUMARI
ANTIMICROBIAL RESISTANCE IN INDIA
45
Introduction:
Antimicrobial resistance (AMR) poses a significant public health challenge in India, where elevated rates
of resistance to antimicrobial agents in both humans and food animals have been observed [1]. The
country is experiencing a surge in infections caused by antibiotic-resistant Gram-positive and Gram-
negative microbes, exemplified by Escherichia coli’s resistance rate surpassing 80% for specific antibiotic
classes [2][3]. Notably, India reported the initial identification of the NDM-1 gene, a factor that swiftly
spread to other regions. The NDM-1 gene, also known as New Delhi metallo-beta-lactamase 1, confers
resistance to a broad range of antibiotics, including carbapenems, considered last-resort antibiotics for
many infections. [4]. The widespread use of antibiotics, coupled with the prevalent use of fixed-dose
combinations for example, combinations of amoxicillin with clavulanic acid, which are commonly used in
India, contributes significantly to the escalating problem of AMR [5]. Globally, the impact of AMR is
staggering, with an estimated 4.95 million deaths in 2019 attributable to drug-resistant infections,
including 1.27 million directly linked to bacterial AMR [6]. In Indian healthcare settings, studies reveal a
prevalence of 59% of Gram-negative species infections, with Escherichia coli being the most frequently
isolated Gramnegative species [7]. Additionally, research in rural communities highlights limited
awareness about antimicrobial medicines and high instances of antibiotic purchase without prescriptions
[8]. Pilot studies underscore substantial antibiotic resistance among pathogens isolated from urine,
wound, and blood cultures conducted in India. [9]. Investigations into Vibrio cholerae in India indicate
increasing resistance to older and newer antibiotics [10]. In India, the multifaceted issue of AMR is
influenced by several specific risk factors, encompassing poor prescription practices, selfmedication,
over-the-counter drug sales, and misuse of antibiotics in agriculture and livestock sectors [11][12]. The
socio-economic and cultural context introduces unique challenges, such as using sludge in agriculture
and improper disposal of livestock animals, contributing to the spread of AMR [13].
DR. RUCHI KUMARI MBBS, MD PHARMACOLOGY
ASSOCIATION
DR. AVINA KHARAT MBBS, MD PHARMACOLOGY
MGM MEDICAL COLLEGE AND MAHARAJA
ASSOCIATION
DR. NARLAPATI VIGNAN MBBS, MD
PHARMACOLOGY MGM MEDICAL COLLEGE AND
MAHARAJA YASHWANT RAO HOSPITAL,
ANTIMICROBIAL RESISTANCE IN INDIA
46
MGM MEDICAL COLLEGE AND MAHARAJA
YASHWANT RAO HOSPITAL, INDORE, INDIA
JUNIOR DOCTORS NETWORK, WORLD MEDICAL
YASHWANT RAO HOSPITAL, INDORE, INDIA
JUNIOR DOCTORS NETWORK, WORLD MEDICAL
INDORE, INDIA JUNIOR DOCTORS NETWORK,
WORLD MEDICAL ASSOCIATION
Initiatives taken:
India has undertaken multiple initiatives to combat AMR, notably the National Action Plan for Antimicrobial
Resistance (NAP-AMR). This initiative aims to enhance the governance and operationalization of AMR
programs by incorporating strategies such as resilient leadership, multistakeholder coordination, innovative
program design, and data-driven monitoring across various sectors, including plant/agricultural, animal
husbandry, human health, and pharmaceuticals [14]. Another significant effort is the National Policy for
Containment of Antimicrobial Resistance, which encompasses measures like the introduction of Schedule H1
for prescription antibiotics, hospital-based surveillance systems, and color-coding of certain antibiotics for
restricted access [15]. The Indian Council of Medical Research (ICMR) has launched the Antibiotic
Stewardship, Prevention of Infection & Control (ASPIC) program, employing digital technology to identify
opportunities and challenges and promote antimicrobial stewardship practices in hospitals [16]. These
initiatives align with national declarations such as the Jaipur Declaration and the Chennai Declaration,
emphasizing strategies like prohibiting over-the-counter antibiotic sales, monitoring in-hospital antibiotic
usage, and establishing national AMR surveillance systems in healthcare settings. The research
underscores the importance of delving into the mechanisms of AMR, including rapid antimicrobial
susceptibility diagnostics, to guide effective prescribing. Additionally, there is a call for incentivized
preclinical research and early clinical development to bolster the discovery of new antimicrobial agents [17].
