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FOURTHMEETINGOFTHE IACG OCTOBER2017

16-17October,2017

OIEHeadquarters,Paris,France

Meeting Report: Fourth meeting of the Ad hoc Interagency Coordination Group on Antimicrobial Resistance (IACG)

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FOURTHMEETINGOFTHE IACG OCTOBER2017

TableofContentsABBREVIATIONS.........................................................................................................................................1

EXECUTIVESUMMARY................................................................................................................................3

1. INTRODUCTION..................................................................................................................................51.1. ABOUTTHEIACG...................................................................................................................................51.2. MEETINGAIMSANDOBJECTIVES...............................................................................................................7

2. AMRACTIVITIES.................................................................................................................................72.1. IACGACTIVITYMAPPING.........................................................................................................................72.2. MONITORINGANDEVALUATION(M&E)FRAMEWORK.................................................................................92.3. CALLTOACTIONCONFERENCE................................................................................................................10

3. IACGWORKPLAN.............................................................................................................................113.1. CO-CHAIRS’PRIORITIES..........................................................................................................................113.2. ADDRESSINGHIV,TBANDMALARIA(HTM)............................................................................................123.3. REFININGTHEWORKPLAN.....................................................................................................................133.4. COUNTRYVISITS...................................................................................................................................14

4. SUBGROUPS.....................................................................................................................................154.1. KEYFEATURESOFSUBGROUPS................................................................................................................15

5. REPORTING......................................................................................................................................175.1. DRAFTINGTHEIACGREPORTS................................................................................................................175.2. FINALDRAFTOFTHEWORKPLAN.............................................................................................................17

6. STAKEHOLDERSPOTLIGHT................................................................................................................196.1. IACGANDSTAKEHOLDERENGAGEMENT...................................................................................................196.2. STAKEHOLDERCONTRIBUTIONS:ANIMALHEALTH.......................................................................................20

ANNEXES..................................................................................................................................................23ANNEXI.MEETINGAGENDA................................................................................................................................23ANNEXII.LISTOFPARTICIPANTS..........................................................................................................................24ANNEXIII:SUBGROUPS......................................................................................................................................26

Imagecredits.Coverimage:GinoCarteciano,CreativeCommons,viaFlickr.AlliconsbytheNounProject(https://thenounproject.com/).

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FOURTHMEETINGOFTHE IACG OCTOBER2017

AbbreviationsAMR AntimicrobialresistanceANMV FrenchAgencyforVeterinaryMedicinalProductsANVISA BrazilNationalHealthSurveillanceAgencyASEAN AssociationofSoutheastAsianNationsDNDi DrugsforNeglectedDiseasesinitiativeEMA EuropeanMedicinesAgencyFAO FoodandAgricultureOrganizationFEAP FederationofEuropeanAquacultureProducersGAP GlobalActionPlanonAMRHTM HIV,TBandMalariaIACG InteragencyCoordinationGrouponAntimicrobialResistanceIDF InternationalDairyFederationIEC InternationalEggCommissionIMS InternationalMeatSecretariatJEE JointExternalEvaluationLMIC Low-andmiddle-incomecountryNAP NationalActionPlanonAMRNGO NongovernmentorganizationOECD OrganisationforEconomicCo-operationandDevelopmentOIE WorldOrganisationforAnimalHealthR&D ResearchanddevelopmentSDGs SustainableDevelopmentGoalsTB TuberculosisUHC UniversalhealthcoverageUN UnitedNationsUNAIDS JointUnitedNationsProgrammeonHIV/AIDSUNEP UnitedNationsEnvironmentProgrammeUNGA UnitedNationsGeneralAssemblyUNICEF UnitedNationsChildren'sFundWASH WaterSanitationandHygieneWCO WorldCustomsOrganizationWHA WorldHealthAssemblyWHO WorldHealthOrganizationWIPO WorldIntellectualPropertyOrganizationWTO WorldTradeOrganization

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FOURTHMEETINGOFTHE IACG OCTOBER2017

