Managing AMR at the Human-Animal Interface. OIE Contributions to the AMR Global Action Plan

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1 Managing AMR at the Human-Animal Interface OIE Contributions to the AMR Global Action Plan 6th Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of Zoonoses Dr Susan Corning World Organisation for Animal Health (OIE) Hokkaido University Sapporo, Japan October 2015

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3 Content Global Action Plan criteria necessary for success OIE input 5 areas of support Conclusion

4 AMR Global Action Plan WHO: AMR Global Action Plan (GAP) Goal: to ensure, for as long as possible, continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way, and accessible to all who need them. It is expected that countries will develop their own national action plans on antimicrobial resistance in line with the global plan. HLTM meeting report

5 So what do we need to achieve success?

6 Needs Collaboration Multisectoral collaboration a successful plan against AMR is inherently interdependent - (including coordination of effective policies; legislation on access to, and restricted use of, quality drugs; and R&D of new drugs) Standards Capacity building Data Country support International standards (to harmonise protocols and methodologies) - to monitor AMR and antimicrobial usage, and good governance of all sectors related to authorisation and use of antimicrobials Building of technical capacity to conduct surveillance of AMR and antimicrobial use, and AMR risk analysis Information collection and sharing - monitoring and surveillance data on AMR and antimicrobial use, and AMR risk analysis Support to countries - to successfully plan and implement national AMR strategies

7 How does the OIE specifically contribute to addressing the needs of the Global Action Plan?

8 OIE actions to tackle AMR: matching GAP needs 1. Collaboration 5. Supporting Member Countries One Health 2. Standards 4. Information collection & sharing 3. Capacity building

9 Tripartite (FAO-OIE-WHO) collaboration on AMR Technical Focal Points nominated Identified common areas for cooperation Use common messages Participation in relevant ad hoc Groups, meetings and trainings Common country & subregional approaches and projects Invited to meetings of the WHO Strategic and Technical Advisory Group on Antimicrobial Resistance and to contribute to the AMR Global Action Plan The OIE will actively participate in the World Antibiotic Awareness Week, on November 2015, in collaboration with international partners.

10 Global Health Security Agenda (GHSA) OIE a key supporting partner to GHSA Action Packages particularly Prevent-1: AMR White House GHSA Event, September 2014: OIE announces formal commitment to contribute 5 aspects of unique importance to the GHSA and its 11 Action Packages

11 Global Health Security Agenda (GHSA) Action Package Prevent-1: AMR 2015 Seoul GHSA High Level Meeting, Seoul, South Korea Action Package Annual Plan: Milestones for the Year 2 of GHSA National One Health AMR plans Twinning to assist countries in AMR efforts AMR stewardship support of international/regional meetings, etc OH surveillance of AMR and antimicrobial use (OIE brief to contribute information as appropriate from its new animal health antimicrobial use database)

12 OIE actions to tackle AMR: matching GAP needs 1. Collaboration 5. Supporting Member Countries One Health 2. Standards 4. Information collection & sharing 3. Capacity building

13 10 years of OIE Standards & Guidelines on antimicrobial agents - updated and adopted between 2012 and 2015 WHO and FAO participate in the ad hoc Group on AMR Terrestrial Code Chapters cover: Harmonisation of national antimicrobial resistance surveillance programmes Monitoring of the quantities and usage patterns Responsible and prudent use Risk assessment (linked the use of antimicrobial agents in animals) OIE List of Antimicrobial Agents of Veterinary Importance

14 OIE List of Antimicrobial Agents of Veterinary Importance (updated 2014 in collaboration with WHO and FAO to take into account concerns for human health) For a number of Antimicrobial Agents there are no or few alternatives for the treatment of diseases in target species. Among the Veterinary Critically Important Antimicrobial Agents, some are also of critical importance for human health (3 rd & 4 th generation Cephalosporins, and Fluoroquinolones):

15 Classes of antibiotics included in the WHO, OIE and FDA lists of Critically Important antimicrobial agents* WHO Critically Important Antibiotics for Human Medicine WHO Highest Priority Critically Important Antibiotics OIE List of Antimicrobial Agents of Veterinary Importance FDA Critically Important Antibiotics for Human Medicine *

16 OIE List of Antimicrobial Agents of Veterinary Importance (updated 2014 in collaboration with WHO and FAO to take into account concerns for human health) For a number of Antimicrobial Agents there are no or few alternatives for the treatment of diseases in target species. Among the Veterinary Critically Important Antimicrobial Agents, some are also of critical importance for human health (3 rd & 4 th generation Cephalosporins, and Fluoroquinolones): Not to be used as preventive treatment in feed or water or in absence of clinical signs Not to be used as first line, unless justified and bacteriological test Extra label/off label limited and reserved for instances no alternatives are available.

17 OIE actions to tackle AMR: matching GAP needs 1. Collaboration 5. Supporting Member Countries One Health 2. Standards 4. Information collection & sharing 3. Capacity building

18 OIE builds veterinary capacity to address AMR issues Nomination and training of National Focal Points to assist OIE delegate in specific areas (eg AMR training veterinary products). December 2015: Focal Point training in Uganda, with one day dedicated to AMR OIE Reference Laboratories and Twinning Programmes Twinning Programmes mobilise the expertise of the 277 OIE Reference Laboratories and Collaborating Centres network to assist laboratory capacity building in developing countries. three Collaborating Centres on Veterinary Medicinal Products (in France, Japan and USA) and a Collaborating Centre on antimicrobial resistance supports the OIE s activities concerning veterinary medicinal products.

