RB Response Consultation on a draft Global action plan to address antimicrobial resistance The questionnaire is divided into four sections. The questions are broadly framed and intended to give you the opportunity to enter into some depth and explain your organization's viewpoint. While only questions marked with * are mandatory, we would appreciate answers to as many as possible. Where a choice of answer needs to be selected please highlight your answer. Before answering the questions, please refer to our list of supporting documents. http://www.who.int/drugresistance/amr-consultation/en/index.html About you 1. Name of individual respondent* (deleted) 2. Email address* (preference for official email addresses) (deleted) 3. Are you authorised to represent your organization or interest group?* Yes 4. Organization Name* RB (Reckitt Benckiser) 5. Address of the organization* Reckitt Benckiser plc Turner House 103-105 Bath Road Slough Berkshire SL1 3UH UK 6. Organization website (if available) www.rb.com/home 1
7. Country* UK 8. Type of Organization* Private sector 9. Main sector of interest Human health 10. Would you like to be added to our mailing list to receive updates on the development of the global action plan?* Yes General questions 1. From the perspective of your organization, what are the most important areas of concern in AMR? AMR is a direct result of oversubscription and misuse of antibiotics. Antibiotics are affordable, easily accessible medications that are viewed by the public as a cure all for a wide variety of common ailments. This misconception, lack of understanding and lack of education regarding how antibiotics work lead to: 1. Increasing patient demand 2. Inappropriate prescription by physicians, resulting from perceived patient pressure 3. Growing accessibility in some geographies, outside the formal healthcare system, due to an unofficial distribution by non-healthcare professionals Therefore, antibiotic resistance is on the rise and patients are not getting effective treatment for their symptoms/ailments. The result is an increase in AMR, decrease in effective modes of patient care, and an increased pressure on an already strained healthcare system, due to multiple treatments to treat/cure patients. Unnecessary medication expenditure, antibiotic resistance (and the associated cost of treating patients infected with resistant bacteria), medicalisation of patients, costs of visits and side effects all mean that we need to take decisive action to break this cycle of inefficiency. Inconsistency between individual countries regarding the categorisation of antibiotics as prescription only medicines, as well as the absence of a global public policy, furthers the escalation of AMR within the community. RB believes that there is an important role for general public in promoting consumer health and wellness. Health is the most popular search topic on the internet (Synthesio- International web monitoring and research, 2010) Consumer health is a growing trend which supplements formal healthcare systems and should be acknowledged and encouraged in its 2
legitimate form. As consumers, people are proactive and motivated to take measures in their own interest, which includes looking after their own health. Further educational efforts in support of responsible self-care should be encouraged to ensure people are making informed decisions in relation to their health. We believe in governments, industry and the private sector working together to provide patients with the education and resources to enable them to manage their own health and wellness. Whether in the form of education about good hygiene and the use of disinfectants to prevent infection, responsible sexual health or guidance and provision of non-antibiotic medications to assist in the management of cold and flu and pain relief, RB drives responsible self-care. 2. Is your organization currently involved in work related to AMR? YES If Yes, How? RB supports many industry associations that have direct relevance to the issue of AMR: The Global Respiratory Infection Partnership (GRIP) - GRIP is committed to consistent, sustainable evidence-based advocacy and intervention for rational antibiotic use. It advocates facilitating antimicrobial stewardship by formulating a framework for nonantibiotic treatment options for respiratory tract infections, and fostering multistakeholder commitment to antibiotic stewardship and rational antibiotic use. GRIP is unique in that it has been created and is resourced by RB as a symbiotic corporate social responsibility project. The Global Hygiene Council - The Global Hygiene Council is a group of the world's top experts in hygiene and hygiene-related fields, including microbiology, virology, infectious disease, immunology, and public health. The Council formed in 2006, and continues to reveal the science behind the hygiene headlines, along with practical advice to help the general public prevent the spread of infection both at home and when out and about. The European Hygiene Council - The European Hygiene Council is a group of 16 of Europe's top experts in hygiene