ExecutivesummaryDuringthe71stsessionoftheUNGeneralAssembly(UNGA),HeadsofStateissuedahigh-levelpoliticaldeclarationbackingaGlobalActionPlanonantimicrobialresistance(GAP)atnational,regionalandgloballevels.TheycalledontheSecretary-General(SG)toestablishanAdhocInteragencyCoordinationGrouponAntimicrobialResistance(IACG)toprovideguidanceonpracticalapproachestoaddressAMRandimprovecoordination,takingtheglobalplanintoaccount.Thisgroup,knownastheIACG,ismadeupof281high-levelexpertsandorganizationsinantimicrobialresistance(AMR)acrosshuman,animalandenvironmentsectors.InOctober2017,thegrouphelditsfourthmeeting.HostedbytheWorldOrganisationforAnimalHealth(OIE)inParis,thismeetingsawtheIACGshareupdatesonarangeofongoingactivities,agreeaplanforfutureworkandwaysofworking,developtheirworkthroughbreakoutsubgroupsessions,andengagestakeholdersfromthelivestockandanimalhealthsectors(seeAnnex1).

AMRactivitymappingTheAMRactivitymappingexerciseundertakenbytheIACGSecretariathighlightssignificantgapsinactivity,especiallyintheplanthealthandenvironmentspaceand,toalesserextent,intheanimalhealthsector.TheIACGagreedthatnextstepsforthemappingworkshouldinclude:• Possiblyexpandingthemappingtoincludeotherstakeholders,withintheUNfamilyandbeyond.• Re-mappingactivitiestotheFrameworkforAction2(includingallUNagencies,notjustIACGmembers).• Integratingotherrelevantdata,including,wherefeasible,commitmentsmadeattheCalltoAction.• Makingtheinitialresultspublicasworkinprogress,withlinkstofurtherinformation.• Usingtheresultstoidentifygapsandinformreportback onprogresstotheSGonnextsteps.

FinalisingtheworkplanTheIACG’sfinalworkplanincludesseveralchangesthatreflectfeedbackfromawebconsultation3ofMemberStatesandotherstakeholders,aswellasrecommendationsfromIACGmembers.Inparticular,theworkplanhasbeenrevisedto:• makerecommendationsmoreexplicit;• clarifythepurposeoftheFrameworkforActionandtheAMRmappingexercise;• strengthenlanguageabouttheIACG’sroleandaddedvalue;• includeareferencetoHIV,TBandMalaria;and• addressstakeholderengagement.Inadditiontofinalisingtheworkplan,IACGmembersfinalisedthedetailsofthreekeymechanismsfordeliveringthework:subgroups,countryvisitsandadraftinggroup(seeTable1).

1Threeseatsarecurrentlyvacant.2WHO2017.AMRFrameworkforAction(www.who.int/antimicrobial-resistance/interagency-coordination-group/20170818_AMR_FfA_v01.pdf?ua=1,accessed15October2017)3Onlineconsultation:InteragencyCoordinationGroup(IACG)onAntimicrobialResistance[website].(www.who.int/antimicrobial-resistance/interagency-coordination-group/online-consultation,accessed6November2017).

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Table1.AgreedmechanismsfordeliveringtheIACGworkplan

EngagingstakeholdersAllIACGmembersagreeontheneedtoengagethefullspectrumofstakeholdersincarryingoutitswork.TheParismeetinginvitedstakeholdersfromtheanimalhealthandfoodsectortooffertheirperspectivesonAMRandtosharetheirprioritiesforIACGguidance.Presentationsweremadebyrepresentativesfrom:InternationalDairyFederation,InternationalMeatSecretariat,InternationalEggCommission,InternationalPoultryCouncil,FederationofEuropeanAquacultureProducers,HealthforAnimals,andUSDAAgriculturalResearchService.TheirprioritiesforIACGactionandguidancearesummarisedinTable2below.Priority NotesTransparency • AtransparentmechanismforconsultingwiththeIACGContinuedengagement • AllowingstakeholderstostayinvolvedinIACGworkMorescienceanddata • Includingtheimpactofantimicrobialresiduesonhumanhealthanda

betterunderstandingofAMRtransmissionpathwaysMonitoringguidance • Awaytomonitorantimicrobialuse(includingtypeofagent)Education • RaisingawarenessamongbothconsumersandprofessionalsPublicinvestment • Overcomingregulatory,financialandtechnicalhurdlesAparadigmshiftinR&D • IncentivizingR&Dtoprimetheproductdevelopmentpipeline

• NotjustfocusingonnewproductsAportfolioofalternatives • Afocusonpracticalsolutionsacrossanimalproductionsystems,

includinggoodhusbandry,andstrongcapacity,capabilityandtraining.Table2.PrioritiesforIACGactionandguidanceidentifiedbystakeholdersfromtheanimalhealthandfoodsector

