PRESENTATION: Antimicrobial Resistance

8/18/2019 PRESENTATION: Antimicrobial Resistance

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Combating AntimicrobialResistance

Dr Klara Tisocki

Coordinator for Essential Medicines and Health Technologies,WHO Regional Office for the Western Pacific

18 April, 2016, Manila

ADB seminarDisclaimer: The views expressed in this paper/presentation are the views of the author and do notnecessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board ofGovernors, or the governments they represent. ADB does not guarantee the accuracy of the dataincluded in this paper and accepts no responsibility for any consequence of their use. Terminologyused may not necessarily be consistent with ADB official terms.


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Overview

The Global Threat of AntimicrobialResistance

Global Action Plan on Antimicrobial

Resistance

Ongoing Work in the Region to Contain Antimicrobial Resistance

Feed-back from Tokyo AMR meeting

Summary (Photo by CDC)


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The “miracle” of antibiotics

2. Armstrong GL et al, JAMA 1999;281(1):61-66

Crude mortality rates for all causes, noninfectious causes and

infectious diseases over the period 1900-1996.


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Antibiotics

Antibiotics the pillar of basic

health care and modern medicine

Wound

infections

Urinary

tract

infections

PneumoniaBlood

infections

Gonorrhoe

aPreterm

babies

Complicate

d deliveries

Hip

Replaceme

nt

Organ

Transplants

Cancer

Treatment

Maternal and

child health

Modern

medicine

Basic

health care


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Antibiotics: precious but diminishing resource


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A Global Health Security Threat

Antimicrobial resistance has an impact on the health of globalpopulations, food safety, the environment and the economy.

The prevention and control of antimicrobial resistance is complex

which requires multi-sectorial collaboration between:

human health care, animal health,

agriculture, food safety, food production, and

environmental protection sectors.

http://ecdc.europa.eu/http://www.oie.int/https://www.google.com/url?q=http://www.environmentalgovernance.org/featured/2013/10/fao-publishes-state-of-food-insecurity-2013/&sa=U&ei=5NwuU5LFHO-20QXi_IHAAQ&ved=0CC8Q9QEwAQ&usg=AFQjCNG8dF54fyo_x32GjUPvpngsmYYCPAhttps://www.google.com/url?q=https://plus.google.com/%2Bwho&sa=U&ei=o9wuU8CyFqPF0QX36YCwBg&ved=0CC0Q9QEwAA&usg=AFQjCNHAj-LL9iWj25jQxWyu8L6v09dObw


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AMR on the international agenda

Global Health Security Agenda: GHSA Antimicrobial Resistance Action Package(GHSA Action Package)

APEC Enhancing Health Security – International campaign program to control

antimicrobial resistance in the Asia-Pacific

ASEAN AMR is a priority in ASEAN post 2015 development Agenda

G7 Leaders statement on AMR June 2015

Berlin declaration of G7 Health Ministers October 2015 and

Asia Pacific Health Ministers meeting on AMR – 16 April 2016

recommendation to go to G7 summit in Japan May 2016

September 2016: G20 Leaders Meeting , UN General Assembly


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Estimates of Burden of Antibacterial

Resistance

European Unionpopu lat ion 500m

25,000 deaths per year

2.5m extra hospital days

Overall societal costs( € 900 million, hosp. days)

Approx. €1.5 billion per year

United Statespopu lat ion 300m

>23,000 deaths

>2.0m illnesses

Overall societal costsUp to $20 billion direct

Up to $35 billion indirect

Source: ECDC 2007 Source: US CDC 2013

Thailand populat ion 70m

>38,000 deaths

>3.2m hospital days

Overall societal costsUS$ 84.6 –202.8 mill. direct

>US$1.3 billion indirect

Source: Pumart et al 2012

Global information is insufficient to show complete disease burden impacts and costs


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The world stands on the edge of a post-

antibiotic era…..

