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WORLD HEALTH ORGANIZATION
Background GuideInMUN 2016
Director: Abhiniti Nalwad.Assistant director: Albana Khanna, Parv Lodha.
Agenda 1: Increasing global resistance to anti-bioticsAgenda 2: Mechanisms to prevent the spread of the Zika Virus
Increasing global resistance to antibiotics
INTRODUCTION:
Antibiotic resistance develops among bacteria; it results in ineffectiveness and impotence in the curative power of drugs, chemicals or other agents and diminishes their ability to mitigate the growth and survival of pathogens.
Antibiotic or antimicrobial resistance should, however, not be confused with adulteration or counterfeit. Counterfeit is the intentional manufacture of a product in imitation of another one to deceive the consumer. Adulteration is the intentional replacement of products ingredients with relatively inferior elements which debases the potency of the medicine without informing the consumer of such degradation in quality. Both of them are considered a violation to consumer rights and every member state’s constitution has sovereign laws which mandate manufacturing activities and ensure that any violation is subject to the punishments laid out in its provisions.
Antimicrobial resistance includes antibiotic resistance along with resistance against medicinal drugs by parasites, virus and fungi.
The WHO reported an increase in resistance to HIV drugs in 2012. A year later, 480,000 cases were reported in 100 countries of drug resistant tuberculosis. Contrary to popular misconceptions, antibiotic resistance can be fatal at times. Unexpected phenomenon like antibiotic resistance during the treatment period can lead to prolonged illness and increased health expenditure.
Infected consumers that have biologically developed resistant bacteria become sources of contagious communication of these resistant pathogens in their nursing homes, clinics or hospitals “Up to 50% of the time antibiotics are not optimally prescribed, often done so when not needed, incorrect dosing or duration.” -cdc.gov
As a result, patients return home after being released from hospitalization, still possessing the resistant bacteria which further multiply within their biological system and contagiously migrate to different hosts. On a larger scale, this means hundreds of people being infected with resistant bacteria.
The problem becomes more intense in the case of animals that are prescribed with antibiotics. Economic utilization of cattle extends not only to the effective application of its products like milk, but even to its wastes. Manure and cow dung are used as fertilizers and the crops grown inherit the chemical composition and fundamental elements of the manure. If the animal is infected with resistant pathogens, they are transmitted to the crops and are also present in meat. Click here for info graphic.
PREVIOUS RESOLUTIONS ADOPTED BY WHO, REGIONAL COMMITTEES AND FAO
World Health Assembly Resolutions
2015
Resolution: WHA A68/20 - Antimicrobial resistance. Draft global action plan on antimicrobial resistance
2014
Resolution: WHA 67.25 - Antimicrobial Resistance
2009
Progress report on 2007 Rational Use of Medicines Resolution (113K) (2009)
For this resolution refer to Page 17 but the other topics can be studied if you feel they are related to antibiotic resistance
2007
Progress report: WHA A60/28 - Progress reports on technical and health matters - Improving the containment of antimicrobial resistance, 5 April 2007 (200K) (2007)
Resolution WHA 60.16 (911K) (2007)
2005
Background: WHA A58/14 - Antimicrobial resistance: a threat to global health security. Rational use of medicines by prescribers and patients (151K) (2005)
WHA58.27 May 2005 – Improving the containment of antimicrobial resistance [pdf 201kb]
2001
Background: WHA A54/17 - Revised drug strategy 10 April 2001 (<100K) (2001) Resolution: WHA 54.11 - WHO medicines strategy, 21 May 2001 (<100K) (2001) Background: WHA A54/9 - Global health security - epidemic alert and response,
April 2 2001 (<100K) (2001) Resolution: WHA 54.14 - Global health security: epidemic alert and response, May
21 2001 (<100K) (2001)
1998
Background: WHA A51/9 - Emerging and other communicable diseases: antimicrobial resistance, 10 March 1998 (<100K) (1998)
Resolution: WHA 51.17 - Emerging and other communicable diseases: antimicrobial resistance. 16 May 1998 (<100K) (1998)
Regional Committees Resolutions
European strategic action plan on antibiotic resistance Regional Committee for Europe, September 2011
FAO Resolution
Refer only to Page 16 of 62 for this resolution.