and hygiene-related fields, including microbiology, virology, infectious diseases, immunology, and public health. The Council formed in 2009 to monitor infection threats and aims to provide realistic recommendations and advice to the public on the importance of hygiene in the home and community, to help prevent the spread of disease and infection. The Council aims to set the hygiene agenda and improve people's health through good hygiene, helping them towards a healthier future. RB (Durex) collaborates with the MTV Staying Alive Foundation to increase young adult education and inspire young people to take control of their sexual health. In the On the Ground programme, RB supports 10 of the current MTV Staying Alive Foundation grantee projects in Latin America, Europe, Asia and Africa through mentoring and training support. The projects include educational fairs, and HIV awareness, empowering young women to make informed decisions around sexual health and contraception. 1. How would you rate your understanding of WHO s intention in the development of a global action plan to address AMR? Very good 3
RB s mission to promote responsible self-care takes a multi-modal approach: Promotion of public awareness and educational campaigns regarding personal wellness including prevention of infection and appropriate treatment Education for doctors, nurses, pharmacists and sexual health experts Economic impact studies cost to health care systems of treating antibiotic resistant infections and downstream costs to society in terms of time out of work RB s understanding is that the global action plan developed by the WHO is likely to include proposals of how to best achieve all of the above. Our recommendation is that a move towards empowerment of patient personal wellness (including improvements in people's general knowledge, level of education and access to non-antibiotic medication alternatives, hygiene products and barrier contraception) will be integral to the successful implementation of a viable action plan. 2. From the perspective of your organization, are the major issues relating to AMR outlined in the draft global action plan? No As much antibiotic overuse and misuse occurs at the community level (inappropriate prescription by family doctors, misuse or direct over the counter purchase by patients, and non-prescription selling of antibiotics by pharmacists). This misuse is facilitated by a disparity in local regulations and cultural / social beliefs (cultural norms regarding hygiene). The current WHO action plan operates at a global level but does not consider how this plan will be effectively implemented on a local community level where interventions will be directly influenced by cultural beliefs. There is a clear need to target global policy makers to ensure that this is truly a global initiative. RB recommends addressing the challenge of variation in global policy and cultural aspects by a global harmonisation of regulations regarding the categorisation of antibiotics as prescription only medicines. Healthcare measurements and budgets are set and managed on the basis of treatment of illness versus incentives based on prevention and wellness. Preventative health measures, as part of properly supported public health campaigns, support the role of hygiene in premaintaining good health. As a consumer health company, RB has a detailed understanding of the needs of consumers, their behaviour and how to foster a positive change in this behaviour towards wellness and prevention. At a community level, RB supports responsible self-care on the part of individuals and acknowledges that the frontline of good health starts at home. Questions on the Building blocks described in the draft outline. You will notice, the global action plan has been constructed around building blocks in recognition that different countries will have different starting points. In this situation, countries can choose building blocks to concentrate upon. Each building block specified has 4
been identified as a key area where specific attention, planning and work are needed to achieve progress in addressing AMR. Through questions in this section, we would like to hear your opinions on these building blocks in more detail. I. Building block-1: Increasing awareness and understanding about AMR and of the actions and changes needed a) What do you consider to be the main issues under this priority? Overall: Behaviour change - creating widespread awareness of the prevalence of antibiotic overuse, misuse and resistance, and facilitating policy change by demonstrating economic value of prioritising initiatives addressing AMR. We need to reinforce a multi-modal approach, with the aim to change the status quo, from treatment to promoting wellness. 