Key Priorities to Address Antimicrobial Resistance in Dominican Republic

Because it threatens fundamental achievements of modern medicine and the country’s health security. Antimicrobial resistance undermines our ability to treat common infections and increases the risks linked to surgeries, childbirth, transplantations, cancer treatment and intensive care. An infection that used to be simple can become prolonged, costly or fatal if antibiotics stop working.

Several factors explain the urgency for the Dominican Republic: widespread self-medication, prescriptions that do not always follow clinical guidelines, distribution channels that facilitate access to antimicrobials without proper control, and veterinary use that, in some cases, still includes antimicrobials as growth promoters. Added to this are risks of transmission through food, the environment and direct contact.

It’s not that bacteria “think”, but they evolve fast: they adapt, mutate and become resistant when we misuse antibiotics. If we do not act, they will continue gaining ground. Our role is to regain the advantage. The national AMR plan, the One Health approach, improved surveillance and this campaign are designed precisely to reverse the trend and preserve the effectiveness of antimicrobials for future generations.

The message is simple: antibiotics save lives when they are used properly, but they put lives at risk when they are misused.

Three key ideas structure the campaign:

• an antibiotic is not a treatment for fever or the flu;
• it should never be used without professional indication or on the advice of a relative;
• responsibility is shared: citizens, health professionals, veterinarians, pharmacists, producers and authorities.

Every time an antibiotic is used unnecessarily, we give bacteria an opportunity to become more resistant. By using these medicines only when they are truly indicated — in human health as well as in animal health — we prevent bacteria from taking the upper hand.

This initiative results from joint work between Expertise France and the Agence française de développement (AFD), with European Union funding, to strengthen the national response to AMR.

In 2022, Expertise France and the Mérieux Foundation conducted an initial project assessment, building on the recommendations of the 2019 Joint External Evaluation (JEE). Two priorities were identified:

• structuring and implementing a national AMR plan under a One Health approach, coordinating human, animal and environmental sectors;
• strengthening the enforcement of national legislation and international standards on responsible antimicrobial use through joint cross-sectoral actions.

Based on this, we designed a coherent approach involving laboratories, surveillance, training, regulation and communication. Strengthening the laboratory system was essential: better analytical capacity means more reliable data and faster detection of resistance. It is also one of the first concrete applications of the International Health Regulations regarding AMR in the country.

The AMR campaign fits fully within the One Health approach because it acts simultaneously on the three fronts where resistance emerges: human health, animal health and the environment. It aims to reduce unnecessary prescriptions, discourage self-medication and promote the rational use of antibiotics in livestock, in line with good veterinary practices. It also underscores the importance of properly managing healthcare waste and effluents to limit the spread of resistant bacteria in ecosystems.

Above all, it creates a shared language among actors who rarely interact: physicians, pharmacists, veterinarians, farmers, laboratories and health authorities. By harmonizing key messages and behaviours, the campaign helps break the cycle of resistance and sends a clear political signal: the country no longer accepts the unchecked progression of AMR and is committing to a cross-sectoral effort to reverse its trajectory.

The campaign is only the visible part. Technical assistance has been crucial to strengthening the system as a whole. Key contributions include:

• revising and consolidating the national AMR plan, now providing a clear roadmap;
• specialized training, particularly in outbreak investigation and early detection of resistance;
• an assessment of antibiotic use within the National Health Service, complemented by an analysis of consumption in agricultural and environmental sectors;
• several technical studies: legal framework, distribution channels and recommendations for more rational use;
• major progress toward integrated surveillance linking human, animal and environmental data;
• the first cohort trained in One Health field epidemiology, with support from international partners.

The approach is holistic, true to One Health principles: strengthening the entire chain, from laboratories to public policy, from veterinarians to clinicians. It enhances the country’s capacity to prevent and control AMR and to safeguard treatment effectiveness for the years ahead.