Global Action Plan on Antimicrobial Resistance Dr Marc Sprenger Director Antimicrobial Resistance Secretariat
When are we entering the post-antibiotic era? For some diseases we have already entered! Fatal pneumonia because antibiotics are not working (K. pneunomiae) Fatal infection with Neisseria gonorrhoeae
What is the cost of not taking action? By 2050, AMR could lead to 10 million deaths every year reduction of 2%-3.5% in GDP globally Between now and 2050, the world can expect to lose US$ 600 to US$ 100 trillion worth of economic output
Global Action Plan on Antimicrobial Resistance One year in development World Health Assembly, May 2014 Requests the Director General to develop a global plan WHO leads development of the plan, May to Dec 2014 With advice from experts, Member States, forums and web consultations WHO Executive Board, Jan 2015 Expresses strong support to take plan to World Health Assembly World Health Assembly, May 2015 Adopts the Global Action Plan over 50 supporting statements Passes new resolution to support action over 60 country sponsors
Increase in WHO organization-wide budget for AMR 60000000 50000000 40000000 30000000 20000000 10000000 0 USD 2014-2015 2016-2017
Financial projections for 2016-2017: distribution by WHO Regional Office AMRO/PAHO AFRO WPRO EMRO SEARO EURO Headquarters Total: USD 53,792,873
Five strategic objectives: 1. Improve awareness and understanding 2. Strengthen the knowledge through surveillance and research 3. Reduce the incidence of infection 4. Optimize the use of antimicrobial medicines 5. Ensure sustainable investment
Five strategic objectives, my translation: 1. EAAD / WAAW: handle AB with care 2. Set up lab and surveillance and report 3. Good IPC in hospital 4. AB: only prescription & instruction & duration 5. Invest in R&D
Implementation of the GAP Guiding Principles 1. Realistic and achievable objectives 2. Work streams approach 3. Take into account different capacities of Member States 4. Involve FAO and OIE, where appropriate 5. All-inclusive approach (HIV, TB and malaria) 6. Joint ownership between HQ and regions when possible 7. Coordination and alignment across WHO (monthly meetings with Global Technical Coordination Group)
Implementation of the GAP Organizational structure Global Policy Group Steering Group Technical Coordination Group HQ & RO technical staff AMR Coordinating Secretariat Marc Sprenger Director Liz Taylor Technical Officer Ellen Attafuah Assistant Pravarsha Prakash Technical Officer Katie Barker Technical Officer
AMR Steering Group
Implementation of the GAP Role of the WHO Steering Group Make high-level recommendations and decisions need to implement AMR policy Agree WHO work plan on AMR Implementation plan proposal for donors and partners Organization-wide resource mobilization strategy Prioritize activities and address budget and funding allocation Provide guidance to the Technical Coordination Group Meet quarterly
Implementation of the GAP Nine work streams 1. Launch and maintain a global communications campaign 2. Support MS in developing their National Action Plans 3. Global Antimicrobial Resistance Surveillance System (GLASS) 4. Support measures to improve infection prevention and control (IPC) 5. Monitor use and enhance stewardship of antibiotic use 6. Encourage R&D and explore new business models 7. Improve point of care diagnostics 8. Address the environmental drivers 9. Engage the United Nations General Assembly
Implementation of the GAP National action plans In May 2015: By May 2017: 34 out of 133 responding countries have a national action plan on AMR all Member States to have plans aligned with the GAP WHO is supporting Member States by: - developing tools and templates & training material - working with ROs and COs to roll out activities and plans in Member States - developing a monitoring and evaluation framework - collecting data on the status of national action plans - reporting back to WHA by 2017
Evolution of the campaign: 2015 2017 2016: Strengthen global awareness campaign; groundwork for behaviour change programme adoption of WHA resolution to make WAAW an official annual observance; all Regions to actively participate conduct targeted research among health & ag profs and policy makers on their awareness and understanding of antibiotic resistance, self-reported behaviours and willingness to change develop a globally-applicable module for a behaviour change programme, building on the global awareness campaign and results of current pilot testing the Tailoring of Antimicrobial resistance Programme (TAP) in the WHO European Region 2015: Launch global awareness campaign conduct baseline public survey on current understanding and awareness of antibiotic resistance and self-reported behaviours related to antibiotics launch 'Antibiotics: Handle with care' campaign mark the first World Antibiotic Awareness Week (WAAW) 2017: Pilot test behaviour change programme Pilot test and evaluate the behaviour change module in 2 countries in each WHO Region conduct second global public survey to measure trends/changes in public awareness, understanding and behaviours provide comms support for WAAW and launch of major technical reports, e.g. on national action plans and GLASS
Antibiotic class discoveries in 20 th century 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 No new antibiotic class discoveries Salvarsan Penicillin Sulfonamide Daptomycin Streptomycin Bacitarin Nitrofurans Chloramphenicol Polymyxin Cholrtetracycline Cephalosporin Pleuromutilin Erythromycin Isoniazid Vancomycin Streptogramin Cycloserine Novobiocin Rifamycin Metronidazole Nalidixic acid Trimethoprim Lincomycin Fusidic acid Fosfomycin Mupirocin Carbapenem Oxazolidinone Monobactam
Gobal Action Plan: Project on R&D Possible deliverables to start with: 1. Tracking of resource flows for R&D through global health R&D observatory, including annual report on pipeline 2. Report on role and possible priority vaccines 3. Report on options for global development & stewardship framework 4. Exploration of product development partnership: WHO/DNDi proposal for a Global Antibiotic Research and Development Facility to promote research, responsible use, and access to new antibiotics 5. Coordination of research initiatives under discussion
Global Antibiotic R&D Facility Aim: A product development partnership that develops in cooperation with private and academic partners antibiotics that focus on global health needs, tries to conserve them as long as possible while ensuring equitable access for all Part of implementation of Objective 5 DNDi ready to play role as "incubator" Next step: WHO & DNDi Consultation, 13 November 2015, Geneva
Why was DNDi created? With Public and Private Funding For underprivileged pat ients Conducts research with: Ministries of Health Public Research Institutions Biotechnology & Pharmaceutical Industries To develop and deliver treatments Universities
DNDi s success is only possible through innovative partnerships Biotechs Int. Org. & NGOs PDPs Universities & Research Institutes Pharmaceutical companies CROs RESEARCH TRANSLATION DEVELOPMENT IMPLEMENTATION PLATFORM MEMBER COUNTRIES DNDi WORLDWIDE FOUNDING PARTNERS CRITERIA FOR SUCCESS Share the same vision Mutual understanding Involvement throughout the whole process Business Plan 2015-2023
After 20h flight: reality check
No prescription needed, just take 2
No knowledge, no instruction
What did they tell me No medical microbiology lab in main hospital No infection and prevention control in hospital No drug regulation No knowledge, no awareness No money for GP But committed local people and Country Office WHO
Thank you
WHA requests the Director-General (68.7): Establish and resource a Secretariat Mobilize all levels of WHO Strengthen collaboration with FAO and OIE Develop framework for monitoring and evaluation Develop and implement GLASS Establish network of WHO Collaborating Centres Develop a global stewardship framework for use and access Promote investment UN General Assembly 2016 Provide support and technical assistance to countries Report back to the WHA
Conclusion 1. Global Action Plan AMR is ambitious 2. Global Action Plan AMR: joint responsibility