Launching the IDEA (Innovation+Design Enabling Access) Initiative as its founding director, Dr. Anthony So, professor of the practice, joined the Health Systems Program in the Department of International Health in September 2016. He is also thematic lead for the Transformative Technologies and Institutions arm of the recently launched Johns Hopkins Alliance for a Healthier World. Dr. So brings expertise in designing innovations that enable or improve access to novel health technologies, and leads initiatives that tackle the growing issue of antimicrobial and antibiotic resistance.

Antimicrobial resistance (AMR) is an emerging health issue across the globe, as bacterial strains are becoming resistant to the antibacterial agents meant to protect against them. In November 2015, it was discovered that a new form of resistance had developed against colistin, an antibacterial agent and the last-line of defense for warding off potentially deadly drug-resistant infections.  

If left unchecked, it is projected that 10 million people will die from drug-resistant infections in 2050, more than the number of people who die from cancer today. Growing resistance to antibiotics will put at risk adequate care for treatments such as cancer chemotherapy, organ donor transplants, and the treatment of women and babies suffering from infections during childbirth. Treating infections presumptively as bacterial can sometimes cost less than giving the diagnostic test, thereby contributing to overuse. However, underuse of antibiotics, particularly in low- and middle-income countries, can take a greater toll than overuse today.

Dr. So heads the North American and the Strategic Policy team of ReAct—Action on Antibiotic Resistance, an independent international network designed to create awareness of antibiotic resistance and advocate for global engagement in preventing this deadly phenomenon. The North American branch focuses on policy issues and supports the work of the Antibiotic Resistance Coalition (ARC), a group of civil society organizations working in human, environmental and agricultural health advocating for global action on AMR.

Both food production and healthcare delivery system use antimicrobials inappropriately. By volume, more antibiotics are used in raising livestock than in human medicine. ARC was, in part, created to bring civil society groups together to address AMR as an intersectoral challenge.

Through the work of ReAct and ARC, Dr. So has led policy, research and advocacy efforts to shape the priorities on tackling antimicrobial resistance and influence global conversations around AMR. With partner groups, the ReAct Strategic Policy Program has produced a monthly newsletter for ARC; co-organized an AMR briefing in lead up to the UN Political Declaration on AMR; co-authored a briefing for member States and civil society on AMR issues for the WHO Executive Board discussions; co-organized a side event on AMR at the World Health Assembly; supported policy recommendations for the Tripartite Agencies (WHO, FAO and OIE) as well as the UN’s Interagency Coordination Group (IACG) on AMR; and recently undertook a commissioned analysis for WHO to lay out policy options for global antimicrobial stewardship.

The ReAct Strategic Policy Program also co-organized a Civil Society Roundtable with the head of the WHO AMR Secretariat and the third annual, WHO-NGO Dialogue Report on AMR this past year. The program also helped to pull together a workshop on AMR for the Junior Doctor’s Network in lead up to the World Medical Association. The workshop timed with efforts within the World Medical Association to consider whether and how best to update its 2008 position on AMR in light of unfolding events.

Working with colleagues at Hopkins, the ReAct Strategic Policy Program submitted a commissioned paper for the UK Review on AMR and has begun to analyze the economics and externalities of AMR under a JHU Discovery Award.

Few programs have worked so actively to raise the issue of antimicrobial resistance on the global stage. Through the IDEA Initiative, the Program’s work on AMR has proven to be an important lens in shaping incentives, policies and intersectoral responses in a way that ensures innovation and access to life-saving antibiotics will be equitable and affordable for those in need. In speaking at the First World Conference on Access to Medical Products in Delhi in November 2017, Dr. So concluded that “The challenge posed by the faltering R&D pipeline for antibiotics is the perfect storm, but also an opportunity to chart a new course on innovation and access for these life-saving health technologies.”