DR. AVINA KHARAT MBBS, MD PHARMACOLOGY
MGM MEDICAL COLLEGE AND MAHARAJA
ASSOCIATION
DR. NARLAPATI VIGNAN MBBS, MD
PHARMACOLOGY MGM MEDICAL COLLEGE AND
MAHARAJA YASHWANT RAO HOSPITAL,
WORLD MEDICAL ASSOCIATION
DR. RUCHI KUMARI MBBS, MD PHARMACOLOGY
MGM MEDICAL COLLEGE AND MAHARAJA
ASSOCIATION
ANTIMICROBIAL RESISTANCE IN INDIA
47
YASHWANT RAO HOSPITAL, INDORE, INDIA
JUNIOR DOCTORS NETWORK, WORLD MEDICAL
INDORE, INDIA JUNIOR DOCTORS NETWORK,
YASHWANT RAO HOSPITAL, INDORE, INDIA
JUNIOR DOCTORS NETWORK, WORLD MEDICAL
Conclusion:
Physicians must adopt a proactive approach to the escalating challenge of antimicrobial resistance
(AMR). This necessitates the promotion of responsible antibiotic prescribing practices, implementation of
antimicrobial stewardship programs, continuous engagement in education, and active support for national
and global initiatives. Adhering to evidence-based guidelines, exercising judicious use of antibiotics, and
raising awareness about the necessity of antibiotic prescriptions only when clinically warranted, are
imperative aspects of our commitment. Actively participating in initiatives like the Antibiotic Stewardship,
Prevention of Infection & Control (ASPIC) program is crucial to promoting the prudent use of
antimicrobials whilst ensuring optimal patient outcomes. Continuous education on AMR is vital for making
well-informed decisions in clinical practice. Collaborative efforts, resilient leadership, and multi-
stakeholder coordination are integral to successful initiatives. Advocacy for increased research and
innovation, including support for studies on mechanisms of resistance and rapid antimicrobial
susceptibility diagnostics is paramount. As physicians, our commitment to addressing the formidable
challenge of AMR in India, our region, and worldwide is pivotal. Proactive measures are required in light
of escalating resistance rates observed in humans and food animals resulting in infections caused by
antibioticresistant microbes. Patient education plays a crucial role in combating AMR, necessitating active
engagement in educating patients about completing prescribed antibiotic courses, avoiding
selfmedication, and understanding the consequences of antibioticmisuse in India.
DR. AVINA KHARAT MBBS, MD PHARMACOLOGY
MGM MEDICAL COLLEGE AND MAHARAJA
DR. NARLAPATI VIGNAN MBBS, MD
PHARMACOLOGY MGM MEDICAL COLLEGE AND
MAHARAJA YASHWANT RAO HOSPITAL,
WORLD MEDICAL ASSOCIATION
ANTIMICROBIAL RESISTANCE IN INDIA
48
YASHWANT RAO HOSPITAL, INDORE, INDIA
JUNIOR DOCTORS NETWORK, WORLD MEDICAL
ASSOCIATION
INDORE, INDIA JUNIOR DOCTORS NETWORK,
DR. RUCHI KUMARI MBBS, MD PHARMACOLOGY
MGM MEDICAL COLLEGE AND MAHARAJA
YASHWANT RAO HOSPITAL, INDORE, INDIA
JUNIOR DOCTORS NETWORK, WORLD MEDICAL
ASSOCIATION
DR. AVINA KHARAT MBBS, MD PHARMACOLOGY
MGM MEDICAL COLLEGE AND MAHARAJA
ASSOCIATION
DR. NARLAPATI VIGNAN MBBS, MD
PHARMACOLOGY MGM MEDICAL COLLEGE AND
MAHARAJA YASHWANT RAO HOSPITAL,
WORLD MEDICAL ASSOCIATION
DR. RUCHI KUMARI MBBS, MD PHARMACOLOGY
MGM MEDICAL COLLEGE AND MAHARAJA
ASSOCIATION
ANTIMICROBIAL RESISTANCE IN INDIA
References:
1. Neelam, Taneja., Megha, Sharma. Antimicrobial resistance in the environment: The Indian scenario. Indian Journal of Medical