Mechanism Howitworks

Subg

roup

sSubgroupsofferawayofadvancingtheanalysisofspecificissues,anddevelopingpreliminaryconclusionsandrecommendationsthatcanfeedintotheIACG’splenarysessions. TheIACGhasestablishedsixsubgroups,closelyalignedwithitsFrameworkforAction:1. Communication,publicawareness,behaviour-change,professionaleducationandtraining2. Nationalactionplans,includingmonitoringandsupport3. Reduceneedforantimicrobialsandunintentionalexposure,andoptimisinguse4. Investininnovationandresearch,andboostresearchanddevelopment(R&D)andaccess5. SDGalignment,globalgovernancepast2019andUNroleandresponsibilities6. Surveillanceandmonitoringforantimicrobialusageandresistance Subgroupswillengageabroadrangeofexternalstakeholderstohelpinformtheirwork.

Coun

tryvisits CountryvisitshelpensuretheparticipationandbuyinofMemberStates.Theycanserveto

raisepoliticalawareness,recruitAMR‘champions’,roadtestIACGthinkingandgathercontext. AllIACGcountryvisitswillbe:short(1–2days);prepared(supportedbyastrongcountrybriefingbeforehand);andhigh-level(focusedonstrengtheningpoliticalwillandadvocacy;andonunderstandingcountrycontexttoidentifychallengesandinformrecommendations).

Draftin

ggrou

p ThedraftinggroupisdesignedtohelptheIACGwriteitsinterimandfinalreports.MadeupofasmallnumberofIACGmembers(subgroupchairs),thegroupwilluseinputsfrombothsubgroupsandthebroaderIACGmembershiptodevelopaninitialsetofwrittenguidanceandpreliminaryrecommendationsfortheIACGtoreviewandrefine.

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1. Introduction

1.1. AbouttheIACGIn2016,theGlobalActionPlanonantimicrobialresistance(GAP)4wasreaffirmedastheblueprintfortacklingAMRduringthe71stsessionoftheUNGA,whereHeadsofStateissuedahigh-levelpoliticaldeclaration5committingtosupportandimplementtheplanatnational,regionalandgloballevels.Throughthedeclaration,UNMemberStatescalledontheSecretary-GeneraltoestablishanadhocinteragencycoordinationgroupofexpertsuntilSeptember2019,toofferadviceandguidanceonhowtoaddressAMRandimprovecoordination,takingintoaccounttheGAP.Thisgroup,knownastheIACG,wasofficiallylaunchedinMarch2017.Itisco-chairedbytheUNDeputySecretary-GeneralAminaJMohammedandtheWHODirector-GeneralTedrosAdhanomGhebreyesusandcomprises28high-levelrepresentativesofUNagenciesandotherinternationalorganizations,andindividualexpertsacrossdifferentsectors.Thegroup’smandateistoprovidepracticalguidanceforapproachesneededtoensuresustainedeffectiveglobalactiontoaddressantimicrobialresistance;andtoreportbacktotheSG.Thisincludesmakingrecommendationsonhowtobettercoordinateactionacrosssectorsandcountries,andservingasavehicleforbuildingpoliticalmomentumandmobilisingabroadbaseofstakeholders.

TheIACGhasagreedasetofguidingprinciplesforitswork(seeIACGguidingprinciplesbelow)andhasdevelopedaFrameworkforAction6,whichincludes14‘contentareas’fortacklingAMR,six‘levers’foraddressingtheseandthreeunderlying‘enablers’(seeFigure1).Itoffersacommonlanguageforallsectorstouse.

4GlobalActionPlanonAntimicrobialResistance.Geneva:WorldHealthOrganization;2015(http://www.who.int/antimicrobial-resistance/global-action-plan/en/,accessed30October2017).571stSessionoftheUNGA.Politicaldeclarationofthehigh-levelmeetingoftheGeneralAssemblyonantimicrobialresistance(ResolutionA/RES/71/3).NewYork:UnitedNations;2016(http://www.un.org/en/ga/search/view_doc.asp?symbol=A/RES/71/3,accessed30October2017).6AMRFrameworkforActionSupportedbytheIACG.IACG;2017(http://www.who.int/antimicrobial-resistance/interagency-coordination-group/20170818_AMR_FfA_v01.pdf?ua=1,accessed30October2017).

