Global antimicrobial stewardship and the need for pharmaceutical system strengthening for antimicrobials within a One Health approach

Objectives The COVID-19 pandemic has highlighted both the vulnerabilities and the critical role of global pharmaceutical systems in enabling equitable access to medicines. In this personal view, we position the pharmaceutical system as a missed research and investment opportunity that, if integrated properly, would benefit antimicrobial stewardship (AMS) programmes within a One Health approach. Key findings The pharmaceutical supply management cycle (PSMC) illustrates the continuous interdependence between four key phases: selection, procurement, distribution and use. Furthermore, a PSMC is subject to external forces of market competition, policy and regulation - across human, animal and environmental health. We present examples of overlap in PSMCs across different One Health sectors and discuss the need for integration within human, animal and environmental health contexts. Summary Despite pharmaceutical systems being fundamental to successful AMS programmes, they are currently neglected and undervalued. Research and investment into pharmaceutical system optimisation and integration into AMS programmes present an opportunity for both high-income countries and low- and middle-income countries to develop responsible, comparable and international AMS innovations and interventions.

Automated summary

The COVID-19 pandemic has brought attention to the vulnerabilities and importance of global pharmaceutical systems in ensuring equitable access to medicines. Despite being fundamental to successful AMS programmes, pharmaceutical systems are currently neglected and undervalued. Research and investment in optimizing pharmaceutical systems and integrating them into AMS programmes present an opportunity for the development of responsible, comparable, and international AMS innovations and interventions in both high-income and low- and middle-income countries.