Research, (2019). doi: 10.4103/IJMR.IJMR_331_18
2. Isha, Patel., Rabia, Hussain., Anam, Khan., Akram, Ahmad., Muhammad, U., Khan., Mohamed, Azmi, Ahmed, Hassalai.
Antimicrobial resistance in India.. Journal of Pharmaceutical Policy andPractice, (2017). doi: 10.1186/S40545-017-0118-6
3. Avika, Dixit., Neeta, Kumar., Sanjiv, Kumar., Vidyasagar, Trigun. Antimicrobial resistance: Progress in the decade since
emergence of New Delhi metallo-β-lactamase in India. Indian Journal of Community Medicine, (2019). doi:
10.4103/IJCM.IJCM_217_18
4. Vidya, Mave., Vidya, Mave., Ajay, Chandanwale., Ajay, Chandanwale., Anju, Kagal., Anju, Kagal., Sandhya, Khadse., Sandhya,
Khadse., Dileep, Kadam., Dileep, Kadam., Renu, Bharadwaj., Renu, Bharadwaj., Vaishali, Dohe., Vaishali, Dohe., Matthew, L,
Robinson., Aarti, Kinikar., Aarti, Kinikar., Samir, Joshi., Samir, Joshi., Priyanka, Raichur., Katie, McIntire., Savita, Kanade.,
Jonathan, Sachs., Chhaya, Valvi., Usha, Balasubramanian., Vandana, Kulkarni., Aaron, M., Milstone., Ivan, Marbaniang., Jonathan,
M., Zenilman., Amita, Gupta., Amita, Gupta. High burden of antimicrobial resistance and mortality among adults and children with
community-onset bacterial infections in India. The Journal of InfectiousDiseases, (2017). doi: 10.1093/INFDIS/JIX114
5. Frederik, Joelving. (2018). India’s antibiotic combinationsthwart effortsto curb drug resistance, say researchers.. BMJ, doi:
10.1136/BMJ.K560
6. Yogendra, Kumar, Gupta., Subasree, Srinivasan. A Silent Pandemic of Antimicrobial Resistance: Challenges and Strategy for
Preparedness in India. Annals of the National Academy of Medical Sciences. India, (2022). doi: 10.1055/s-0042-1756285
7. Jitendra, Vaghasiya. Susceptibility and resistance pattern of bacterial isolates and development of antibiogram in a tertiary care
hospital of western India. Journal of medical pharmaceutical and allied sciences, (2023). doi: 10.55522/jmpas.v12i1.3987
8. Matrujyoti, Pattnaik., Ashish, Kumar, Nayak., S., L., Rajasekar, Karna., Subrat, K, Sahoo., Subrata, Kumar, Palo., Srikanta,
Kanungo., Jaya, Singh, Kshatri., Debaprasad, Parai., Kamini, Walia., Taru, Singh., Hari, Ram, Choudhary., Sanghamitra, Pati.,
Debdutta, Bhattacharya. Perception and determinants leading to antimicrobial (mis)use: A knowledge, attitude, and practices study
in the rural communities of Odisha, India. Frontiersin Public Health, (2023). doi: 10.3389/fpubh.2022.1074154
9. Sumana, Mahadevaiah., Gautam, Kalyatanda. Prevalence of antimicrobial resistance in urine, blood, and wound pathogens
among rural patients in Karnataka, India. Antimicrobialstewardship & healthcare epidemiology, (2023). doi: 10.1017/ash.2023.162
10. Phenotypic and genotypic characterization of antimicrobial resistance in clinical isolates of Vibrio cholerae over a decade (2002-
2016). Indian Journal of Medical Microbiology, (2022). doi: 10.1016/j.ijmmb.2021.11.008
11. Sinan, BARAN. Combating Antimicrobial Resistance in India: The RoadAhead. (2023). doi: 10.1007/978-981-16-9723-4_1-1
12. Sumana, Mahadevaiah., Gautam, Kalyatanda. Prevalence of antimicrobial resistance in urine, blood, and wound pathogens
among rural patients in Karnataka, India. Antimicrobialstewardship & healthcare epidemiology, (2023). doi: 10.1017/ash.2023.162
13. Kamini, Walia., VC, Ohri., Jayaprakasam, Madhumathi., V, Ramasubramanian. Policy document on antimicrobial stewardship
practices in India.. Indian Journal of Medical Research, (2019). doi: 10.4103/IJMR.IJMR_147_18
14. Falguni, Debnath., Debjit, Chakraborty., Sandip, Giri., Shatabdi, Saha., S., Pyne., Raja, Chakraverty., Agniva, Majumdar., Alok,
Kumar, Deb., Vishal, Diwan., Rajesh, Bhatia., Shanta, Dutta. Existing Policies/Guidelines on the Environmental Dimension of
Antimicrobial Resistance in India: An Insight into the Key Facets through Review and SWOT Analysis. Tropical Medicine and
Infectious Disease, (2022). doi: 10.3390/tropicalmed7110336
15. Jyoti, Joshi., Anita, Kotwani. Learnings from select Indian public welfare programsto catalyze the implementation of India’s
national actional plan on antimicrobial resistance. International Journal of Community Medicine and Public Health, (2021). doi:
10.18203/2394- 6040.IJCMPH20213042
16. Yogita, Thakral. Social (In)equities and Ethical Challenges: Role of Information Practices in Antimicrobial Resistance in India.