1. General public/consumers/patients promote understanding around preventative behaviour (sexual health) and hygiene as the frontline to good health and prevention of infection. Increase awareness of the limitations of antibiotics, and demote long-lasting cultural expectations that have always regarded antibiotics as the best treatment option or cure all. Additional information and consumer education needs to look at self-care and wellness in the wider context to change perception to prevention is better than cure, to provide the public with information about how else to go about tackling conditions which they might perceive need an antibiotic, and to take measures to reduce the risk of infection in the first place. It is also necessary to educate how to manage ailments where antibiotics will be ineffective (for example, influenza, sore throat and cold/coughs). a. Mothers b. Young people (open-minded to behavioural change) c. Teachers (educators of future generations) 2. Healthcare professionals awareness of non-antibiotic alternatives and how to support a patient to self-care; minimize unnecessary antibiotic prescriptions that result from perceived/real patient pressure; absence of evidence based practical guidelines for effective guidelines for infectious disease management; fear of litigation due to misdiagnosis; difficulty in patient follow-up for delayed prescriptions; dearth of point-of-care diagnostics a. Pharmacists b. Doctors c. Nurses d. Sexual health experts 3. Government awareness of economic impact studies conducted by academic, public bodies and international organisations resulting from the demand AMR places on healthcare infrastructures and budgets, due to unnecessary medication expenditure, antibiotic resistance (and the associated cost of treating patients infected with resistant bacteria), medicalisation of patients, costs of visits and side effects, and absence of legislation prohibiting over the counter / non-prescription provision of antibiotics a. Departments of health 5
b. National governments c. Professional bodies i.e. Medical societies (guideline development) b) What are the main actions that need to be done -- and who are the main actors/stakeholders who need to take action -- to go beyond the status quo? Government: Introduction of regulatory changes and harmonisation of regulations and legislation across the globe. Reclassification of antibiotics as prescription only medications to prohibit retail purchase practice. Global consistency dispensing policy to prohibit antibiotics being directly available from the prescriber to circumvent financial incentive for physicians to prescribe antibiotics. Guideline development regarding (non) antibiotic management of infectious disease and pathway of care. Regulatory enforcement of policy Incentives to promote implementation of preventative hygiene strategies and the non-use of antibiotics Prescribers and Pharmacy healthcare practitioners in primary care (GPs, pharmacists): Compulsory inclusion of AMR, its consequences and appropriate guidance for stewardship and containment strategies in the curricula of all healthcare professional training, as well as in their continued professional development (CPD). Continuous training to ensure that knowledge base of HCPs on latest guidelines, antibiotic prescribing and AMR data is kept up to date, knowledge of alternatives (e.g. products for symptom control) is current, and communications skills are well practised to cope with demanding members of the public. Development and implementation of evidence based guidelines for (non) antibiotic treatment of infectious disease. Annual audit of CPD activities related to antimicrobial stewardship for healthcare professionals in practice. Mandatory pharmacy dispensing audits Public: Public health campaigns to educate people on the importance of hygiene as the frontline to good health and prevention of infection. Multi-media public health campaigns to highlight the public s collective responsibility towards the conservation of antibiotics and the personal impact of AMR. 6
Teacher professional training and education of children and young people in schools, colleges and universities. These populations are the future decision making adults and parents. Education and advice on the self-management of minor aliments using nonantibiotic alternatives, and the ineffectiveness of antibiotics for certain ailments. c) What steps have already been taken to address this priority? (please provide references where possible) Transparency in maintaining information flow between RB, consumers and government is a central tenet of our business. RB, like many industry organisations provides educational material for health professionals and the public alike (http://www.rb.com/site/rkbr/templates/ourbrands3col.aspx?pageid=335&cc=gb#s). RB supports The Global Respiratory Infection Partnership (GRIP). GRIP is committed to consistent, sustainable evidence-based advocacy and intervention for rational antibiotic use. GRIP have produced a suite of materials and training modules including patient leaflets, an animation, consultation guides for physicians and pharmacists, posters, prescribing pad for personalised non-antibiotic symptomatic treatment advice, and a sore throat fact file CPD module. These are all available for download at the GRIP website: http://www.gripinitiative.org/downloadable-materials-all-resources.php. The Hygiene Council, also has monitored infection threats, responding to emerging