Strategy and Policy Cohesion:Strategy and Policy Cohesion:

“The One Health Agenda: will it deliver”“The One Health Agenda: will it deliver”

Elizabeth J. Phillips, MD, FRCPC,FRACP, FACTMElizabeth J. Phillips, MD, FRCPC,FRACP, FACTM

Professor & Director, Centre for Clinical Pharmacology & Infectious DiseasesProfessor & Director, Centre for Clinical Pharmacology & Infectious DiseasesInstitute for Immunology & Infectious Diseases, Murdoch UniversityInstitute for Immunology & Infectious Diseases, Murdoch University

John A. Oates Chair in Clinical ResearchJohn A. Oates Chair in Clinical ResearchProfessor of Medicine & PharmacologyProfessor of Medicine & PharmacologyDirector of Personalized ImmunologyDirector of Personalized Immunology

Oates Institute for Experimental TherapeuticsOates Institute for Experimental TherapeuticsVanderbilt University School of MedicineVanderbilt University School of Medicine

““Drugs Don’t Work”Drugs Don’t Work”

Allan Roses, December 2003Allan Roses, December 2003

VP of Genetics (GSK)VP of Genetics (GSK)

>90% of drugs have efficacy in 30-50% of >90% of drugs have efficacy in 30-50% of peoplepeople

Overview of Global and National ResponseOverview of Global and National Response

Social, financial and environmental depthSocial, financial and environmental depth Education and communicationEducation and communication National antimicrobial resistance response National antimicrobial resistance response

documents supporting commitmentdocuments supporting commitment Global antimicrobial responseGlobal antimicrobial response Implementation – what are the measurable Implementation – what are the measurable

outcomesoutcomes

The AMR One Health Policy Toolkit: The AMR One Health Policy Toolkit: Animal-Human InterfaceAnimal-Human Interface

Awareness Awareness Surveillance (obstacles to data collection) and antimicrobial Surveillance (obstacles to data collection) and antimicrobial

stewardship in agriculturestewardship in agriculture Education and CommunicationEducation and Communication Evidence base (decreased AMR after voluntary withdrawal) Evidence base (decreased AMR after voluntary withdrawal)

and ongoing effectiveness monitoringand ongoing effectiveness monitoring Broad agricultural implications and complexity of the “AMR Broad agricultural implications and complexity of the “AMR

web” (aquaculture, the plant connection)web” (aquaculture, the plant connection) Alternatives to antimicrobials in agricultureAlternatives to antimicrobials in agriculture Industry and regulatory issuesIndustry and regulatory issues

Globalisation & Governance of AMRGlobalisation & Governance of AMR Challenges in developing world parallel those in Challenges in developing world parallel those in

developed world – political & cultural considerationsdeveloped world – political & cultural considerations Defining extent of problem, educational compaignsDefining extent of problem, educational compaigns Conservation of antibiotics and promote stewardship and Conservation of antibiotics and promote stewardship and

infection control infection control Challenges of global demand for animal protein Challenges of global demand for animal protein

(antimicrobial consumption in agriculture) – need (antimicrobial consumption in agriculture) – need incentives to change practice, non-antibiotic approaches, incentives to change practice, non-antibiotic approaches, infection controlinfection control

AMR shows no boundariesAMR shows no boundaries

One Health ApproachOne Health Approach

Broadly engageBroadly engage– Doctors, veterinarians, farmers, industry and communityDoctors, veterinarians, farmers, industry and community

Consistent approachesConsistent approaches– Infection prevention, optimize antibiotic utilization in human Infection prevention, optimize antibiotic utilization in human

and animal sectors, new treatments and diagnostic methodsand animal sectors, new treatments and diagnostic methods

Simple messagesSimple messages– What can be done now?What can be done now?