“A post -antibio t ic era means , in effect, an end tomodern medic ine as we know i t. Things as commonas strep throat or a child’s scratched knee couldonce again kill.”

9

Dr Margaret Chan

(WHO)


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Antimicrobial resistance- where do we fail?

Final threat to Modern MedicineNo effective treatment for serious pathogens

EconomyNo new medicine due to inadequate market incentives

Evolution

Premature resistance due to inappropriate use

EcologyAvoidable infections due to inadequate public health


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Common Factors driving AMR across

different diseases including Tuberculosis Health system factors

o poor surveillance, poor diagnostic capacity

o poor quality antimicrobial products, unregulatedprescribing/dispensing weak infection control, lack of rapiddiagnostic tools

Behavioural factors

o patients poor adherence, self-medication, culturalpreferences/beliefs

o unclear diagnosis, financial incentives, industry promotion

Medicines factors

o long drug half-life, cross-resistance between classes, treatmentlength and complexity, monotherapy, lack of effective newcombinations

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WHO Global Action Planendorsed at World Health Assembly on 27 May, 2015

Principles:

Whole-of-society engagement, including a one-health approach

Prevention first

o good sanitation, hygiene and infection prevention and control

Ensure Access

o preserve the ability to prevent and treat infections

Sustainability

o all countries to have a National Plan by 2017

Incremental targets for implementationo different states for different countries


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Th d f liti l it t


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The need for political commitments

international cooperation

International problem with

unknown magnitude

Multisectoral problem -

cross-sectoral interventions

Conservation of effectiveness ofantibiotics = global public good

Health security/ economic &

development threats

High level sustained politicalattention to AMR globally,regionally

National cross-sectoral

commitments to implementnational plans on AMR

Sustained financing ofinvestments for newproducts (diagnostics,medicines)

Globally, regionallycoordinated efforts tochange attitudes,behaviours, health systempractices to tackle AMR


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AMR in SDGs? - It is not there!


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SDG GOAL 12: Sustainable production & consumption

SDG GOAL 2: Hunger and food securitySDG GOAL 3: Health & UHC


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Antimicrobial Resistance

Awareness

andAdvocacy


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UHC

Building resilient health system to contain

AMR - UHC


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UHC

‘One Health’

‘One Health’ – a multisectoral approach to AMR


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UHC

‘One Health’

SDGs

Containment of AMR as a Development Agenda


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UHC

‘One Health’

SDGs

GOVERNANCE OF AMR as a development agenda

National, Regional and Global actions to

contain AMR


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UHC

‘One Health’

SDGs

GOVERNANCE OF AMR as a development agenda

Enhance R&D(new antibiotics and

diagnostics)

Nationa

l

Region

alGlobal

Harmonization ofsurveillance and

regulations

National ActionPlan on AMR


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Governance of AMR Philippines

AO 42 series of 2014 – Creation of an Inter-Agency Committee for the Formulation

and Implementation of a Nat Action Plan to Combat AMR in the Philippines

Co Chairs: Dept of Health and Dept of Agriculture

Members: Dept of Trade and Industry, Dept of Interior and Local Govt, Dept ofScience and Technology

Key Stakeholders

- Other Government Sectors: Dept of Education, Commission on Higher Education

- Academe: association of deans, national student groups

- Professional Societies: Professional Regulatory Boards and med societies- Civil Societies and Patient Organizations: Med Transparency Alliance, Phil Assoc

of Patient Organizations

- Pharmaceutical Industry organizations


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Governance of AMR Japan

MHLWMinistry of Health,

Labour andWelfare

MAFFMinistry of

Agriculture,Forestry and

Fisheries

FSC/CAOFood SafetyCommission,Cabinet Office

Cabinet Secretariat (CAS)

