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A global perspective: One Health response
to Antimicrobial Resistance
Karin Waefler, Technical Officer
Control of Antimicrobial Resistance Programme
The future…
OECD’s “Stemming the superbug” report 2018
Stemming the Superbug Tide: just a few dollars more. 2018. www.oe.cd/amr-2018
Scope of analyses and forecasting
3rd generation cephalosporins-resistant E. coli, fluoroquinolones-resistant E. coli,
carbapenem-resistant K. pneumoniae, cephalosporins-resistant K. pneumoniae,
carbapenem-resistant P. aeruginosa, vancomycin-resistant E. facealis and E.
faecium, metcillin-resistant S. aureus, and penicillin-resistant S. pneumoniae.
Argentina, Australia, Austria, Belgium, Brazil, Bulgaria, Canada, Chile, China,
Colombia, Costa Rica, Croatia, Cyprus, Czech Republic, Denmark, Estonia,
Finland, France, Germany, Greece, Hungary, Iceland, India, Indonesia, Ireland,
Israel, Italy, Japan, Korea, Latvia, Lithuania, Luxembourg, Malta, Mexico,
Netherlands, New Zealand, Norway, Peru, Poland, Portugal, Romania, Russian
Federation, Saudi Arabia, Slovak Republic, Slovenia, South Africa, Spain, Sweden,
Switzerland, Turkey, United Kingdom, and United States.
8 antibiotic-bacterium pairs:
52 countries in OECD, EEA & G20:
One Health and
the relevant international organisations
• May 2018: Tripartite MoU for AMR signed
• Sep 2018: Workplan Developed
• June 2019: Tripartite Trust Fund launched
• 10 pilot countries identified globally for Tripartite+ implementation
Tripartite and Tripartite Plus
Tripartite policy framework
WHO Global Action Plan on AMR and its
implementation
Global AMR Action Plan - Objectives
1. Improve awareness and understanding
2. Strengthen knowledge and evidence base
3. Reduce incidence of infection
4. Optimize use of antimicrobial medicines
5. Develop economic case for sustainable investment
http://who.int/antimicrobial-resistance/ global-action-plan/en/
GAP Implementation: objective 1
“Improve awareness and understanding of AMR through effective communication, education and training.”
• World Antibiotic Awareness Week
• Behaviour Change activities
• Health Workforce Education
• Online Community of Practice (CoP)
Awareness: Tailoring Antimicrobial Resistance
Programmes
GAP Implementation: objective 2
“Strengthen the knowledge and evidence base through surveillance and research.”
• GLASS
• Monitoring global progress
Countries enrolled in GLASS85 countries and 1 area as of 3 October 2019
National Body commitment
Share dataon status of
national AMR surveillance
Share AMR dataAt least 1 surveillance site and at least one indicator
Monitoring global progress on AMR
• 3rd global tripartite self-assessment survey
• 159 out of 194 (82%) WHO Member States responded, representing 92% of world population
• 50 out of 53 European Member States responded
• Report available online
• Global Database for AMR Country Self Assessment
Source: http://www.who.int/antimicrobial-resistance/publications/Analysis-report-of-AMR-country-se/en/
No policies or plans in place and few or no activities underway.
Activities have started in some places or for some target groups, and related policies or plans are in development.
Some activities are underway at national level, and policies or plans have been developed.
Functional implementation of policies and activities, at national scale.
All planned activities are being implemented and functioning at national scale. There is active monitoring and updating of plans.
Self-assessment at country level. It closely reflects GAP on AMR
Country Progress: National Action Plan Development
32
7293
112 122
49
51
67 5723
10
11 11
2015 2016 2017 2018 2019
2015-2019NAP developed
NAP underdevelopment
Caution with interpretation of results
• A self-assessment survey
• Multi-sectoral and complex
– responders not always fully informed
• Some questions complex or unclear
• Some responses aspirational
• Changes between 1st, 2nd and 3rd surveys
GAP Implementation: objective 3
“Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures.”
• Hand hygiene campaigns
• Core components on Infection Prevention and Control (2016)
Core components of infection prevention and
control programmes at the national
and acute health care facility level
Core Component 1IPC Programme
Core Component 5Multimodal Strategies
Core Component 2IPC Guidelines
Core Component 3IPC Training/Education
Core Component 4HAI Surveillance
Core Component 6Monitoring, audit &
feedback
Core Component 7Workload, staffing& bed occupancy
Core Component 8Built environment,
materials & equipment for IPC
Source: http://www.who.int/infection-prevention/publications/ipc-components-guidelines/en/
GAP Implementation: objective 4
“Optimize the use of antimicrobial medicines in human and animal health.”
• Essential Medicines List / AWaRecategories (updated in 2019)
• WHO’s list “critically important antimicrobials for human medicine” (WHO CIA list) (2017)
Online course: “Antimicrobial Stewardship: A competency-based approach” (https://www.openwho.org/)
Prudent use: Antimicrobial stewardship
GAP Implementation: objective 5“Develop the economic case for sustainable investment that takes account of the needs of all countries and to increase investment in new medicines, diagnostic tools, vaccines and other interventions.”
• Global Priority Pathogens List of
Antibiotic-Resistant Bacteria (2017)
AMR over time
https://www.gov.uk/government/publications/health-matters-antimicrobial-resistance/health-matters-antimicrobial-resistance
• 51 new antibiotics in the clinical pipeline
• 33 against priority pathogens
• ~9 are innovative
• Of 10 phase-I antibiotics to tackle gram-negative bacteria only 1-2 will make it to market in 7 years
• Pipeline is insufficient to treat priority pathogens & TB
Antibacterial agents in clinical development
Source: http://apps.who.int/iris/bitstream/10665/258965/1/WHO-EMP-IAU-2017.11-eng.pdf?ua=1
World Antibiotic Awareness Week
2019
• Launch of the fifth CAESAR report
• Third joint media toolkit with ECDC
• Augmented reality App
Awareness Week around Nov 18
World Antibiotic Awareness Week 2019 18. – 24.11.2019
apps.who.int/world-antibiotic-awareness-week/activities
https://www.who-europe-campaigns.org/world-antibiotic-awareness-week-waaw/
Acknowledgments
• AMR Coordination
– Danilo Lo Fo Wong
– Saskia Nahrgang
– Ketevan Kandelaki
– Marcello Gelormini
– Karin Waefler
– Karen Taksoee-Vester
• Infection Prevention and Control
– Ana Paula Coutinho
• Communications
– Cristiana Salvi
• Health Technologies & Pharmaceuticals
– Sarah Garner
– Kotoji Iwamoto
• Food Safety
– Peter Sousa Hoejskov
• High Threat Pathogens
– Caroline Brown
– Joanna Zwetyenga
• Vaccine Preventable Diseases & Immunization
– Katrine Habersaat
