No action today, no cure tomorrow

Transcription

1 No action today, no cure tomorrow 明日のために 今行動を 24 November 2016, Tokyo Takeshi KASAI Director, Programme Management, WHO Western Pacific Region

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3 Key messages AMR is caused by our action yesterday and WHO is so concerned in particular about AMR in ASIA There are multiple driving forces causing AMR and it is essential to adopt whole-of-government and whole-of-society approaches with the joint-leadership of the health and animal sectors AMR is a global agenda that requires action today for tomorrow s cure. AMR requires imagination to understand AND a long-term system to address

4 Why we worry? なぜ WHO は憂慮しているのか? Treatment of drug resistance is more difficult, expensive and does not necessarily result in good outcomes AMR has been increasing and spreading globally Antibiotic consumption has been increasing and effective regulatory systems are not yet in place Less new drugs are entering the market

5 Drug resistant TB: A man-made disaster Drug resistance created through inappropriate treatment Patients have to undergo toxic and costly treatment for two years or more Treatment outcome is poor with high mortality 5-year survival rate of XDR-TB: 23% * MDR-TB is defined as resistance to isoniazid and rifampicin. XDR-TB is defined as resistance to at least isoniazid and rifampicin, and to any fluoroquinolone, and to any of the three

6 性菌による推計死亡者数 薬剤耐 European Union population 500m 25,000 deaths per year 2.5m extra hospital days Thailand population 70m >38,000 deaths >3.2m hospital days United States population 300m >23,000 deaths >2.0m illnesses Overall societal costs ( 900 million, hosp. days) Approx. 1.5 billion per year Overall societal costs US$ mill. direct >US$1.3 billion indirect Overall societal costs Up to $20 billion direct Up to $35 billion indirect Source: ECDC 2007 Source: Pumart et al 2012 Source: US CDC 2013

7 Drug resistance spreads globally International dissemination of New Delhi metallo-ß-lactamase (NDM) producing Enterobacteriaceae Alan P. Johnson1 and Neil Woodford Journal of Medical Microbiology (2013), 62,

8 Increase use of antimicrobials in the health sector

9 Drug use in animal and fishery sectors (A) Largest five consumers of antimicrobials in livestock in 年の使用量の上位 5カ国 2030 年の推計使用量 増加量の多い上位 5 カ国 増加の割合の多い上位 5 カ国

10 Global distribution of relative risk of an Emerging Infectious Disease Event; 新興感染症のリスク Maps are derived for EID events caused by a, zoonotic pathogens from wildlife, b, zoonotic pathogens from non-wildlife, c, drug-resistant pathogens and d, vector-borne pathogens. The relative risk is calculated from regression coefficients and variable values, categorized by standard deviations from the mean and mapped on a linear scale from green (lower values) to red (higher values). 10

11 Current US$ Dynamic development of Asian countries 0 Proportion of people access to internet Structure of Health Expenditure a in current US$ per capita Out-of-pocket Expenditure per capita in US$ Other Private Health Expenditure per capita in US$ General Government Health Expenditure per capita in US$

12 Hard-to-reach populations 少数民族の住む僻地

13 Drug Resistant Malaria in the Mekong subregion

14 New drugs 抗菌薬 :Drying up after a golden age!

15 フレミング博士の予言 Early warnings by Sir Alexander Fleming on resistance It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body. The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.

16 The future we see

17 Global Action Plan on Antimicrobial Resistance Awareness Surveillance and research Reduce incidence of infection Optimize use of drugs Sustainable investment Endorsed at World Health Assembly on 27 May 2015

18 37 countries & areas Wide geographical range Various climate zones Economic situation Population sizes

19 Mechanism for progress AMR Campaign Technical Support Regional Office for the Western Pacific National Coordination National Coordination National Coordination National Plan Coordination National Plan Awareness Coordination/ Campaign Plan Awareness National Campaign Plan Plan Awareness Campaign Awareness Campaign Surveillance Health System surveillance antimicrobial stewardship Health system Monitoring consumption WHO Country office 19

20 Progress on National Action Plans on AMR 1. Launched National Plans (9): Australia (2015) Cambodia (2015) China (2016) Cook Islands (2016) Fiji (2015) Japan (2016) Philippines (2015) Republic of Korea (2016) Viet Nam (2013) 2. In progress (8): Hong Kong SAR (China) Lao PDR Mongolia Papua New Guinea New Zealand Samoa Singapore 3. Priority countries for 2017: Kiribati Solomon Islands Tonga Vanuatu Additional Pacific Island Countries 20

21 World Antibiotic Awareness Week November 2016 Regional Platform: joint planning (July 2016) 2 National action plans launched 5 Countries launched guidelines (Antimicrobial Stewardship, Antibiotic Guidelines, Infection Prevention and Control) 12 countries held high level multisectoral events 16 conducted training workshops of health professionals

22 World Antibiotic Awareness week Samoa: held 1 st Annual AMR Summit opened by the Prime Minister

23 World Antibiotic Awareness week Lao PDR: 1 st multistakeholder workshop to develop the National Action Plan supported by FAO-OIE-WHO

24 World Antibiotic Awareness week Philippines: launched National Antibiotics Guidelines, Manual of Procedures in Implementing Antimicrobial Stewardship in Hospitals, and Methods Guide for Antimicrobial Use Monitoring.

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26 What we learned from HPAI Public Health Sector alone cannot control the disease effectively Requires effective coordination with animal and food safety sectors We know so little about the epidemiology particularly in the ecosystem including the role of wildlife Photo: courtesy to FAO

27 One Health One Health EMPRES-Asia OIE PVS Pathway

28 アジア太平洋感染症対策戦略 APSED-Zoonoses Coordinated Response Surveillance information from human health sector Surveillance information from animal health sector Human Health Animal Health Wildlif e Coordination Mechanism Research Analysis Research Analysis Coordinated Risk Reduction

29 Examples from Mongolia and Philippines Ching et al. Outbreak of Henipavirus Infection, Philippines, Emerging Infectious Diseases Vol. 21, No. 2, February 2015

30 Tokyo Meeting of Health Ministers on AMR in Asia 16 April 2016 Communiqué of Tokyo Meeting of Health Ministers on AMR in Asia Biregional Technical Consultation on AMR in Asia April 2016 Outcome Statement to support the implementation of the Tokyo Communiqué

31 持続可能な開発目標 No body left behind! 誰も取り残されることのない未来に向けて

32 Framing of AMR as a Development Agenda in Tokyo IHR and UHC

33 If you want to go faster, go alone, if you want to go far, go together. アフリカのことわざ