Health technology assessment in action,(2022). doi: 10.18502/htaa.v5i4.10167
49
YASHWANT RAO HOSPITAL, INDORE, INDIA
JUNIOR DOCTORS NETWORK, WORLD MEDICAL
INDORE, INDIA JUNIOR DOCTORS NETWORK,
YASHWANT RAO HOSPITAL, INDORE, INDIA
JUNIOR DOCTORS NETWORK, WORLD MEDICAL
DOUAA ROUFIA
ATTABI
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50
Antimicrobial resistance (AMR) is a significant public health challenge in Algeria. The Ministry of Health of
Algeria has reported increasing rates of AMR due to the overuse and misuse of antibiotics in both human
medicine and agriculture, along with increasing rates of methicillin-resistant Staphylococcus aureus
(MRSA) and multidrug-resistant (MDR) tuberculosis (TB). TB and its multidrug-resistant form (MDR-TB)
are significant health challenges in Algeria. A study covering the period from 2008 to 2017 reported
215,581 TB cases in Algeria, with an average annual rate of about 57 cases per 100,000 people. This
high incidence highlights the ongoing public health challenge posed by both TB and its drug-resistant
strains in the country [1].
Additionally, recent studies in Algeria highlight the growing challenge of antimicrobial resistance (AMR).
For instance, a study utilizing whole-genome sequencing (WGS) to analyze Mycobacterium tuberculosis
complex (MTBC) stains revealed a concerning trend; 25.6% of the 82 isolates examined were drug-
resistant, encompassing both multidrug-resistant (MDR) and pre-extensively drug-resistant (XDR) TB
strains. This finding emphasizes the gravity of the AMR crisis in Algeria, which is not limited to
tuberculosis but extends to various pathogens, posing a significant public health threat. The situation
demands urgent attention and action to develop effective strategies for managing and mitigating AMR in
the region.[2]
Algeria has taken proactive steps to combat antimicrobial resistance (AMR) through various national
efforts and strategies:
ANTIMICROBIAL RESISTANCE (AMR): A SIGNIFICANT
PUBLIC HEALTH CHALLENGE IN ALGERIA
JUNIOR DOCTORS NETWORK, ALGERIA.
STUDENT SAN JOSE STATE UNIVERSITY
CALIFORNIA, USA
National TB Program: One notable strategy includes the withdrawal of TB
medications from private pharmacies and providing free diagnostics and
treatment for TB patients. This is supported by the establishment of the
National TB Laboratory, enhancing the national response to tuberculosis
and its drug-resistant forms [3].
1.
Identification of Resistance Genes: Efforts have been made to identify
various resistance genes against plasmid cephalosporinases,
carbapenems, aminoglycosides, and fluoroquinolones, thereby informing
targeted treatment strategies [4].
2.
51
DOUAA ROUFIA ATTABI, ALGERIA. MEMBER,
Algeria has initiated several steps to tackle AMR, as reported by the World Health Organization (WHO) and
detailed in the 2021 TrAcss country report. The TrAcss 2021 Country Report on Algeria highlights the nation’s
commendable efforts in combating AMR. It details Algeria’s successful development and implementation of a
National Action Plan (NAP) on AMR, involving multisectoral collaboration across human, animal, and plant health
sectors. The country has established stringent regulatory frameworks to control the prescription and sale of
antimicrobials. Notably, Algeria uses AMR data effectively to inform its strategies, demonstrating a commitment
to evidence-based policymaking. The report offers a five-year assessment of Algeria’s progress, emphasizing
improvements in AMR governance, awareness, surveillance, and infection control. While acknowledging these
successes, the report also suggests areas for further development, including enhancing AMR education and
monitoring antimicrobial consumption. Overall, Algeria’s approach sets a positive example in the African region
for managing AMR challenges [5]. In 2020, Algeria joined the Global Antimicrobial Resistance Surveillance
System (GLASS) for Antimicrobial Resistance (AMR) and/or Antimicrobial Consumption (AMC), demonstrating its
commitment to strengthening national surveillance systems for AMR [6].