- Coordination Office of Measures on Emerging InfectiousDiseases

- Office of Healthcare Policy

MEXTMinistry of Education,

Culture, Sports,Science andTechnology

MOFAMinistry of

Foreign Affairs

MOEMinistry of theEnvironment

NIIDNational

Institute ofInfectiousDiseases

NCGMNational

Center forGlobal

Health andMedicine

NVALNational

Veterinary Assay

Laboratory

PMDAPharmaceutical and Medical

Devices Agency

AMEDJapan

Agency forMedical

Researchand

NARONational

Agricultureand FoodResearch

Organization

FAMICFood and

AgriculturalMaterialsInspection

Center

JICAJapan

InternationalCooperation

Agency

FRAFisheriesResearch Agency

Prime Minister’s Office

- Ministerial Meeting on Measures on Emerging InfectiousDiseases

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Progress on National comprehensive actionplan on AMR in the Region

1. Launch of National Plans on AMR :

• Japan April 2016

• Philippines - (2015)

• Australia (2015)

• Cambodia (2015)

• Fiji (2015)

• Viet Nam (2013)

2. In progress:

• Republic of Korea

• Samoa• Cook Island

• Lao and others


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Progress on AMR

2. Support antimicrobial stewardship training

Philippines

Lao People’s Democratic Republic

Mongolia

3. Actions towards the Development of aGlobal AMR Surveillance System GLASS

Target: assess impact and trends of AMR

Surveillance standards defined

Surveillance manual developed

Information platform soon to be launched

Country enrolment to start in 2016


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WHO’s ongoing work in the Region

4. WHO promoted World Antibiotic Awareness Week 16-22November 2015:

2015 Theme - Antibiotics: Handle with Care

21+ Countries in the Region participated


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Ministerial Communique

Control of Antimicrobial Resistance requires coordinatedstrategies involving multiple sectors:

o Human health

o Animal health

o Agriculture, food safety, food production

o Environmental protection sectors

Call for collective action at the national, regional and global

level


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Asia Pacific

Technical Consultation on AMR in Asia 14-15 April, Tokyo, Japan


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Tokyo AMR Communique, Health Ministers 12 countries

Acknowledge the urgent need for:

Increased advocacy, education and awareness-raising activities involving all

stakeholders in relevant sectors about AMR and the responsible use of antimicrobials; Accelerated progress towards universal health coverage (UHC) to ensure access

to quality essential health-care services and to promote access to safe, quality,

effective and affordable antimicrobial medicines, diagnostics and vaccines for all,

including antimicrobials under proper measures to preserve their effectiveness;

Cross-cutting, multisectoral “One Health” approaches in all countries, involvingdifferent stakeholders, such as human and veterinary medicine, agriculture,

aquaculture, the environment and others, as appropriate to enable collaborative action

to minimize AMR and attain optimal health for humans and animals;

Global, regional and national cooperation and collaboration to preserve the

effectiveness of antimicrobials as a global public good;

Implementing and monitoring regulations, including production, distribution and use

of vaccines, diagnostics and antimicrobials for both human and animal use;

Accelerated research and development (R&D) in AMR, including the development

of new antimicrobials, diagnostics and vaccines;


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Do hereby declare launching an “Asia-Pacific One HealthInitiative on AMR” to jointly identify and tackle challenges posed by

AMR in the Asia-Pacific region by drawing a roadmap to actualize the

regional frameworks on AMR in the following priority areas of work:

Surveillance system and laboratory network; Health-care management;

Antimicrobial access and regulation;

Research and development;

Tokyo AMR Communique, Health Ministers 12 countries


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Summary

The antimicrobial resistance threat is already affecting

all countries. Every day people die from infections that do not

respond anymore to antibiotics.

Collaborative action is needed by public healthofficials, politicians, scientists, healthcare professional,agriculture sector, and health care industry

We all have the responsibility to

take action.


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Thank you

Dr Klara Tisocki

Coordinator Essential Medicines and Health TechnologiesWHO Western Pacific Regional Office

[email protected]

www.wpro.who.int/topics/drug_resistance/en/

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PRESENTATION: Antimicrobial Resistance