New competition champions antibiotic stewardship in low-resource settings

01 Aug 2019

Written by Anthony D. So and Joshua Woo

A new competition, launched by Innovate4AMR, is recruiting teams of students to tackle antibiotic stewardship in low-resource healthcare settings. The objective is to increase access to antibiotics and reduce inequity. Organisers of the competition, Anthony D. So and Joshua Woo from the John Hopkins Bloomberg School of Public Health, discuss what this means.

State of play

Antimicrobial resistance (AMR) claims the lives of 700,000 people a year and 5.7 million people a year die from infections potentially treatable with antibiotic drugs. If unchecked, AMR may push 24 million people into extreme poverty by 2030, causing economic harm rivaling the magnitude of the 2008-2009 financial crisis.

Implementing both feasible and effective antibiotic stewardship programmes poses one of the most significant challenges in stopping the spread of AMR. We have long had inventory checklists of what might be done in such programmes, but little insight into how to catalyse these changes in our healthcare delivery system.

– Anthony D. So, Johns Hopkins Bloomberg School of Public Health and React

While the healthcare delivery and even the food system have tried a variety of programmes and approaches, such as delayed prescribingAntibiotic Smart Use and company scorecards to name a few, we need to bring forward more innovative solutions, but also engage the next generation of AMR champions.

Applying a systems approach

Design competitions that engage those in training have the potential to raise awareness around AMR as well as mobilising voices to address AMR in our healthcare delivery system and in their communities. We have worked with the International Federation of Medical Student Associations (IFMSA) to reach out not only to its 1.3 million medical student members from 123 countries around the world, but also to nearly half a million people around the world through social media. Interested students can gain a health systems perspective on these challenges in our Prezi diagram and will also receive booster emails providing educational resources. Past student proposals for Innovate4AMR have engaged healthcare workers at various levels, taking a systems approach to antibiotic stewardship, such as delayed prescriptionsbehavioural economic approaches and herbal remedy alternatives.

Adaptable and scalable solutions for resource-limited settings

Around the world, especially in resource-limited settings, antibiotic resistance is perpetuated by factors such as lack of training, lack of diagnostic facilities, and a lack of robust supply chains for antibiotics, among others. For example, non-prescription sales of antibiotics were found in nearly 30 developing countries internationally. In low- and middle-income countries, the implementation of National Action Plans (NAPs) on AMR face particularly serious barriers. Context-specific, data driven stewardship programmes are vital in the success of NAPs.

Innovate4AMR competition launched in 2018 and, in this first year, the winning team proposals ranged from changing the effectiveness of stewardship programmes in secondary schools throughout Kampala, Uganda, to the proposed implementation of a delayed prescribing program within Filipino communities. From the United States to Honduras, from Pakistan to China, Innovate4AMR competitors put forth region-specific solutions to antibiotic stewardship, giving other students a chance to gain a deeper understanding of the different challenges around the world, while maximising the chances of implementation and success. In 2018, 145 teams covering six continents took up the challenge of Innovate4AMR.

We are looking for solutions that can be adapted and scaled in resource-limited settings, where the need for antibiotic stewardship remain critically important.

– Joshua Woo, a research assistant with the idea (innovation + design enabling access) initiative and react


Innovate4AMR is the online student competition looking for innovative and creative solutions that will help address the issues of AMR. ReAct – Action on Antibiotic Resistance and the IDEA (Innovation + Design Enabling Access) Initiative at the Johns Hopkins Bloomberg School of Public Health has joined forces with the International Federation of Medical Student Associations along with other partners, including the WHO and the South Centre to help organize this competition.

Winning teams will present proposals at a capacity building workshop in Geneva during World Antibiotic Awareness Week in November! For more information, visit, view the video here, and sign up for updates and regular newsletters here.

Anthony D. So, MD, MPA is a Professor of the Practice at the Johns Hopkins Bloomberg School of Public Health and leads the ReAct – Action on Antibiotic Resistance Strategic Policy Program, as well as the IDEA (Innovation + Design Enabling Access) Initiative at Hopkins. His team at Hopkins currently acts as the Secretariat for the Antibiotic Resistance Coalition (ARC). More information on the ARC can be found here.

Joshua Woo is a research assistant with the IDEA (Innovation + Design Enabling Access) Initiative and ReAct – Action on Antibiotic Resistance Strategic Policy Program. In addition to helping organize Innovate4AMR, he regularly edits the Antibiotic Resistance Coalition (ARC) newsletter.