problems by creating practical and simple recommendations to help the public to improve levels of hygiene, both in the home and when out and about. Every year, the Council assesses the latest hygiene issues in a number of ways, such as the spread of disease and infection. The Council aims to set the hygiene agenda and improve people's health through good hygiene, helping them towards a healthier future. RB (Durex) collaborates with the MTV Staying Alive Foundation to increase young adult education and inspire young people to take control of their sexual health. In the On the Ground programme, RB supports 10 of the current MTV Staying Alive Foundation grantee projects in Latin America, Europe, Asia and Africa through mentoring and training support. The projects include educational fairs, and HIV awareness empowering young women to make informed decisions around sexual health and contraception, and spreading the message that prevention is better than cure. d) What are concrete and measurable indicators of progress for this priority? (Including, for example, global and national goals to be achieved within 2, 5 and 10 years) Within 2 years 30 Governments signed up to the WHO action plan Within 5 years Countries with permitted pharmacy-selling of antibiotics to have classified 50% of antibiotics as available by prescription only, development of international guidelines regarding the appropriate use of antibiotics. 50% reduction of antibiotic prescription for minor ailments in non-at risk groups. 7
10 years Member countries to have classified at least 80% of antibiotics as prescription only medicines. 90% reduction of antibiotic prescription for minor ailments in non-at risk groups. II. Building block-2: Identifying the most important approaches for preventing development of infections and the steps needed to move beyond guidance to more effective implementation of such approaches a) What do you consider to be the main issues under this priority? Healthcare measurements and budgets set and managed on the basis of treatment of illness versus incentives based on prevention and wellness. Preventive health measures as part of properly supported public health campaigns fostering the importance of hygiene as the frontline to good health. There is a public perception that antibiotics will cure all ailments, rather than an understanding of the importance of prevention of infection by effective personal hygiene, such as hand washing and use of antiseptics / disinfectants. Public health campaigns should focus on raising awareness of prophylactic flu vaccination, better hygiene (e.g. washing hands, catching sneezes in disposable tissues, safer storage and preparation of foods, household cleanliness), safer sexual practices, and the promotion and improvement in access to, and recommendation of, non-antibiotic products for symptomatic relief. We need to drive greater patient knowledge of what to expect with common conditions and their selfmanagement, as well as when to seek medical advice. b) What are the main actions that need to be done -- and who are the main actors/stakeholders who need to take action -- to go beyond the status quo? Government, industry and private sector collaboration to: empower public self-care and wellness via public health campaigns, raising awareness of the importance of hygiene as the frontline to good health; the ineffectiveness of antibiotics in certain ailments; appropriate and cultural-sensitive information regarding the health benefits of barrier methods in sexual health. Insurance company awareness of the burden of treatment costs associated with the consequences of antibiotic resistance, the encouragement of wellbeing via incentives, and policy holder education regarding AMR and self-management of minor ailments. Pharmacist education to be provided to enable pharmacists to reinforce hygiene messages, advise on whether travel should be restricted, inform on the duration of symptoms and recommend time away from work/school. o Where appropriate, pharmacists to receive education on the who/why/when/how of vaccination, especially in countries in which the pharmacist will carry out vaccination 8
Education and guidelines targeted to schools, universities and highly populated workplaces on barrier precautions. Academia research regarding the impact of antibiotics on the microbiome and development of healthy immunity. Global monitoring and tracking infection outbreaks to focus key messages and public campaigns on reinforcing hygiene and non-antibiotic symptomatic relief to areas of a greatest risk. Education and advice to be made available via multi-media channels (and even mobile phones), to facilitate dissemination and access at home. c) What significant work has already been done to address this? (please provide references where possible) As a consumer health company RB understands what drives consumer behaviour. It advocates increased public responsibility for self-care, promoting the pharmacist and over the counter medications as central to effective advice regarding hygiene and wellbeing. RB is supporting the Global Respiratory Infection