– Reinforce positive achievements, raise awareness of risk, Reinforce positive achievements, raise awareness of risk, attention to health science, social, environmental and attention to health science, social, environmental and economic issues and uncertainties surrounding alleconomic issues and uncertainties surrounding all

Australian Colloquium 2013

Driver’s and Consequences of Driver’s and Consequences of Antimicrobial ResistanceAntimicrobial Resistance

Multidisciplinary ToolkitMultidisciplinary Toolkit

System changeSystem change Training and educationTraining and education EvaluationEvaluation Reminders (eg workplace)Reminders (eg workplace) Safety climateSafety climate Adapt to cultureAdapt to culture

Dr. Didier Pittet

Partnership, Leadership & InnovationPartnership, Leadership & Innovation

The Human health and social care sectorThe Human health and social care sector Livestock, food retail and veterinary sectorsLivestock, food retail and veterinary sectors Research councils, other research funders and Research councils, other research funders and

academicsacademics Pharmaceutical industryPharmaceutical industry Local governments, professional boards, scentific Local governments, professional boards, scentific

and other advisory committeesand other advisory committees

UK 5 year antimicrobial resistance strategy 2013-2018

WHO Global Action PlanWHO Global Action Plan

Building Block 1: Building Block 1: AWARENESSAWARENESS Building Block 2: Building Block 2: IDENTIFYING and IDENTIFYING and

OPERATIONALIZING INFECTION PREVENTION OPERATIONALIZING INFECTION PREVENTION APPROACHESAPPROACHES

Building Block 3:Building Block 3: OPTIMIZING ANTIMICROBIAL USE OPTIMIZING ANTIMICROBIAL USE IN HUMAN & ANIMAL HEALTH & AGRICULTUREIN HUMAN & ANIMAL HEALTH & AGRICULTURE

Building Block 4:Building Block 4: CLOSING KNOWLEDGE GAPS CLOSING KNOWLEDGE GAPS Building Block 5:Building Block 5: INNOVATION INNOVATION Building Block 6:Building Block 6: COSTS AND INVESTMENTCOSTS AND INVESTMENT

US National Goals, Sept 2014US National Goals, Sept 2014

1. Slow Emergence of AMR1. Slow Emergence of AMR 2. Strengthen National One-Health Surveillance 2. Strengthen National One-Health Surveillance

EffortsEfforts 3. Advance development of rapid diagnostic 3. Advance development of rapid diagnostic

tests to identify and characterize AMR.tests to identify and characterize AMR. 4. New Antibiotics, therapeutics and vaccines4. New Antibiotics, therapeutics and vaccines 5. Global effort on AMR prevention, 5. Global effort on AMR prevention,

surveillance, control and antibiotic R&D.surveillance, control and antibiotic R&D.

Canadian AMR ResponseCanadian AMR Response

ACTION 1:ACTION 1: establish and increase surveillance in establish and increase surveillance in both animal and human settingsboth animal and human settings

ACTION 2: ACTION 2: promote appropriate antibiotic use in promote appropriate antibiotic use in animal and human settingsanimal and human settings

ACTION 3:ACTION 3: work with animal agriculture sector work with animal agriculture sector (antibiotic stewardship in veterinary medicine)(antibiotic stewardship in veterinary medicine)

ACTION 4: ACTION 4: promote innovationpromote innovation

October 2014

Where to go from here?Where to go from here?

Definition and measurement of problem, awareness and Definition and measurement of problem, awareness and broad and global engagementbroad and global engagement

Build on existing success and models that have a proven Build on existing success and models that have a proven track recordtrack record

What can we do now and defining prioritiesWhat can we do now and defining priorities What are the short and long-term measurable outcomesWhat are the short and long-term measurable outcomes Diagnostic test development Diagnostic test development Antibiotic pipeline (a lengthy process that will not modify Antibiotic pipeline (a lengthy process that will not modify

behavior or attack root of the problem)behavior or attack root of the problem) Other approaches (vaccine, non-antimicrobial)Other approaches (vaccine, non-antimicrobial)