ANTIMICROBIAL RESISTANCE (AMR): A SIGNIFICANT
PUBLIC HEALTH CHALLENGE IN ALGERIA
Given the challenges of AMR in Algeria there is a pressing need for enhanced efforts in both awareness and
policy implementation. Medical student associations like IPSF Algeria and IFMSA Algeria play a pivotal role in
awareness campaigns. Their efforts include conducting educational sessions in schools, mosques and
community centers, utilizing social media for campaigns, and organizing workshops and seminars for healthcare
workers and students. In February 2018, the ARPEC association, a chapter of the International Pharmaceutical
Students Federation, organized an awareness day on antimicrobial resistance at Batna airport, Algeria. This
event sought to educate the public about the growing threat of antibiotic resistance and to promote the
responsible use of antibiotics. Additionally, IFMSA Algeria organized a sensitivity campaign on the dangers of
random drug use during the same month under the name “ the drug is not sweet”
DOUAA ROUFIA ATTABI, ALGERIA MEMBER,
JUNIOR DOCTORS NETWORK, ALGERIA.
STUDENT SAN JOSE STATE UNIVERSITY
CALIFORNIA, USA
52
References
1. Selmane S. Forecasting the Incidence of Tuberculosis in Algeria. Int J Mycobacteriol. 2021 Jan
1;10(Suppl 1):S37. Available from:
https://journals.lww.com/ijmy/Abstract/2021/10001/Forecasting_the_Incidence_of_Tuberculosis_in
.37.aspx
2. Benremila D, Djoudi F, Gharout-Sait A, Kheloufi S, Spitaleri A, Battaglia S, et al. Comprehensive Drug
Resistance Characterization of Pulmonary Tuberculosis in Algeria: Insights on Mycobacterium
tuberculosis Strains by Whole-Genome Sequencing. Microb Drug Resist. 2023 Apr 28. Available from:
https://pubmed.ncbi.nlm.nih.gov/37115530/
3. Boulahbal F. Relationship between National TB program and prevalence of TB drug resistance in
Algeria, 1965 to 2013. Int J Mycobacteriol. 2015 Mar 1;4:3. Available from:
https://www.sciencedirect.com/science/article/pii/S2212553114001484
4. Arlet G. News of antibiotic resistance among Gram-negative bacilli in Algeria. Pathol Biol (Paris). 2014
May 10;62(3):169-78. Available from: https://europepmc.org/article/med/24819127
5. World Health Organization. 2021 TrACSS Country Report on the Implementation of National Action
Plan on Antimicrobial Resistance (AMR) – Algeria [Internet]. Geneva: World Health Organization; 2021
[cited 2023 Nov 20]. Available from: https://cdn.who.int/media/docs/defaultsource/antimicrobial-
resistance/amr-spc-npm/tracss/tracss-2021- algeria.pdf?sfvrsn=e0ff6b82_9&download=true
6. World Health Organization. Global Antimicrobial Resistance and Use Surveillance System (GLASS)
Report: 2021 [Internet]. Geneva: WHO; 2021 [cited 2023 Nov 20]. Available from:
https://iris.who.int/bitstream/handle/10665/341666/9789240027336-eng.pdf
ANTIMICROBIAL RESISTANCE (AMR): A SIGNIFICANT
PUBLIC HEALTH CHALLENGE IN ALGERIA
DOUAA ROUFIA ATTABI, ALGERIA MEMBER,
JUNIOR DOCTORS NETWORK, ALGERIA.
STUDENT SAN JOSE STATE UNIVERSITY
CALIFORNIA, USA
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Who can become a JDN member?
To join the JDN you:
Must be within 10 years of graduation from medical school or registered in an
ongoing postgraduate medical education program, until it is completed.
Must be an associate member of the WMA*
Note: Associate membership of the WMA is free for all doctors for the first five
years after graduation.To join the JDN, please follow the links and complete:
How to become a JDN member?
1. Associate Membership Registration (and select the Junior Doctor form):
2. JDN Registration:
Registration requires validations of the associated documents, there may be a
delay of a few weeks from the time of registration to the time you are added to
the mailing lists. All registrants who have submitted a completed application will
receive an email confirming that they have been added and an invitation to be
added to the mailing list; others will be informed how to adequately complete
their application.
For more information, please contact jdn@wma.net.

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BECOME A JDN MEMBER
MEMBERSHIP
ISSN (ONLINE) 2312-220X
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ISSN (PRINT) 2415-1122