AMR is a significant and growing threat—it needs this group’s expertise to help identify a collective and cohesive way forward. AminaMohammed,UNDeputySecretary-General,addressingmembersoftheIACGinOctober2017.

We have been working for years at the technical level… Now we have political support and we hope to keep this momentum alive so we can be stronger to support member countries design and implement effective national action plans. MoniqueEloit,OIEDirectorGeneral,addressingmembersoftheIACGinOctober2017.

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TheframeworkadoptedbytheIACG:• reflectsthekeyprioritiesandfocusoftheUN’shigh-levelpoliticaldeclaration;• isalignedwiththeGAP,buildsonitandsupportsitsimplementationacrosskeypriorities;• alignswiththeSustainableDevelopmentGoals(SDGs),manyofwhichwon’tbeachievedwithout

addressingAMR;and• framesAMRmeasuresasAMR-sensitiveandAMR-specific.

Figure1:TheIACG’sFrameworkforActioncovers14contentareas,sixleversandthreeenablers.Republishedfrom:WHO2017.AMRFrameworkforAction(www.who.int/antimicrobial-resistance/interagency-coordination-group/20170818_AMR_FfA_v01.pdf?ua=1,accessed15October2017)

IACGguidingprinciples• Ensuringthatpracticalapproachesarephasedandstepwise.• Ensuringthatrecommendationsarebasedonutilizationofexistingtoolsacrossorganizationsand

systemsthroughcollaborationandcoordination,andavoidingredundancy.• Noapportioningofblame,butworkingtoensurethattheAMRsituationgetsbetter,notworse.• Workingtosupportsystemsstrengthening,promotingthedisseminationofbestpracticesandcase

studies,andaccesstoservicesandhealthtechnologies.• CommittingtoaninclusiveandtransparentprocessbasedonGAPobjectivesandalignedwithSDGs.• Notduplicatingtheworkofothers.

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1.2. MeetingaimsandobjectivesInOctober2017,theIACGhelditsfourthmeeting.HostedbyOIEinParis,themeetingwaslargelyadecision-makingoneintendedtoprogressthegroup’swork.Themeetinghadfourkeyobjectives:a. Updateallmembersonongoingactivities.b. Agreeaplanforfutureworkandwaysofworking.c. Establishsubgroupsanddecidetheirmembership,scope,waysofworkinganddeliverables.d. Engagestakeholdersfromthelivestockandanimalhealthsector.

2. AMRactivitiesInclosedsessionsoftheParismeeting,IACGmemberswerebriefedonaselectionofkeyAMRactivities,includingtheIACG’sAMRactivitymappingexercise,theMonitoringandEvaluationFramework,theCalltoActionconference,theG20GlobalAntimicrobialR&DCollaborationHub,andtheintergovernmentalbodyCodexAlimentarius.

2.1. IACGactivitymapping

ActivityupdateAtitsfirstmeetinginMay2017,IACGmembersaskedthegroup’ssecretariattomaptheAMRworkalreadybeingdonebythetripartite(FAO,OIE,WHO),IACGmemberorganizationsandotherUNagencies.Thismappingwasintendedasafirststeptowardsunderstandingwhatactivitiesareunderway,whatdataarebeingcollected,andwherethegapslie.TheSecretariatdevelopedacategoricalframeworktomapactivitiesagainstthefiveGAPobjectives(plusacross-cutting‘strategicleadershipandcoordination’objective),whilecapturingadditionalinformation,suchasthenatureofactivities(strategicplanning,standards,operationalimplementation,advocacy),whatsectorthey’rein(human,animalorplanthealth,orenvironment),theirstatusandtheirrelevancetotheSDGs.

Todate,tenagencieshaveparticipatedinthemappingexercise.7ThemostchallengingaspectformostwasidentifyingasinglerelevantSDGbecausemanyactivitiesarerelevanttomultiplegoals.TheframeworkhasnowbeenrevisedtoallowmorethanoneSDGtobeselectedperactivity.