Partnership (GRIP). GRIP is committed to consistent, sustainable evidence-based advocacy and intervention for rational antibiotic use. GRIP have produced a suite of materials and training modules including patient leaflets, an animation, consultation guides for physicians and pharmacists, posters, prescribing pad for personalised non-antibiotic symptomatic treatment advice and a sore throat fact file CPD module. These are all available for download at the GRIP website: http://www.gripinitiative.org/downloadable-materials-all-resources.php. The Hygiene Council has monitored infection threats, responding to emerging problems by creating practical, simple recommendations to help the public to improve levels of hygiene both in the home and when out and about. Every year, the Council assesses the latest hygiene issues in a number of ways, including the spread of disease and infection. The Council aims to set the hygiene agenda and improve people's health through good hygiene, helping them towards a healthier future. RB (Durex) collaborates with the MTV Staying Alive Foundation to increase young adult education and inspire young people to take control of their sexual health. In the On the Ground programme, RB supports 10 of the current MTV Staying Alive Foundation grantee projects in Latin America, Europe, Asia and Africa through mentoring and training support. The projects include educational fairs, and HIV awareness empowering young women to make informed decisions around sexual health and contraception and spreading the message that prevention is better than cure. d) What are concrete and measurable indicators of progress for this priority? (Including, for example, global and national goals to be achieved within 2, 5 and 10 years) Reduction in attendances at general practice, health clinics and hospital admissions due to preventable infections - coughs and colds, food poisoning, STDs 9
Rate of uptake of influenza, pneumonia and pertussis vaccines Public surveys to assess hygiene practices Changes in antibiotic prescribing levels and market data on symptomatic relief treatment sales Uptake and increased availability of flu vaccination Reduction in preventable infections, such as STDs Public uptake of better hygiene practices, as assessed by public surveys Healthcare professional positive attitude change in regard to prescription of antibiotics for minor ailments as measured by attitudinal studies III. Building block-3: Optimizing the use of existing antimicrobials for human and animal health and in agriculture a) What do you consider to be the main issues under this priority? Low cost or no cost and easy accessibility of antibiotics Variability in, or non-existence of, global and national guidelines with respect to (non) antibiotic management, diagnosis, appropriate prescription of antibiotics and around over the counter distribution of antibiotics. Lack of adherence to local guidelines, where they exist for appropriate prescription of antibiotics and variability in regulation and behaviour around over the counter distribution. Dearth of surveillance-informed and evidence-based guidelines for the treatment of community-acquired, self-limiting infections, particularly those of viral origin Lack of/poorly enforced regulations and legislation regarding access to antibiotics Lack of auditing of antibiotic use at the level of primary care, by countries, regions and individual GPs. Lack of systems supporting alternatives to antibiotics (e.g. national systems incentivising appropriate antibiotic prescribing; national schemes supporting purchase of products that are alternatives to antibiotics where appropriate, such as products that provide symptom or pain relief. Inconsistent enforcement of guidelines and regulations where they exist. Poor understanding and awareness regarding the role of antibiotics in farming and agriculture. Increased transparency and clarity regarding security and safety around the effect of antibiotics in animal feed. Consumer awareness with appropriate labelling to allow the choice to avoid foods items that contribute to antibiotic resistance. 10
b) What are the main actions that needs to be done -- and who are the main actors/stakeholders who need to take action -- to go beyond the status quo? There is a clear need to target global policy makers to ensure that this is truly a global initiative. RB recommends addressing the challenge of variation in global policy and cultural aspects by: Global recognition of the importance of consumer health as a recognised segment in support of the formal health care system. Harmonisation of regulations and legislation regarding the appropriate prescription and classification of antibiotics. International collaboration of government bodies to draft, implement and enforce guidelines o Even in Europe, where harmonisation is a key common purpose, across the 28 member nations, there still exists a vast array of different legal classifications, distribution, marketing and communication regulations. Only a handful of consumer health products are available in all countries on more or less the same terms. In countries where