REGIONAL PREVALANCE OF ANTIBIOTIC RESISTANCE
Africa:
Resistance for several bacteria has been reported in the African region. This includes significant E. coli resistance to third generation cephalosporins and fluoroquinolones–two important and commonly used types of antibacterial medicine. Eighty percent of Staphylococcus aureus infections are reported to be resistant to methicillin (MRSA), meaning treatment with standard antibiotics does not work. Reports from different parts of Nigeria have observed temporal trends in the prevalence of resistance among enteric organisms, such as Escherichia coli and Shigella. In an outbreak of resistant Acinetobacter in a South African hospital, mortality was around 50% and outbreaks of life threatening diarrheal disease have occurred in hospitals, associated with similar rates of mortality.
DRUG RESISTANT TUBERCULOSIS IN AFRICA
Americas:
Antibiotic resistance in the Americas is similar to Africa but more intense. There is E.coli resistance to cephalosporins and fluoroquinolones. Ninety percent of Staphylococcus aureus infections are resistant to MRSA. “Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections.” –cdc.gov
Eastern Mediterranean:
“Susceptibility test results from invasive isolates of Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Enterococcus faecium and faecalis routinely recovered from clinical samples of blood and cerebrospinal fluid within participating laboratories situated in Algeria, Cyprus, Egypt, Jordan, Lebanon, Malta, Morocco, Tunisia and Turkey were collected as part of the ARMed project.” –publmed.gov
Europe:
Sixty percent of Staphylococcus aureus infections are reported to be methicillin-resistant (MRSA). To know about the surveillance of antimicrobial resistance within the EU, click here.
South-East Asia:
In 2011, the health ministers of the Region articulated their commitment to combat drug resistance through the Jaipur Declaration .
Western Pacific:
AWARENESS STATISTICS IN THE WESTERN PACIFIC REGION
Source: who.int
There are high levels of E. coli resistance to fluoroquinolones. Resistance to third generation cephalosporins in K. pneumoniae is also widespread. In some parts of the Region, as many as 80% of Staphylococcus aureus infections are reported to be methicillin-resistant (MRSA).
GOAL AND QUESTIONS A RESOLUTION MUST ANSWER:
Delegates of this committee will propose, advocate, scrutinize, analyze and constitute provisions, design indicators and establish standards that not only check the outbreak or sporadic transmission of resistant bacteria but also permanently prevent it.
What strategies should the surveillance system adopt? Which indicators should be adopted by the surveillance system? How can surveillance in developing countries be carried out with advanced
technology? Which economic, consumption and health indicators should be used that serve as
detectors of spreading resistant bacteria? Should/What standards be/are established for food, beverage and other consumption
products that can be used to detect the presence of any resistant bacteria? Should these standards be re-examined by large pharmacies and retail sellers or they
should be examined only by the government (keeping the possibility of corruption in mind)?
Are resolutions, declarations, multilateral or bilateral agreements that are presently in effect but were ratified in the past suitable for the current situation?
Does the possibility of intentional introduction of resistant bacteria into the ecosystem by pharmaceutical industries exist? If so, how should they be investigated?
In the case that an alternative to antibiotics is discovered/invented that is effective against resistant bacteria as well, how should the antibiotics present in storage be effectively mobilized to be economically utilized?
Should individuals that possess resistant bacteria (and proven to do so) be experimented on?
Which organizations or agencies can the WHO collaborate with, to promote and conduct activities and practices that prevent resistance?
Has the WHO collected enough data which can serve as a base for analysis to prioritize research and innovation with Health Ministries and private pharmaceutical companies or should the WHO rather facilitate and assist the collection of statistical data by Central Statistic Organizations and Health Ministries first and then conduct research at a later stage?
Should the WHO be allowed, or allow other organizations, to incorporate the execution of experiments and tests on animals as part of their research? If not, what alternatives should be adopted by the WHO and other organizations?
Despite a comprehensive plan, why did the WHO’s 2001 strategy to contain antibiotic resistance fail?
How should the strategies implemented, programmes and activities executed be recorded, so that they can be referred to, in the future?
Please don’t confine your research only to these questions. An extensive and elaborate research supports and encourages reasonable and logical debates.