19 OIE actions to tackle AMR: matching GAP needs 1. Collaboration 5. Supporting Member Countries One Health 2. Standards 4. Information collection & sharing 3. Capacity building

20 Proportion of OIE Member Countries with an official system for collecting quantitative data 95% 96% No; 111; 73% 67% Yes; 41; 27% 46% 56% 5% 4% 33% 54% 44% Africa Americas Asia - Oceania Europe Middle East Yes No

21 Plan to set up an official system to collect quantitative data - Worldwide Number of OIE MC No 35% 11 Yes 65% Years 65% 96%

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23 Recommendations and mandate for OIE AM data collection To OIE Member Countries - to develop an official harmonised national system for collecting data on the monitoring of antimicrobial resistance in relevant animal pathogens and quantities of antimicrobial agents used in food producing animals at the national level based on the OIE standards. To OIE - to collect harmonised quantitative data on the use of antimicrobial agents in farmed animals with the view to establish a global database. AMR Global Action Plan GAP: OIE mandate to initiate work on surveillance of AM use in animals (with the support of FAO and WHO)

24 OIE global database on the use of antimicrobial agents in animals An OIE ad hoc Group (consisting of international experts + FAO and WHO representatives) was convened, and first met in January 2014, to: address recommendation no 7 of the OIE Global Conference on the Responsible and Prudent Use of Antimicrobial Agents for Animals establish an overall approach to collect and report standardised quantitative data on antimicrobial agents used in animals supporting implementation of Chapter 6.8 of the Terrestrial Animal Health Code and 6.3 of the Aquatic Animal Health Code.

25 OIE global database: basic information to be collected through a questionnaire and Focal Point training to enhance Member Countries engagement in the initiative to prevent antimicrobial resistance to improve awareness and provide an overview of antimicrobial use in animals to measure trends in the use of antimicrobial agents in animals over time to assist risk managers to evaluate the effectiveness of efforts and mitigation strategies to implement OIE standards, Resolution Nr 26 and contribute to the Global Action Plan

26 How OIE global database will benefit Member Countries The database will not only provide a solid foundation for the work of the three organisations in their fight against bacterial resistance, but the information gathered will also make it easier for Member Countries to: analyse and control the source of the veterinary products, obtain more reliable information on imports, trace their movements, and better evaluate the quality of the products in circulation.

27 OIE global database on the use of antimicrobial agents in animals Collection of baseline information and different reporting options Antimicrobial sales /use in food producing animals Collection of quantitative information Usage patterns by animal species Antimicrobial agent or class Administration route Type of use (therapeutic vs nontherapeutic)

28 Status: OIE global database on the use of antimicrobial agents in animals Phase One: questionnaire sent to Member Countries: October 2015 Training of OIE Regional and Sub-regional technical contact points: October cycle National Focal Point training, starting in Uganda: December 2015 Ad hoc Group meeting: January 2016 Feedback to the OIE World Assembly: May 2016 global sustainable long term investment 28

29 OIE actions to tackle AMR: matching GAP needs 1. Collaboration 5. Supporting Member Countries One Health 2. Standards 4. Information collection & sharing 3. Capacity building

30 OIE supports national strategies to address AMR issues OIE PVS (Performance of Veterinary Services) Pathway - determines capability of National Veterinary Services to meet intergovernmental quality standards and provides targeted support for national strategies Veterinary Services & Legislation (importation, distribution, use of antimicrobial agents in animals) Supporting veterinary education & Day One competence of veterinary graduates Strengthening veterinary statutory bodies and veterinary oversight on the distribution and use of antimicrobials

31 OIE supports national strategies to address AMR issues WHO-IHR / OIE-PVS Monitoring Framework Collaboration The joint use of the outputs of the WHO IHR Monitoring Framework and of the OIE PVS Pathway by Member Countries enables a detailed assessment of the existing national forces, bridges and gaps in human and animal health coordination and supports the development of joint national strategies (including AMR) in human and animal health sectors

32 OIE supports national strategies to address AMR issues WHO-IHR / OIE-PVS Monitoring Framework Collaboration Publication of WHO-IHR / OIE-PVS Operational Guide for Good Governance at the Human-Animal Interface (Dec 2014) WHO-OIE identification of countries eligible for Joint National Working Seminars (evolution to a higher political level) WHO and OIE collaborative review and confirmation of Joint National Working Seminars to be undertaken in Year 2 of GHSA programme: Philippines* Indonesia* Costa Rica** Vietnam* *funding: Australia ** funding: Canada

33 OIE actions to tackle AMR: matching GAP needs 1. Collaboration 5. Supporting Member Countries One Health 2. Standards 4. Information collection & sharing 3. Capacity building

34 Challenges to OIE and partner efforts Awareness raising is needed at all levels Animal health and welfare must be sustained Food security and food safety must be ensured Veterinary supervision for animal use is a priority No universal optimal solution for the delivery of antimicrobials at farm level worldwide The well qualified veterinarian is crucial

35 and with our collaborative efforts, maybe centuriesold AMR will remain a thing of the past

36 ..because if you believe the recent headlines, mankind will indeed succeed in its fight against AMR Daily Mail, 22 October 2015 Has the first person who'll live to 1,000 already been born?

37 The OIE will actively participate in the World Antibiotic Awareness Week, November 2015, in support of the Global Action Plan. Thank you. Arigatō ありがとうありがとう

38 Information is available at the OIE website ANTIMICROBIAL RESISTANCE (AMR):