regulations regarding classification and use of antibiotics exist, penalties for non-compliance should be enforced Surveillance, monitoring and evaluation of antibiotic use on both a national level and individual practitioner level, with trend analyses highlighting areas for intervention. Audits to be run alongside pilot schemes that are testing any policy changes or educational initiatives, to assess outcome and identify where improvements can be made or local adaptation may be required. Policies to ensure that antimicrobial stewardship is included in professional training and continued professional development for primary care physicians and pharmacists and nurses. National guidelines around care, concerning when to use antibiotics and nonantibiotic symptomatic treatments. Support for patients and healthcare professionals to recognise symptoms and recommend alternative symptomatic relief. Awareness and provision of information regarding non-antibiotic alternatives for self-care. c) What steps have already been taken to address this priority? (please provide references where possible) RB is supporting the Global Respiratory Infection Partnership (GRIP). GRIP is committed to changing attitudes and prescription practices on a global scale. In addition to an annual 11
meeting bringing together physicians, pharmacists and influencers from all over the world, GRIP have produced an easily translatable suite of materials and training modules including patient leaflets, an animation, consultation guides for physicians and pharmacists, posters, a prescribing pad for personalised non-antibiotic symptomatic treatment advice and a sore throat fact file CPD module. These are all available for download at the GRIP website: http://www.grip-initiative.org/downloadable-materials-all-resources.php. The Hygiene Council has monitored infection threats, responding to emerging problems by creating practical, simple recommendations to help the public to improve levels of hygiene both in the home and when out and about on a global scale. Every year, the Council assesses the latest hygiene issues in a number of ways, such as the spread of disease and infection. The Council aims to set the hygiene agenda and improve people's health through good hygiene, helping them towards a healthier future. RB (Durex) collaborates with the MTV Staying Alive Foundation to increase young adult education and inspire young people to take control of their sexual health. In the On the Ground programme, RB supports 10 of the current MTV Staying Alive Foundation grantee projects in Latin America, Europe, Asia and Africa through mentoring and training support. The projects include educational fairs, and HIV awareness empowering young women to make informed decisions around sexual health and contraception and spreading the message that prevention is better than cure. d) What are concrete and measurable indicators of progress for this priority? (Including, for example, global and national goals to be achieved within 2, 5 and 10 years) Within 2 years 30 Governments signed up to the WHO action plan Within 5 years Countries with permitted pharmacy-selling of antibiotics to have classified 50% of antibiotics as available by prescription only. Development of international guidelines regarding the appropriate use of antibiotics. 50% reduction of antibiotic prescription for minor ailments in non-at risk groups. 10 years Member countries to have classified at least 80% of antibiotics as prescription only medicines. 90% reduction of antibiotic prescription for minor ailments in non-at risk groups. IV. Building block-4: Identifying and closing critical gaps in knowledge needed to address AMR a) What do you consider to be the main issues under this priority? Overall: global and national economic studies and usage audits conducted by nondepartmental public bodies, professional societies / associations and international organisations. Government awareness of the economic impact resulting from the demand AMR places on healthcare infrastructures and budgets, due to unnecessary medication expenditure, antibiotic resistance (and the associated cost of treating patients infected with resistant 12
bacteria), medicalisation of patients, costs of visits and side effects, and absence of legislation prohibiting over the counter / non-prescription provision of antibiotics. Pharmacy and public awareness of individual role AMR. Realisation by pharmacists that they have a role and responsibility at the point of dispensing. The empowerment of patients to understand they have choices in how to self-manage their health and minor ailments b) What are the main actions that need to be done -- and who are the main actors/stakeholders who need to take action -- to go beyond the status quo? Government: Introduction of regulatory changes and harmonisation of regulations and legislation across the globe. Reclassification of antibiotics as prescription only medications to prohibit retail purchase practice. Guideline development regarding (non) antibiotic management of infectious disease and pathway of care. Regulatory enforcement of guidelines