BIBLIOGRAPHY
Antibiotic / Antimicrobial Resistance | CDC Data and reports: Antimicrobial resistance and consumption Antibiotic resistance in the southeastern Mediterranean--preliminary results from the
ARMed project. - PubMed - NCBI Antibiotic Resistance Threats in the United States, 2013 | Antibiotic/Antimicrobial Resistance
| CDC Antibiotic resistance – the challenge for Africa - s18244en.pdf WHO | WHO’s first global report on antibiotic resistance reveals serious, worldwide threat
to public health
Mechanisms to prevent the spread of the Zika Virus
INTRODUCTION:
The outbreak of Zika virus in April 2015 which steadily transmitted through the islands of the Pacific in the Far East and Americas, received prodigious emphasis by the fact that it was witnessed while another fatal virus outbreak was being contained in Africa – Ebola.
The Zika virus owes its name to the Zika Forest, which is situated next to an inlet of Lake Victoria, not far from Entebbe in Uganda. The 25 hectares (62 acres) of tropical forest is a protected zone and it is used only for scientific research.
While Ebola is no longer an international threat to public health, as claimed in the 9th meeting of the Emergency Committee, the outbreak of Zika virus has been declared a Public Health Emergency of International Concern by the WHO.
Zika is a mosquito-borne disease; transmitted by the Aedes mosquitoes (the same insect that transmits chikungunya and yellow fever). It was first identified in Uganda in 1947 in rhesus monkeys and in humans in 1952 in Uganda and Tanzania. Colombia has had the highest
number of confirmed cases; while Brazil has the highest number of suspected cases. Malaysia, Thailand, Cambodia, Philippines and Indonesia are among countries that have reported numerous cases.
Most people who get infected with the Zika virus do not show any symptoms. Only one in five people who get it will feel sick. Fever, skin rashes, muscle and joint pains, and headache are among the common symptoms. However, the Zika has been observed to adversely affect pregnant women. “Zika's symptoms are similar to those of dengue, but the new virus carries a much bigger risk for pregnant women, as growing evidence is linking birth defects to pregnant mothers who have contracted Zika in their first or second trimesters.” –Romper.com Infants with microcephaly have been reported among mothers who were infected with Zika virus while pregnant.
TERRITORIES AFFECTEDAlthough numerous cases have been reported mostly in the Americas, Oceania/Pacific Islands, and Cape Verde in Africa, a research conducted revealed that 2.17 billion people reside in areas that have environments vulnerable to the Zika virus. In total, 64 countries (as of April 2016) and territories have reported transmission of Zika virus since 1 January 2007
Source: NBC News
THE AMERICAS:
Large areas of the Americas are vulnerable to the virus, with the riskiest areas being in Brazil, Colombia and Venezuela (in order of their vulnerability). Coastal areas in southern Brazil that witness frequent rainfall and areas of northern Brazil are high risk areas but central
Brazil is relatively safer.
Denver and Salt Lake City are less vulnerable owing to their negligible mosquito populations. These cities being dry prevent the geographical formation of breeding grounds. Moreover, their high altitudes make them less accessible to mosquitoes.
THE PACIFIC ISLANDS:
Outbreaks of mosquito-borne illnesses are common in the tropical and sub-tropical climates in many Pacific Islands. Local virus transmission has been reported in Samoa, Tonga and the Fiji islands. “A total of eight people in Japan have so far been confirmed with Zika virus infection since the first such case in the country in 2013, with all of them infected overseas.” – Japan Today
AFRICA:
Evidence of human infection with Zika has been reported in Sierra Leone, Tanzania, Gabon, Egypt, the Central African Republic and Uganda but not all of them have been confirmed with a 100% assurance. African countries vary in their access to healthcare and disease detection and management, and ones with strong health systems are likely to cope better with a Zika outbreak. Cape Verde is the only African country to have reported case of Zika virus infection, 7000 of them occurring between October and December in 2015.
For a list of all the countries/territories affected: click here.