Usingthedatacollected,theSecretariatcreatedaseriesof‘maps’thatplot,foreachGAPobjective,thenatureofactivityagainstthesectoritliesin.Eachmapworksatahighlevel,seekingtounderstandwhattheAMRlandscapelookslike.TheSecretariat’sfindingsweresharedanddiscussedwithIACGmembersattheParismeeting(seeTable3andInsights,lessonslearnedandnextstepsbelow).GAPobjective Observations

GAP1Awarenessandunderstanding

• Planthealthandenvironmentsectorsarebehindontheseissuescomparedwithhumanandanimalhealth

GAP2Evidencebase

• TripartitecooperativeinitiativesactivelysupportnationalactionplansonAMRandmonitorandevaluatetheiroutcomes

GAP3Reducingincidence

• Thereisastronghumanhealthfocus• Theexactrelevancetoplanthealthandenvironmentishardtosee

7FAO,OECD,OIE,UNAIDS,UNEP,UNICEF,Unitaid,theWorldBank,WHO(plustheWHOHIV/TB/Malariateam),WIPO.

AMR is a cross-cutting issue that affects all the sustainable development goals.

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GAP4Optimisinguse

• Thereislotsofworkacrosshumanandanimalhealth,especiallyintheareaofstandards,guidelinesandbestpractices

GAP5Economiccaseandinnovation

• Thisareaistop-heavywithworkonstrategicplanningandcoordination• Itneedsadownwardspushtowardsstandardsandoperationalwork

Strategicleadershipandcoordination

• Therearesomecross-sectorstrategicleadershipinitiatives,butmorecomprehensiveonesareneeded,coveringplanthealthandenvironment

• Ongoingeconomicstudiesmayfeedintofuturestrategicleadership• Weexpectlotsmoreinformationfromotherorganizationsinthisarea

Table3:FindingsofAMRmappingexerciseinbrief. Insights,lessonslearnedandnextsteps

I. Themappingexerciseneedsvalidating• Acrossallobjectives,therearegapsin

activity,especiallyintheplantandenvironmentspace.

• Butarethesegaps‘real’?Areareassufficientlyresourced?There’smuchmoreactivityoutthereandvalidatingresults(byaddingactivitiesofotherstakeholdersandlookingcriticallyatgaps)isimportant.

• Themappingdoesnotincludecountry-levelactivities,whichmayexplaintherelativelylownumberofactivitiesinoperationalimplementationandadvocacyorpromotion.

• Tomoveforwardwithsubgroups,theIACGneedstomovebeyondhigh-levelinformationtoexaminethedetailsofwhatishappeningontheground,includinglookingatwhatcivilsocietyisdoing.

II. Themappingresultsarealreadyuseful;buttheycanbemademoreso

• TheIACGshouldexpandthemappingexercisetoincludeotherstakeholdersintheUNfamilyandbeyond.• Expansionincludesintegratingthecommitmentsmadeat

theCalltoActioninBerlin,andaddingothermappingactivities(particularlyonR&D,wheremappinghasbeendonebefore).

• ActivitiesneedremappingtotheIACGFrameworkforAction.• Toensuretheyare‘user-friendly’,mapsneedtobeflexible,andshouldincludelinkstomoreinformation.• Thesedatawillinevitablybeusedtoinformfinancialdecisions—thenaturalnextstepistolookathow

muchmoneyisbeinginvested,where,andwhatresourcesareavailable.

There are large areas with nothing—are there really no activities or is it that we simply haven’t identified any?

At the end of the day, we want a public-facing, online relational database.

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2.2. MonitoringandEvaluation(M&E)Framework

ActivityupdateWhentheWHAagreedtheGAP,italsocalledforthedevelopmentofamonitoringframework.OverthepasttwoyearsthetripartitehavedevelopedajointapproachtoM&EforAMRatcountryandgloballevels.Manyexpertswereinvolvedintheprocess,whichincludedapubliconlineconsultationin2017.Overalltheconsultationendorsedtheproposedapproachandapplaudeditsuseofamulti-sectoralframework,althoughmanyrespondentscalledformoreworktobedoneontheanimal,plantandenvironmentindicators.Workisnowunderwaytoincorporatethecomments,refinetheapproachandreviewandfocusthelistofindicators.BecausemanycountriesarestillonlyjustbeginningtodevelopanAMRresponse,M&Eoverthenextfewyearswillfocusonprogressasmuchas,ormore,thanonimpact.Tothatend,thetripartitehasalreadyconcludedaself-assessmentsurveytoidentify,amongotherthings,thestateofNAPdevelopmentandnationalsurveillancesystemsforAMR.ThetripartiteiskeenfortheIACGtoendorsetheapproach,assessGAPindicatorsandadviseonbothwhoshouldconsolidateandreviewglobalreporting,andhowevaluationshouldbecommissionedandfinanced.

