Global efforts to combat Antimicrobial Resistance Dr Danilo Lo Fo Wong Senior Adviser AMR On behalf of the WHO/Europe AMR Working Group
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 Few new antibiotics in the pipeline Threatens entering a post-antibiotic era
Antibiotic resistance
The evidence is convincing: The more we use them, the more we lose them From Albrich et al EID 2004
Antibiotic resistance WHO meetings, consultations, workshops in 1971, 1977, 1981, 1982, 1994, 1996, 1997, 1998, 1999, 2002, 2004, 2008, 2009 World Health Assembly resolutions in 1986, 1988, 1990, 1992, 1994, 1996, 1998, 2001, 2005, 2007, 2009 WHO global strategy for containment of antimicrobial resistance published in 2001 Despite progress, strategies for containment not widely implemented
Antibiotic resistance
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 by Irwin RJ
Broader concept of AMR Currently perceived as "medical" or "health issue Development of AMR involves Health sector (health systems, doctors, pharmacists...) Communities (patients, families ) Agriculture sector (farmers ) Private sector (pharmaceutical companies ) Governments (regulatory authorities, politicians ) AMR is a social & economic issue
Global report on surveillance Most important findings of this report: Very high rates of resistance observed in all WHO regions. Many gaps in information on pathogens of major public health importance. Key tools to tackle AMR, e.g. surveillance systems, do not exist in many countries http://www.who.int/drugresistance/documents/surveillancereport/en/
Available National Data* on Resistance for Nine Selected Bacteria/Antibacterial Drug Combinations, 2013 *National data means data obtained from official sources, but not that data necessarily are representative for the population or country as a whole
Renewed global efforts Centralized secretariat at WHO HQ (December 2011) WHO Global AMR Task Force AMR Strategic and Technical Advisory Group (STAG) High-level awareness raising, e.g. World Health Assembly AMR Side Events 2012 hosted by Sweden, Ghana 2013 hosted by Sweden, UK 2014 hosted by Netherlands, UK and Turkey
Global AMR Action Plan Resolution adopted at World Health Assembly (May 2014) Call for Global Action Plan by WHA 2015 Stakeholder and public engagement Technical consultations AMR surveillance (December 2012, March 2014) STAG (September 2013, April 2014) High-level ministerial meetings Netherlands (June 2014), Norway (Nov 2014), Sweden (Dec 2014)
Guiding principles Whole-of-society engagement Actions based on best available knowledge and evidence Prevention first Access not excess Sustainability Incremental targets for implementation
European strategic action plan on antibiotic resistance 2011 2016
European strategic action plan on antibiotic resistance (2011 2016) WHO European action plan adopted by all 53 Member States Recognizing AMR neglected in many countries of the region No systematic AMR surveillance in large part of the Region Need for intersectoral coordination International spread through travel and trade Need for international standards and data sharing
Action Plan Strategic Objectives 1. Strengthen intersectoral coordination 2. Strengthen surveillance of antibiotic resistance 3. Promote rational use and strengthen surveillance of antibiotic consumption 4. Strengthen infection prevention and control and surveillance in health care settings 5. Prevent emerging resistance in veterinary and food sectors 6. Promote innovation and research on new drugs 7. Improve awareness, patient safety, and partnership
Country situation analysis Country situation analysis Goal Visit key Ministries, institutions, agencies, laboratories Mission report with observations and recommendations Follow-up activities Appointment of National AMR Focal Point Installation of Intersectoral Coordination Mechanism (ICM) Development of national AMR action plan Performed: Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Kyrgyzstan, Tajikistan, Uzbekistan, Moldova, Turkmenistan
WHO supports countries to complete the picture Data source: European Centre for Disease Prevention and Control (ECDC). European Antimicrobial Resistance Surveillance network (EARS-Net), 2010.
