Over 1.27 million people worldwide die of bacterial Antimicrobial Resistance (AMR) yearly. Decades of misuse and overuse of antibiotics and other antimicrobials have made these drugs less effective in treating common infectious diseases, accelerating the emergence and spread of AMR.
Refugees’ and migrants’ experiences in the country of origin, migration journey, entry and integration policies, and living and working conditions in the host country can increase the vulnerability of these populations to infectious diseases and challenge their ability to access antibiotics and treat illnesses appropriately.
The fourth report of the WHO Global Evidence Review on Health and Migration (GEHM), Capturing the evidence on access to essential antibiotics in refugee and migrant populations, gathers evidence on the access to essential antibiotics for refugees and migrants and finds that access to and use by these populations is heterogeneous and significantly influenced by the health systems of the host countries. While the extent of their access globally is unclear, the report puts a spotlight on the most common health system barriers to access and use of antibiotics across regions: long waiting times to see a doctor, limited capacity of health services, high health care costs, inappropriate prescription of antibiotics, and lack of translated materials or interpretation services.
Barriers in accessing health services and obtaining and using antibiotics may result in unnecessary or incorrect use, which often leads to poorer health outcomes for the users and further development of drug-resistant pathogens.
“Some studies show that refugees and migrants often resort to informal markets and self-medication to overcome health system barriers in the host country,” said Dr Santino Severoni, Director of the WHO Health and Migration Programme. “Access to safe, effective, affordable, high-quality antibiotics for all, including refugees and migrants, is key to promoting the health of these populations and is essential to addressing AMR and maintaining the ability to treat infections.”
The report also identifies non-health policies and factors that challenge the access to and appropriate use of antibiotics for refugees and migrants, such as previous unsatisfactory experiences with formal care, and the ease of informal access to antibiotics. Furthermore, these populations may encounter stigma, fear of deportation due to the migratory status, or language barriers, and be unable to reach care due to lack of time or transportation and financial constraints.
Based on the findings of the review, a series of policy considerations is put forward in five areas to improve access to and appropriate use of antibiotics in refugee and migrant populations and contribute to reversing the development of AMR globally:
- Build global governance for AMR action by ensuring significant investment; aligning and integrating WHO global action plans for refugees and migrants and for AMR into a coherent framework for concerted action; establishing financial arrangements in low- and middle-income countries (LMIC) markets for equitable antimicrobial access and use.
- Improve global data collection by strengthening surveillance systems for data-driven, evidence-informed policy solutions; supporting research through concerted and targeted funding to fill substantial knowledge gaps.
- Tackle national-level barriers to seeking formal care by facilitating access to care by improving language accessibility and health literacy for refugees and migrants; monitoring and supporting the provision of migrant- and refugee-sensitive cultural competency training for health care personnel; improving migrants’ and refugees’ knowledge of antibiotics through community-based initiatives.
- Tackle national-level barriers to utilizing formal care by removing systemic barriers to care based on legal status; ensuring that essential, quality-assured antibiotics are affordable; improving knowledge of and registration for entitlements to care in vulnerable populations and health care providers; avoiding policies that restrict antibiotic access for vulnerable populations.
- Overcome barriers at national level to adequate and quality care by ensuring access to point-of-care diagnostic tools for optimal case management in vulnerable populations.
Equitable access to and appropriate use of existing and new antimicrobial medicines for all, including refugees and migrants, is a basic human right and is vital for an effective global public health response to the ever-increasing range of infections caused by bacteria, parasites, viruses and fungi.
“We need to focus on people and vulnerable populations while addressing AMR. Equitable access to infection prevention measures, to timely and quality diagnostic services, and to quality-assured antibiotics are key building blocks in the global AMR response,” said Catharina Van Weezenbeek, Director, SPC/AMR.
“We need to strengthen our evidence on the burden and impact of AMR in refugee and migrant populations, and then help refine national regulations and policies as well as global guidelines. We look forward to working closely with the Health and Migration Programme on these activities.”