Absence of historical references

Study highlights lack of research for systematizing Brazilian policy on prevention and control of antimicrobial resistance

Editorial staff

Studies on antimicrobial resistance prevention and control in Brazil are scarce, with more research needed to help systematize an approach to the issue. A comprehensive review by a group of researchers linked to the University of Brasília (UnB), the Oswaldo Cruz Foundation (FIOCRUZ), and the Brazilian Ministry of Health has revealed the shortcoming of existing policies and highlighted the importance of understanding their history in order to support new proposals and reformulations.

The study, published in the Pan American Journal of Public Health , was based on documents published on LILACS, PubMed, and Embase prior to December 2020, in addition to a survey of documentation on official Brazilian government websites to December 2021, including technical reports, theses, government documents, and nontraditional publications that could provide additional information.

A total of 7,436 articles were analyzed, of which 2,640 were duplicates, resulting in 4,706 eligible documents. After an initial screening, 103 documents were selected for reading of abstracts, from which 58 were chosen to be read in full. In the end, data were extracted from 22 published articles. A further 75 documents were identified and four more publications included through manual searches.

The conclusions of the review show that Brazil began formulating policies on antimicrobial resistance before the creation of its public health system (SUS) in 1988. Examples include the establishment of the country’s internationally renowned National Immunization Program in 1973 and the National Hospital Infection Control Program in the 1980s, which involved public and private institutions. Active surveillance, with guidelines and measures for controlling and preventing infections, was adopted in 1992.

In the early 2000s, antimicrobial resistance was recognized as one of the biggest threats to global public health.

The World Health Organization (WHO) has warned about the issue, which results in millions of deaths annually and was ranked as the third leading cause of death worldwide in 2019.

In response, the WHO, the Food and Agriculture Organization of the United Nations (FAO), and the World Organisation for Animal Health (WOAH) published guidelines on the formulation of national strategies to combat bacterial resistance, especially in developing countries. These guidelines were intended to support the creation of effective action plans.

Brazil joined these efforts, launching the National Action Plan for the Prevention and Control of Antimicrobial Resistance in the Scope of One Health (PAN-BR 2018–2022) in 2018. The document is considered a landmark in Brazilian governmental policy, as the first drafted from the perspective of the interconnection between human, animal, and environmental health (a concept that has been called One Health). Recognizing the complexity of the issue, the plan proposes a comprehensive approach to antimicrobial resistance that promotes public health, animal health, and environmental preservation.

According to the study authors, it “contributes to the systematization of knowledge about policies in the human health sector, is timely given the PAN-BR’s expiry in 2022, and may contribute to the formulation of a new national plan.”

The researchers also point out that the proposed categorization of policies could be used in future studies related to human health, animal health, or the environment.

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