The European AMR Challenge - strategic views from the human perspective - World Health Organization Regional Office for Europe Dr Danilo Lo Fo Wong Senior Adviser on Antimicrobial Resistance Division of Communicable Diseases, Health Security, and Environment
World Health Organization objective "the attainment by all peoples of the highest possible level of health"
WHO Structure and collaboration World Health Assembly / Executive Board WHO HQ Regional Committee Regional Office Regional Office Regional Office Member States CO CO CO CO CO CO CO CO CO CO CO CO Networks Institutions NGOs UN agencies WHO CC Universities Foundations Individual experts
WHO Regions
The antibiotic era Many antibiotics/antimicrobials developed Many millions of lives saved Complications of medical interventions avoided Life expectancy dramatically increased More productive livestock
Antibiotic resistance A natural phenomenon Accelerated by misuse of antibiotics Claims lives, costs money, affects livelihoods, undermines health programmes Very few new antibiotics in the pipeline Threatens a return to the pre-antibiotic era
Antibiotic resistance World Health Assembly resolutions in 1984,1998, 2001, 2005, 2007, 2009 WHO global strategy for containment of antimicrobial resistance published in 2001 Despite progress, strategies for containment not widely implemented 2011: World Health Day on Drug Resistance
WHD 2011 slogan
Antibiotic resistance in Europe - what do we know -
Data available from European AMR surveillance
Antimicrobial Consumption in Europe - 2009 Total consumption of antibiotics for systemic use expressed in DDD per 1 000 inhabitants and per day in 2009 Source: ESAC 2010 / ESAC-Net / ECDC Data source: ESAC 2010 / ESAC-Net / ECDC For Cyprus and Lithuania: total consumption (both community and hospital sector). For Spain: reimbursement data that do not include over-the-counter sales without a prescription.
European strategic action plan on antibiotic resistance
European strategic action plan on European strategic action plan on antibiotic resistance 2011 2016 Dr Guenael Rodier Director, Division of Dr Communicable Guenael Rodier Diseases, Health Security Director, Division of Communicable and Environment Diseases, Health Security and Environment
Regional Committee for Europe Resolution, Baku, Azerbaijan, 12-15 September 2011 Member States Ensure political commitment and resources for developing and implementing national plans Strengthen surveillance and monitoring of antibiotic resistance and consumption Establish multisectoral and comprehensive coordination and cooperation mechanisms Adhere to infection control Raise awareness through national campaigns
Regional Committee for Europe Resolution, Baku, Azerbaijan, 12-15 September 2011 WHO Regional Office for Europe Provide strategic leadership, guidance and tools for implementing the strategic action plan Support Member States in implementing national plans Create platforms for sharing and analysing data and experience Engage in broad regional and global partnerships Promote innovation and research
European strategic action plan on antibiotic resistance Full endorsement at Regional Committee Developed through inclusive and consultative processes Building on existing declarations and resolutions Coherent with global plans Need for close collaboration with many partners
Cornerstones of strategic direction I. Surveillance - to document the problem II. Prevention - to slow the emergence of HAI and AMR III. Containment - to reduce the spread IV. Research & Innovation - to develop new tools, new drugs & guidelines Multi-dimensional aspects - multisectoral, interdisciplinary
Rendering EPIDEMIOLOGY OF ANTIMICROBIAL RESISTANCE Dead stock Drinking water Farm Effluents and Manure Spreading Offal AQUACULTURE Rivers and Streams SOIL WILDLIFE Sea / Lakes Sewage Vegetation, Seed Crops, Fruit Drinking Water Swimming Industrial & Household Antibacterial Chemicals Animal Feeds SHEEP VEAL CALVES SWINE FOOD ANIMALS OTHER FARMED LIVESTOCK CATTLE POULTRY Commercial Abattoirs / Processing Plants Meat Handling Preparation Consumption HOSPITALIZED HUMAN EXTENDED CARE FACILITIES COMMUNITY - URBAN -RURAL COMPANION ANIMALS Direct Contact after Linton AH (1977), modified EURL-AR by Irwin Workshop RJ
Action Plan Strategic Objectives 1. Strengthen intersectoral coordination Comprehensive national action plans Multisectoral and interdisciplinary national coordination mechanisms 2. Strengthen surveillance of antibiotic resistance National surveillance systems, collecting, analysing and reporting data to monitor trends Regional databases, tools and standards
Cycle of Public Health Protection Surveillance Risk management Epidemiological evaluation Risk assessment Research
Action Plan Strategic Objectives 3. Promote rational use of antibiotics and strengthen surveillance National mechanisms for coordination National guidelines on prudent use of antibiotics Surveillance of antibiotic consumption 4. Strengthen infection control and surveillance in health care settings Prevention of hospital-acquired infections Hospital infection control and surveillance committees
Action Plan Strategic Objectives 5. Prevent emerging resistance in veterinary and food sectors Prudent use of antibiotics in these sectors Integrated systems for surveillance of antibiotic resistance and use
Action Plan Strategic Objectives 6. Promote innovation and research on new drugs International surveillance networks and information sharing on promising research Active role in research for governments and academic networks; national and international task forces 7. Improve awareness, patient safety, and partnership Educational initiatives, behaviour change campaigns, awareness programmes for health care providers and the public Broad partnership at national, regional and global levels
Considerations for implementation and monitoring Strategic action plan with: Time frame for implementation Estimated resource needs Input, process and output indicators to monitor progress Stepwise approach: Map available data and resources Develop and implement national action plans Establish integrated coordinating mechanisms Raise awareness and support Strengthen surveillance
WHO strengthening surveillance Focus on non-eu Member States Perform country visits Promote national committees Review national action plans Build surveillance capacity Establish pool of experts Set up surveillance network Compatible with EARS-Net and ESAC-Net Close cooperation with RIVM, ESCMID, Uni Antwerp Set up advisory board
WHO Collaborating Centres (Europe) WHO CC for Antimicrobial Resistance in Foodborne Pathogens Danish Institute for Food and Veterinary Research, Department of Microbiology - Copenhagen, Denmark WHO CC for Risk Assessment of Pathogens in Food and Water National Institute for Public Health and the Environment, Bilthoven, The Netherlands WHO CC for Reference & Research on Hospital Infections Health Protection Agency, The Laboratory of Healthcare Associated Infection - London, United Kingdom WHO CC on Patient Safety Infection Control Program, Department of Internal Medicine, University of Geneva Hospitals - Geneva, Switzerland WHO CC for Drug Statistics Methodology Norwegian Institute of Public Health - Oslo, Norway
Partnerships and collaboration Agencies EC / ECDC / EFSA CDC / FDA Governments Foundations Global Fund Center for Global Development Task Forces Trans Atlantic Task Force on Antimicrobial Resistance Networks and initiatives ReACT Alliance for the Prudent Use of Antibiotics Antibiotic Action Federations Etc. Int. Fed. of Pharm. Manufacturers and Associations Int. Pharmaceutical Federation
A coordinated global response is urgently needed "Nobody is exempt from the problem nor from playing a part in the solution" (WHO Global Strategy for Containment of Antimicrobial Resistance)