Incentives to promote implementation of preventative hygiene strategies and the non-use of antibiotics. Prescribers and Pharmacy healthcare practitioners in primary care (GPs, pharmacists): Compulsory inclusion of AMR, its consequences, and appropriate guidance for stewardship and containment strategies in the curricula of all healthcare professional training, as well as in their continued professional development (CPD). Continuous training to ensure that the knowledge base of HCPs on the latest guidelines, antibiotic prescribing and AMR data is kept up to date, knowledge of alternatives (e.g. products for symptom control) is current and communications skills are well practised to cope with demanding members of the public. Development and implementation of evidence based guidelines for (non) antibiotic treatment of infectious disease. Annual audit of CPD activities related to antimicrobial stewardship for healthcare professionals in practice. Mandatory pharmacy dispensing audits Public: Public health campaigns to educate people on the importance of hygiene as the frontline to good health and prevention of infection. Multi-media public health campaigns to highlight the collective responsibility towards the conservation of antibiotics and the personal impact of AMR. 13
Teacher training and education of children and young people in schools, colleges and universities. These populations are the future decision making adults and parents. Education and advice on the self-management of minor aliments using nonantibiotic alternatives and the ineffectiveness of antibiotics for certain ailments. c) What steps have already been taken to address this priority? (please provide references where possible) Transparency in maintaining information flow between RB, consumers and government is a central tenet of our business. RB, like many industry organisations provides educational material for health professionals and the public alike (http://www.rb.com/site/rkbr/templates/ourbrands3col.aspx?pageid=335&cc=gb#s). RB supports the Global Respiratory Infection Partnership (GRIP). GRIP is committed to consistent, sustainable evidence-based advocacy and intervention for rational antibiotic use. GRIP have produced a suite of materials and training modules, including patient leaflets, an animation, consultation guides for physicians and pharmacists, posters, a prescribing pad for personalised non-antibiotic symptomatic treatment advice and a sore throat fact file CPD module. These are all available for download at the GRIP website: http://www.gripinitiative.org/downloadable-materials-all-resources.php. The Hygiene Council has monitored infection threats, responding to emerging problems by creating practical, simple recommendations to help the public to improve levels of hygiene both in the home and when out and about. Every year, the Council assesses the latest hygiene issues in a number of ways, including the spread of disease and infection. The Council aims to set the hygiene agenda and improve people's health through good hygiene, helping them towards a healthier future. RB (Durex) collaborates with the MTV Staying Alive Foundation to increase young adult education and inspire young people to take control of their sexual health. In the On the Ground programme, RB supports 10 of the current MTV Staying Alive Foundation grantee projects in Latin America, Europe, Asia and Africa through mentoring and training support. The projects include educational fairs, and HIV awareness empowering young women to make informed decisions around sexual health and contraception and spreading the message that prevention is better than cure. d) What are concrete and measurable indicators of progress for this priority? (Including, for example, global and national goals to be achieved within 2, 5 and 10 years) Within 2 years 30 Governments signed up to the WHO action plan Within 5 years Countries with permitted pharmacy-selling of antibiotics to have classified 50% of antibiotics as available by prescription only, development of international guidelines regarding the appropriate use of antibiotics. 50% reduction of antibiotic prescription for minor ailments in non-at risk groups. 14
10 years Member countries to have classified at least 80% of antibiotics as prescription only medicines. 90% reduction of antibiotic prescription for minor ailments in non-at risk groups. V. Building block-5: Developing an innovative and sustainable approach to develop and distribute critical products and technologies needed to address AMR a) What do you consider to be the main issues under this priority? Lack of access to, and cost of, rapid diagnostic tests in primary care. This leads to riskaverse prescribing habits without having evidence that the infection will respond, or has higher probability to respond to antibiotic treatment and lack of advice regarding nonantibiotic self-care alternatives. Inaccessibility to antiseptic/disinfectants, to encourage the importance of personal hygiene, and barrier method contraception as infection prevention methods. b) What are the main actions that needs to be done -- and who are