Mapping the Antimicrobial Supply Chain in Bangladesh: A Scoping-Review-Based Ecological Assessment Approach

Area of Science:

• Global Health
• Pharmaceutical Sciences
• Public Health Policy

Background:

• Antimicrobial resistance (AMR) is a significant global health threat requiring strategies to balance antimicrobial access and prevent misuse.
• National-level frameworks are needed to assess and profile antimicrobial supply chains for effective AMR containment.

Purpose of the Study:

• To propose a 16-indicator framework for assessing national capacity to ensure antimicrobial access and appropriate use.
• To profile the antimicrobial supply chain in Bangladesh using this framework.

Main Methods:

• A scoping review was conducted to gather data on 16 indicators related to key players and products in Bangladesh's antimicrobial supply chain.
• Indicators assessed included local production capacity, pricing, regulation, pharmacy/pharmacist density, and WHO Access, Watch, and Reserve (AWaRe) classifications.

Main Results:

• Bangladesh demonstrates high local antibiotic production (98%) and has pricing controls, indicating strong access capacity.
• High proportions of medicine outlets without pharmacist oversight (4:1) and significant use of WHO Watch (54%) and medically important antimicrobials (MIAs) (90%) suggest potential for misuse.

Conclusions:

• Bangladesh has the capacity for antimicrobial access but requires enhanced regulation of antimicrobial quality and community-level stewardship to mitigate misuse and combat AMR.
• Further regulations on licensing medically important antimicrobials may be necessary.