CAESAR Network (Central Asian and eastern European Surveillance of Antimicrobial Resistance) Network of national surveillance networks in non-eu MS Joint initiative European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Dutch National Institute of Public Health (RIVM) Close collaboration with ECDC Use methodology compatible to EARS-Net
Expanding AMR surveillance throughout Europe European Antimicrobial Resistance Surveillance Network (EARS-Net) Central Asian and eastern European Surveillance of Antimicrobial Resistance (CAESAR) European Centre for Disease Prevention and Control World Health Organization Regional Office for Europe Countries submitting data to CAESAR Strengthening the fight against Countries antimicrobial Symposium visited for resistance CAESAR zum 7. participation Europäischen in Bosnia and Antibiotikatag current Countries situation to be visited and 18 future for November CAESAR challenges, participation 2014, 29 Vienna, October Austria 2013 Countries participating in EARS-Net
Region-wide AM use data Technical workshops Training, data collection and analysis of national AM use data Non-EU Member States Joined initiative University of Antwerp, Belgium Close collaboration ECDC Use methodology compatible with EU Member States Lancet Infectious Diseases 2014 Strengthening the fight against Published antimicrobial Symposium Online, March resistance zum 20, 7. 2014 Europäischen in Bosnia and Antibiotikatag current http://dx.doi.org/10.1016/s1473-3099(14)70071-4 situation and 18 future November challenges, 2014, 29 Vienna, October Austria 2013
Expanding AM use surveillance throughout Europe European Surveillance of Antimicrobial Consumption Network (ESAC-Net) WHO/Europe-ESAC Project Group European Centre for Disease Prevention and Control World Health Organization Regional Office for Europe Countries which reported 2011 data to WHO Strengthening the fight against Countries antimicrobial Symposium in the process resistance zum of collecting 7. Europäischen Bosnia data and Antibiotikatag current Countries situation invited and to join 18 future November challenges, 2014, 29 Vienna, October Austria 2013 Countries participating in ESAC-Net
Expanding AM use surveillance throughout Europe Use methodology compatible with ESAC-Net Enable data comparison in the European Region Lancet Infectious Diseases 2014 Strengthening the fight against Published antimicrobial Symposium Online, March resistance zum 20, 7. 2014 Europäischen in Bosnia and Antibiotikatag current http://dx.doi.org/10.1016/s1473-3099(14)70071-4 situation and 18 future November challenges, 2014, 29 Vienna, October Austria 2013
Infection prevention and control Global Infection Prevention and Control Network (GIPCN) SAVE LIVES: Clean Your Hands - WHO's global annual campaign 2014 link to AMR
AMR in the food chain Booklet: AMR from a food safety perspective National workshops Albania, Tajikistan, Uzbekistan, Turkmenistan Subregional workshops Balkans (Albania), Central Asia (Kazakhstan) Advisory Group on Integrated Surveillance of AMR (AGISAR) Global Foodborne Infections Network (GFN)
Liaise with innovation initiatives EC DG Research & Innovation Joint Programming Initiative AMR Innovative Medicines Initiative Discussion on new business models ReAct action on antibiotic resistance Antibiotic Action
Awareness day Materials: Infograph Website Video Press release Presentation Activities Country events (press conferences, seminars) EC/ECDC/WHO twitter chat
Expanding awareness throughout Europe European Antibiotic Awareness Day (EAAD) In 2013, expanded to 44 countries in Europe 18 November 2014 theme: Self-medication Everyone is responsible, everywhere WHO focus The role of pharmacist in encouraging prudent use of antibiotic medicines and averting antimicrobial resistance Global Twitter Chat: 24 hours US, Canada, Europe, Australia, New Zealand WHO Regional Offices
Campaign support Call for proposals (April 2014) - Template, SMART objectives, selection criteria Proposal review (May 2014) - Panel of expert partners (WHO, RIVM, ECDC, BAPCOC) Grants awarded (ARM, BIH, GEO, KGZ, MKD, MNE, SRB) - Implementation June 2014 to February 2015 Workshop (Q1 2015) - Exchange experiences and expertise
Partnership
Acknowledgments Division of Communicable Disease, Health Security & Environment Guenael Rodier Cristiana Salvi Siff Malue Nielsen AMR Coordination Danilo Lo Fo Wong Nienke van de Sande-Bruinsma Saskia Nahrgang Food Safety Hilde Kruse Health Systems and Public Health Hans Kluge Health Technologies and Pharmaceuticals Hanne Bak Pedersen Nina Sautenkova Ganna Bolokhovets Influenza & other Respiratory Pathogens Caroline Brown Vaccine Preventable Diseases & Immunization Robb Butler Alert and Response Operations Ana Paula Coutinho Jukka Pukkila
No action today No cure tomorrow Thank you for your attention