the main actors/stakeholders who need to take action -- to go beyond the status quo? Availability and cost of rapid diagnostic tests for infectious diseases to determine the causal agents (bacterial / viral). Government distribution and promotion of disinfectant and barrier contraception. Better understanding of how people use modern technologies, and where they use them to effectively target information regarding prevention of infection, and who to consult for advice for particular symptoms. c) What steps have already been taken to address this priority? (please provide references where possible) As a consumer health company, RB understands consumers and how they access and act on health information. RB champions the call for responsible self-care and dissemination of public health advice via media and non-media channels appropriate to the technology accessible by the end user. d) What are concrete and measurable indicators of progress for this priority? (Including, for example, global and national goals to be achieved within 2, 5 and 10 years) Prescriber access to rapid diagnostic tests for identified at risk groups. Uptake of national policies that reflect the internationally agreed best evidence guidance can be assessed along with prescribing audits of antibiotic use. Widespread awareness and understanding of AMR and its resulting consequences. VI. Building block-6: Assessing the long term economic, developmental and social costs and implications of AMR as a basis for sustainable investment and action a) What do you consider to be the main issues under this priority? 15
Costs of inappropriate prescription - antibiotics themselves are low cost, yet inappropriate prescription, such as in the case of minor ailments, means that this is an unnecessary expenditure with healthcare systems. Indirect costs, such as AMR (additional assessments and processes treating patients infected with resistant bugs), medicalisation of patients, cost of primary care visits for minor illness, and unnecessary side effects of antibiotic treatment, also need to be considered. Healthcare measurements and budgets set and managed on the basis of treatment of illness versus incentives based on prevention and wellness. Cost savings due to preventative health measures as part of properly supported public health campaigns, fostering the importance of hygiene as the frontline to good health. b) What are the main actions that needs to be done -- and who are the main actors/stakeholders who need to take action -- to go beyond the status quo? Global harmonisation of regulations and legislation regarding the appropriate prescription and classification of antibiotics. International collaboration of government bodies to draft, implement and enforce guidelines o In Europe, where harmonisation is a key common purpose, across the 28 member nations, there still exists a vast array of different legal classifications, distribution, marketing and communication regulations. Only a few products are available in all countries on more or less the same terms. Appropriate enforcement of regulations when they are in place Surveillance, monitoring and evaluation of antibiotic use on both a national level and an individual practitioner level, with trend analyses highlighting areas for intervention. Audits to be run alongside pilot schemes that are testing any policy changes or educational initiatives, to assess outcomes and identify where improvements can be made or local adaptation may be required. Policies to ensure that antimicrobial stewardship is included in professional training and continued professional development for primary care physicians and pharmacists. Awareness and provision of information regarding non-antibiotic alternatives for self-care. c) What steps have already been taken to address this priority? (please provide references where possible) d) What are concrete and measurable indicators of progress for this priority? (Including, for example, global and national goals to be achieved within 2, 5 and 10 years) 16
Within 2 years 30 Governments signed up to the WHO action plan Within 5 years Countries with permitted pharmacy-selling of antibiotics to have classified 50% of antibiotics as available by prescription only, development of international guidelines regarding the appropriate use of antibiotics. 50% reduction of antibiotic prescription for minor ailments in non-at risk groups. 10 years Member countries to have classified at least 80% of antibiotics as prescription only medicines. 90% reduction of antibiotic prescription for minor ailments in non-at risk groups. Concluding questions 3. What contribution would your organization be able to make in implementing the global action plan? There is a clear need to shift current behaviour and incentive away from treating disease and towards patient wellness its consequent prevention of disease. As a consumer health company, RB understands consumers and how they access and act on health information. RB champions dissemination of public health advice and policy change to call for responsible self-care and empowerment of patient driven wellness. 17