Discussionhighlights I. TheIACGendorsestheapproachintheshort-term• TheIACGagreesthattheapproachwillworkforthenexttwoyears.• Thegroupwilldevoteasessionatitsnextface-to-facemeeting(Jan

2018)togetmoreinformation,discusstheIACG’spotentialroleintheframework,andexplorethelistofproposedindicators.

II. ThereisneedforacommonM&Eframework • TheM&EframeworkmustsupportanaccountabilitymechanismthatextendsbeyondtheGAP.• Thequestionishowtointegratethisintohigh-levelpoliticalforumprocesses?Theseprocessesstartat

thecountrylevel,sothatisthepointatwhichAMRshouldbeintegrated.

III. Theinformalmarketisabigunknown• Theindicatorwithgreatesttractionsofaristheratioofdrugswewanttohaveavailableagainstthosewe

wanttoconserve,whichiscalculatedbasedonwhatiscomingintoacountryatcustomslevel.• Butitalsoneedspointsurveysanddataontheinformalmarket,whichislargelyunknown.IV. TheM&Eframeworkisanopportunityformoredata• LackofaccesstodrugsisakeydriverofdiseasessuchasHIVand,assuch,isfundamentaltowhat’s

happeninginAMR:ifwedon’tmonitoraccesswemaymissabigpartoftheAMRstory.• Trackinghumanandlaboratoryresourceswouldbeuseful,albeithardtodoinpractice.• Understandinghowmuchisbeingproduced,whereandforwhatpurpose(whetherthatbedistributedby

doctorsorvets,mixedinfeedorusedoncrops,forexample)wouldbeamajorachievement.Butitrequiresthecooperationofpharmaceuticalcompaniestosharedata.

The country maps are a great achievement.

Pharmaceutical companies…are part of the solution.

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2.3. CalltoActionconferenceHeldinBerlin,October2017,theCalltoActionconferencewasaninnovativeeventaimedatacceleratingmomentum,alignmentandcooperationonAMR.TheeventwashostedbythegovernmentsoftheUK,GhanaandThailand,withWellcomeTrustandtheUNFoundation,inpartnershipwiththeIACG.ItwasdesignedtosupporttheIACG’swork.8Participantsincludedrepresentativesfromindustry,academia,NGOs,governmentsandfundingbodies.AllwerecalledontofocusonthemostcriticalgapsintacklingAMR,andtopubliclycommittoconcertedandtangibleactionstoaddressthese.Morethan60suchcommitmentsweremade,coveringarangeoftopicsfromtrackingglobalburdenofdiseasetodevelopingAMRtrainingcurricula.9ParticipantsalsomaderecommendationstotheIACGonwhatisrequiredtotackleAMR—rangingfromcontext-specificsolutionstoscientificstandards,R&Dincentivesandpublicawarenesscampaigns—whichwillinformtheIACG’sreportbacktotheUNSecretaryGeneral.

Insights,lessonslearnedandnextstep

I. CallstoActioncanhelptheIACGtapintoexpertiseandkeepmomentumhigh

• Thereisnoquestionthatthepoliticalcommitmentto

tackleAMRexists,butitisnotmatchedbyenoughconcreteactionontheground.

• Theconferenceheardanewcallforacceleration,withparticipantsaskingformoretohappen,andfaster.

II. Thenextconferenceneedsbroaderengagement• Despitemanyinvitations,participationfromtheglobalSouthwaslow.• Tobeinclusiveandmeaningful,thenexteventmustincludemoreparticipantsfromLMICs—theevent’s

successinBerlinshouldhelpsecurefutureinvolvement. III. Theseconferences,nowandinthefuture,candrivetheIACG’sworkTheCalltoActionconferencescanbeusedtodriveandsupporttheIACG’sworkby:• publishingalistofcommitmentstoholdpledgerstoaccountandkeeptrackofprogress;• usingmeetingstoreportbackontangiblepromisesnowand,fromthere,togeneratemorepromises;• integratingthecommitmentsintotheIACGmappingworktoprovideafullerpicture;• tailoringmeetingstospecificgapsoraudiences,andhostingconsultationsessionsforstakeholders;and• reinforcingtheroleoftheIACGtoconveneandcoordinate,ratherthanimplement.

8Oneoftheconference’sstatedobjectiveswasto“ensureweidentifyallongoingworkatanationalandinternationalleveltoinformtheIACG”.Seehttps://wellcome.ac.uk/news/global-call-action-drug-resistant-infectionsformoreinformation.9ThesearebeinganalysedbytheCalltoActionorganizingcommitteeandwillbeshared,infull,withtheIACGinduecourse.