TIMELINE
Source : FOX News
The following timeline charts the origin and spread of the Zika virus from its discovery nearly 70 years ago:
1947: Scientists researching yellow fever in Uganda's Zika Forest identify the virus in a rhesus monkey
1948: Virus recovered from Aedes africanus mosquito in Zika Forest
1952: First human cases detected in Uganda and Tanzania
1954: Virus found in Nigeria
1960s-80s: Zika detected in mosquitoes and monkeys across equatorial Africa
1969-83: Zika found in equatorial Asia, including India, Indonesia, Malaysia and Pakistan
2007: Zika spreads from Africa and Asia, first large outbreak on Pacific island of Yap
2012: Researchers identify two distinct lineages of the virus, African and Asian
2013-14: Zika outbreaks in French Polynesia, Easter Island, the Cook Islands and New Caledonia. Retrospective analysis shows possible link to birth defects and severe neurological complications in babies in French Polynesia
March 2, 2015: Brazil reports illness characterized by skin rash in northeastern states
July 17: Brazil reports detection of neurological disorders in newborns associated with history of infection
Oct. 5: Cape Verde has cases of illness with skin rash
Oct. 22: Colombia confirms cases of Zika
Oct. 30: Brazil reports increase in microcephaly, abnormally small heads, among newborns
Nov. 11: Brazil declares public health emergency
November 2015-January 2016: Cases reported in Suriname, Panama, El Salvador, Mexico, Guatemala, Paraguay, Venezuela, French Guiana, Martinique, Puerto Rico, Guyana, Ecuador, Barbados, Bolivia, Dominican Republic, Nicaragua, Curacao, Jamaica
Feb. 1: World Health Organization (WHO) declares public health emergency of international concern
Feb. 2: First case of Zika transmission in United States; local health officials say likely contracted through sex, not mosquito bite
Feb. 5: U.S. Centers for Disease Control and Prevention says virus being actively transmitted in 30 countries, mostly in the Americas
Feb. 8: U.S. President Barack Obama requests $1.8 billion to fight Zika
Feb. 12: Brazil investigating potential link between Zika infections and 4,314 suspected cases of microcephaly. Of those, 462 confirmed as microcephaly and 41 determined to be linked to virus
Feb. 17: Brazil investigating potential link between Zika and 4,443 suspected cases of microcephaly. Of those, 508 confirmed as microcephaly and most of those cases are linked to the virus. WHO seeks $56 million to fight Zika.
Feb. 18: CDC adds Aruba and Bonaire to countries and territories with active outbreaks, bringing total to 32.
Feb. 23: CDC investigating 14 cases of possible sexual transmission of Zika. CDC also adds Trinidad and Tobago and Marshall Islands to countries and territories with active outbreaks, bringing total to 34.
Feb. 25: Brazil says confirmed microcephaly cases number more than 580 and considers most of them to be related to Zika infections in the mothers. Brazil is investigating an additional 4,100 suspected cases of microcephaly.
Feb. 27: France detects first sexually transmitted case of Zika.
Feb. 29: CDC adds St. Maarten, and Saint Vincent and the Grenadines to countries and territories with active outbreaks, bringing total to 36.
March 1: Brazil says confirmed microcephaly cases rose to 641 and considers most of them to be related to Zika infections in the mothers. Brazil is investigating an additional 4,222 suspected cases of microcephaly.
March 8: WHO advises pregnant women to avoid areas with Zika outbreak and said sexual transmission of the virus is "relatively common."
March 9: CDC adds New Caledonia to countries and territories with active outbreaks, bringing total to 37.
March 15: Cuba reports first case of Zika contracted in the country.
March 16: Cape Verde identifies first case of microcephaly.
March 18: CDC says during Jan. 1, 2015 to Feb. 26, 2016, 116 residents of the United States had evidence of recent zika virus infection based on laboratory testing.
Brazil says confirmed microcephaly cases rose to 863 and considers most of them to be related to Zika infections in the mothers. Brazil is investigating an additional 4,268 suspected cases of microcephaly.
March 19: CDC adds Cuba to countries and territories with active outbreaks, bringing total to 38.
March 21: South Korea confirms first case of Zika.
SOURCES: World Health Organization, U.S. Centers for Disease Control and Prevention, Reuters
TRANS PACIFIC PARTNERSHIP
The most moot point is the effect of TPP (Trans Pacific Partnership). Although not ratified yet, an implementation of its provisions (about intellectual property rights) will mean extended patent monopolies which will translate into surging prices of medicines in the Pacific region.
The Trans-Pacific Partnership (TPP) is a trade agreement signed by twelve Pacific Rim countries on 4 February 2016, after seven years of negotiations.
The TPP aims to open new avenues for employment, create economic conditions that are conducive to the retention of jobs, promote good governance and liberalize investments and business.
Article QQ.A.4 of the TPP Intellectual Property chapter states that “The Parties affirm their commitment to the Declaration on the TRIPS Agreement and Public Health.”
