Denmark takes the lead in international AMR organisation

There is a need for an international organisation that can support low- and middle-income countries in tackling the effects of antimicrobial resistance (AMR).

That was the message from the World Bank in 2018 – and Denmark stepped forward to take on the challenge.

ICARS – the International Centre for Antimicrobial Resistance Solutions – was established, with its headquarters in Copenhagen.

Today, the organisation has grown to more than 50 employees representing over 25 nationalities at its headquarters in the Danish capital. It has also recently opened an office in Nairobi, which currently has four employees.

According to Theresa Høgenhaug, Head of Partnerships and Global Relations at ICARS, the World Bank's prediction that an organisation like ICARS was needed has proven to be correct.

"What the World Bank predicted in 2018 was that failing to support low- and middle-income countries in implementing initiatives to combat the spread of AMR would have long-term human and economic consequences globally. It would also push more low-income countries into extreme poverty," she explains, adding:

"Most countries actually have action plans for combating AMR, but progress in implementing concrete solutions is lacking. Countries need support and funding to put initiatives into action."

Today, ICARS operates under the auspices of the Danish Ministry of Foreign Affairs. Denmark remains its largest contributor, but several other countries and foundations also provide funding. ICARS also receives financial support through various European Commission programmes.

Local challenges – and local solutions

ICARS supports more than 80 projects in over 35 countries across One Health sectors (sectors concerned with human, animal, environmental and planetary health, ed.) in Africa, Asia, Eastern Europe and Latin America.

Although the projects differ, they are all based on the same fundamental principles, Theresa explains.

"Our approach always combines top-down and bottom-up engagement. In practice, this means that we work with governments to secure political commitment in each country, while also collaborating with national and local institutions and researchers who will lead the implementation and drive the work on specific solutions. These may include local pharmacy associations, hospitals, agricultural organisations, universities and others," she says, continuing:

"We don't arrive with a Danish or European solution. Instead, we start with the challenges facing each country and its local context, drawing on both existing evidence and the generation of new evidence. ICARS provides technical support and funding."

One of ICARS' core principles is to ensure that knowledge and expertise are developed locally, enabling initiatives to be scaled up and implemented nationwide.

In short, the aim is to create sustainable interventions with a lasting impact.

"We don't arrive with a Danish or European solution. Instead, we start with the challenges facing each country and its local context."

A good example is a project in Kyrgyzstan.

In Kyrgyzstan, respiratory diseases account for approximately half of all childhood illnesses. One of ICARS' first projects in the country focuses on reducing antibiotic use for acute respiratory infections and is being carried out in close collaboration with the country's Ministry of Health.

As part of the project, ICARS has also collaborated with the Global Health Unit at Rigshospitalet, Copenhagen University Hospital.

By introducing rapid C-reactive protein (CRP) tests at local clinics in the Chui and Naryn regions, antibiotic use has fallen significantly.

The government and the World Bank are now discussing additional funding and the possibility of scaling up the initiative based on the evidence generated.

The aim is to establish a solid financial foundation for making the testing method a permanent national standard in Kyrgyzstan.

At the same time, the project supported the training of the country's first PhD graduate in infectious diseases.

Strengthening local capacity is a key part of ICARS' work. It helps ensure that initiatives remain sustainable once ICARS-supported projects come to an end and responsibility for continuing the work is transferred to national stakeholders.

A huge need for ICARS

ICARS has recently launched a new strategy outlining the organisation's priorities towards 2030.

The strategy maintains its focus on supporting low- and middle-income countries in implementing evidence-based solutions.

In addition, ICARS aims to scale up solutions that have proven effective and ensure that they become embedded in permanent national legislation.

Another important priority is encouraging countries to integrate AMR efforts into broader national action plans, including pandemic preparedness, food security and climate policy.

The organisation will also focus on synthesising evidence across projects and countries.

The need for action and demand for expertise are enormous. At the same time, ICARS' new strategy places greater emphasis on ensuring that low- and middle-income countries have a voice in the wider global debate.

"At the United Nations General Assembly in September 2024, AMR was on the agenda at a high-level meeting. This generated attention and important momentum around the global challenge. ICARS was present and played an active and central role in translating political ambitions into concrete action," Theresa explains, continuing:

"We helped shape the declaration adopted by the member states. At the same time, around 40 side events on AMR took place in New York during those days, but only a few gave low- and middle-income countries the opportunity to speak for themselves about their challenges and solutions."

"Ensuring that these countries are represented and that their voices are heard in the global dialogue and in setting global priorities is also an important part of ICARS' work."