The Glbal Mmentum fr AMR Mving frm Knwledge t Actin Cmbating Antimicrbial Resistance: A One Health Apprach Natinal Academy f Medicine Washingtn DC 20 June 2017 Keiji Fukuda
Since 20th century t nw Intense scientific discvery 1928 Penicillin discvered 1937 sulfnamides intrduced Mid 1950 s transferable resistance identified Estimated 200,000 published articles since 1950 s* 1950s 1970s: glden perid f drug develpment *Julian Davies and Drthy Davies. Origins and evlutin f antibitic resistance. Micrbil Ml Bil Rev 2010; 74 (3):417-433
Extensive internatinal & natinal effrts 1959 WHO scientific grup recmmends studies n resistance (The Wrk f WHO, 1959, Official Recrds f WHO n. 98) 1981 WHO Scientific Wrking Grup reprt includes guidelines fr the apprpriate use f antibitics (WHO/BVI/PHA/ANT/82.1) 2001 WHO Glbal Strategy fr cntainment f antimicrbial resistance (WHO/CDS/CSR/DRS/2001.2) 2009 Transatlantic Taskfrce n Anitmicrbial Resistance (TATFAR) 2011 Wrld Health Day Antimicrbial resistance: n actin tday, n cure tmrrw plicy package 2011 Eurpean Actin Plan 2011 Jaipur Declaratin
Many standards & guidelines available frm OIE, FAO, WHO Preserving the efficacy f antimicrbials under veterinary supervisin OIE intergvernmental standards Use and surveillance f antimicrbials Veterinary legislatin Quality f Veterinary Services OIE List f antimicrbial agents f veterinary imprtance OIE web prtal n AMR www.ie.int/antimicrbial-resistance
1998 Wrld Health Assembly reslutin WHA51.17 Emerging and ther cmmunicable diseases: antimicrbial resistance - Cncerned abut the rapid emergence and spread f human pathgens resistant t available antibitics; - Aware that antimicrbial resistance is increasingly hampering treatment f infectius diseases as a result either f ttally ineffective currently available antibitics r f the high cst f new generatin agents; - Cncerned abut the extensive use f antibitics in fd prductin, which may further accelerate the develpment f such resistance,.
Benefits & cnsequences Majr gains in scientific knwledge, cncepts & prfessinal guidance Psitining Cmplex phenmenn f primarily medical relevance (mre recent incrpratin f ne health) Expectatin f endless antibitic drug supply Real wrld trends Lss f cmpanies interested in antibitics Cntinued increase in levels wrldwide
2014 WHO reprt Antimicrbial resistance: glbal reprt n surveillance 114 cuntries in all WHO regins Selected (hspital & cmmunity) infectins & resistance patterns High AMR in all regins E cli, K pneumniae, S aureus, S pneumniae, N gnrrhea. 3 rd generatin cephalsprins, flurquinlnes, methicillin.. Under reprting f key cncerns like MDR TB Significant gaps in surveillance & infrmatin
Need fr strategic change Current appraches essential but nt enugh Actively bradened engagement beynd health & science Partnering (FAO, OIE, WHO) arund ne health cncept Active reach ut t plitical, ecnmic, security, business sectrs Cperatin & cmmunicatin amng like-minded champins Significant results Greater attentin beynd health & scientific sectr Glbal Actin Plan (2015) G20 & UN High Level Meeting (2016)
UN High-Level Meeting n AMR Milestne Increased legitimacy Frmalized engagement & cmmitment Mandated Interagency Crdinating Grup n AMR But all such gains time-limited unless built upn Will it result in cperatin amng nn-health ministries, departments, agencies? Will it catalyse private sectr actins?
Hw d we cnslidate gains & mve frm knwledge t actins?
High-level aims remain unchanged Lwest pssible sustained levels f AMR Reliable develpment & prductin f essential technlgies, including antimicrbial medicines Affrdable & equitable access
At this time, need emphasis n 3 fundatinal elements 1. Further scializatin f AMR 2. Clsure f specific knwledge gaps hindering plicy & behavir 3. Visible leadership & actin by lead grups
Scializatin is the fundamental driver Sme issues t large t be addressed as technical Tbacc cntrl, climate change, cancer, HIV, AMR. Ppular cncern & supprt enabled new plicies, initiatives, funding AMR mving in right directin, but nt yet felt by average persn as Familiar & persnally relevant Critically imprtant & urgent Issue where vicing cncern makes a difference
Challenge t mve frm abstract, technical & distant t human, persnal, nw Need multiple vices t recraft AMR Abut peple -- faces & stries Persnal --- everyne, everyday health Urgent -- untreatable infectins here nw Reversable --- if gvernments, cmpanies, individuals act
Pace f change will require clsing certain knwledge gaps Observatin Evidence smetimes drives actin Insufficient evidence always cited as justificatin fr slwlness Key gaps Hlistic picture: AMR epidemilgy & etilgy Health, agriculture & envirnment Relative imprtance & pathways t human infectins Mst (cst) effective interventins Hw t mve int pst-grwth prmtin agriculture wrld- wide
Key grups must be visibly active UN IACG Actively cnvene & engineer cperatin & crdinatin amng sectrs Gvernments Leadership Braden invlvement f nn-health agencies Legislatin & financing WHO, FAO, OIE & ther internatinal rganizatins Keep AMR in frnt f gvernments Prvide strategic advice in additin t technical guidance Exemplify ne health partnering
Key grups must be visibly active Natinal health & agriculture Civil sciety Industry Make knwledge f AMR & best practices nrmative Separate prfit frm prvisin f antibitics Find ways t phase ut antibitics as grwth prmters Scrutiny Organize effrts arund fd Return t making new antimicrbial drugs Internalize access as nrmative Funders & academia Use funding t drive multidisciplinary, impact based research s big questins & issues will be addressed faster
Hng Kng an example Highly evlved envirnment (prfessinal, scientific, business) Prfessinals ready t engage but uncertainty ver directins Ppulatin attentive t health but lw awareness abut AMR Right cmbinatin f fcus, netwrk building, trust, crdinatin, cmmunicatin & funding can create engine fr change
Thank yu