Now, the 3rd point of the Declaration on the TRIPS Agreement and Public Health states that “We recognize that intellectual property protection is important for the development of new medicines. We also recognize the concerns about its effects on prices.” This means that even though signatories of the declaration are aware about the effect IP rights have on prices, they still would encourage IP rights in the pharmaceutical industry. This would mean that IP rights would privilege a few companies with monopoly power giving them substantial control over the prices of medicines.
The committee shall, therefore, discuss whether the outbreak of Zika virus is too trivial for the signatories to refrain from ratifying the TPP. If not ratifying the TPP, should the IP rights chapter be scrapped out? All twelve signatories signed the TPP on February 4, 2016. The agreement will enter into force after ratification by all signatories, if this occurs within two years. If the agreement is not ratified by all before 4 February 2018, it will enter into force after ratification by at least 6 states which together have a GDP of more than 85% of the GDP of all signatories.
For the full IP Chapter of TPP, click here.
An article in the New England Journal of Medicine described TPP's impact on healthcare in both developed and less developed countries, which could lead to increased prices of medical drugs due to patent extensions, which could threaten millions of lives. Even countries like New Zealand and Malaysia experienced negative responses against the deal because of surging medicine prices.
“The big US pharmaceutical companies are out to get Pharmac. They’re happy to have it exist on favor, but they want to gut all of the price-savings rules so they can increase medicine prices.”- Ms. Wallach, a US Trade campaigner
Pharmac is a government agency of New Zealand that channelizes public funding to pharmaceutical companies in New Zealand.
Trade Negotiations Minister of New Zealand Tim Groser denied the claims saying that the opponents of the deal are "trying to wreck this agreement"
The signatories of TPP include: Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, United States and Vietnam. So while these countries support the TPP, countries that are negatively affected by implication of the TPP provisions could use
the outbreak of Zika virus to convince these countries to refrain from ratification.
Signatories
Potential future members (other APEC member economies)
GOAL AND QUESTIONS A RESOLUTION MUST ANSWER
Delegates of the committee will propose, advocate and constitute provisions that establish a mechanism which prevents the spread of Zika virus. Apart from this, the mechanism should attempt at mitigating factors and conditions which culminate into another virus outbreak in territories of the Pacific, the Americas and Africa.
What strategies should be adopted by the response framework? What programmes can the mechanism undertake at an international level? How will the programmes and mechanism adapt to changing trends in reported and
suspected cases? Should protection of non-infected people be prioritized or the cure of virus infected
people or should they be done simultaneously acknowledging the fact that it could lead to loss in efficiency of both?
To what extent is establishing a diagnosis relationship over the internet possible? To what extent can the establishment of a relief and consultancy hotline contribute to
preventing the spread of Zika? Is it important, at this stage, to forbid the utilization of materials that can stem the
mosquito population, solely to protect the environment? What factors could cause project failure and failure of strategy implementation? How can these factors be dealt with? How can the mechanism refer to the strategy adopted to contain Ebola and implement
it in this case? How can implementation of strategies, further research and execution of programmes
be recorded to assist future mechanism that work towards combating fatal outbreaks? Is the outbreak of Zika virus too trivial to expect signatories of the TPP to refrain
from ratification?
If the signatories refuse to refrain from ratification, can the clauses related to Intellectual Property rights and patents in the pharmaceutical industry be scrapped out until the outbreak is contained?
Please don’t confine your research only to these questions. An extensive and elaborate research supports and encourages reasonable and logical debates.
BIBLIOGRAPHYZika virus: 2.2 billion people in 'at risk' areas - BBC NewsDengue fever, Chikungunya and Zika virus in the Pacific Islands | SafeTravelWHO | Zika virus and complicationsZika virus | Ministry of Health NZZika virus - Wikipedia, the free encyclopediaAreas with Zika | Zika virus | CDCWHO | Zika virusCountries & Territories with Active Local Zika Virus Transmission | Zika virus | CDCZika outbreak expands; WHO assesses threat to Africa | CIDRAPTimeline - Zika's origin and global spread | Fox NewsWikileaks-secret-TPP-treaty-IP-chapter.pdfTPP - Wikipedia, the free encyclopediahttp://www.newshub.co.nz/politics/us-companies-out-to-get-pharmac-2012120508#axzz4792izgANhttps://www.pharmac.govt.nz/about/