[The Call to Action] offered a clear indication of the ocean of knowledge and resources out there.

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3. IACGworkplanTheParismeetingincludedseveralagendaitemsaimedspecificallyatfinalisingtheIACGworkplan.Groupmemberswereaskedtoreflectoncommentsmadebyco-chairs,respondentstothewebconsultationandcolleaguestodecidethefinalwordingoftheworkplan,definekeyactivitiessuchasstakeholderengagementandcountryvisits,andagreewaysofworking.

3.1. Co-chairs’prioritiesBothIACGco-chairsaddressedtheParismeetingtohighlighttheirprioritiesforthegroup.

AminaMohammed,UNDeputySecretary-GeneralSpeakingthroughavideoaddress,UNDeputySecretary-GeneralAminaMohammedpointedtofourareasofworkthatsheseesascriticaltothegroupfulfillingitsmandate:

a. Stakeholderengagement:buildingonthesuccessoftheCalltoActionconference,thisincludesconsideringhowtoleveragemeetingstomaintainbroadengagementacrossallstakeholders.

b. Cross-sectoralcommunication:thisinvolvescommunicatingmoreeffectivelyaboutAMRtothegeneralpublicandprofessionalsacrossthemedical,agricultural,environmentandfoodsectors.

c. Planofaction:thisincludesagreeingaclearlydefinedworkplantosteerthefutureworkofthisgroupandfinalisingawayofworkingthatcanfacilitatetheeffectiveimplementationofthisworkplan.

d. Countryvisits:thisincludesvisitingcountriestofindoutwhatisbeingdoneatnationalandcommunitylevels,andensuringIACGrecommendationsaregroundedinevidenceandcountryrealities.

DrTedrosGhebreyesus,WHODirector-GeneralWhenWHODirector-General,DrTedrosGhebreyesusaddressedthegroup,hemadeeightrecommendationsforactionintheimmediateandshortterm:

a. FillIACGvacancies:therearethreeIACGmembervacanciesthatneedtobefilledassoonaspossible.b. Proceedwithsubgroups:thesixproposedsubgroupsmakesenseandshouldbeadoptedimmediately.c. Enablesupport:theWHOiscommittedtosupportingtheIACGbutwantsthegrouptodefinethesupport

itneeds—thatmeanssubmittingaproposalforsupport,outliningpersonnelandresourcerequirements.d. Fundraise:thisbeginsbytheSecretariatputtingacosttoIACGactivitiesintheworkplan,preparinga

budgetandmakingalistofallpotentialdonorsandsupporters(forthegroupasawholeandsubgroups).e. IncludeHIV,TBandMalaria:WHOconsidersthatsomereferencetoHIV,TB,andmalaria(HTM)inthe

IACGworkplanisadvisable.LessonslearnedfromHTMcouldproverelevanttoresistanceelsewhere.f. Undertakecountryvisits:thisisimportanttoensurecountryparticipationandownership.g. Identifyinstitutionalcapacities:includetheseintheIACGAMRactivitymappingexercise.h. InvolvetheDirector-General:DrGhebreyesusiskeentobeinvolvedintheIACGasmuchaspossible,and

askedIACGmemberswhathecoulddotobestsupportthegroup(seeFigure2below).

Dr Tedros…and I are committed to giving you our full support as you survey the AMR landscape and formulate your recommendations.

AMR will be my top priority.

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Figure2:SuggestionsbyIACGmembersondifferentwaystheWHODirector-Generalcansupportthegroup. 3.2. AddressingHIV,TBandMalaria(HTM)The2017webconsultationontheIACGworkplanresultedinseveralcallsforspecificreferencetobemadetoHTM.10DuringtheParismeeting,IACGmembersreviewedtheprosandconsofdoingso.

Pros • Opportunityknocks.ThereareseveralmeetingsonHTMscheduledoverthenextyear(includingthe

UNGAhigh-levelmeetingonTBin2018)thatofferagoodopportunityforcementingpoliticalcommitmentto,andraisingtheprofileof,IACGwork.

• Lessonstolearn.HTMhavealonghistoryoftacklingdrugresistance,leadingthefieldintermsofbothprogrammesandfunding,andtheIACGcouldlearnfromtheirexperience.

• Agendaofthepoor.HTMarethethreebiggestinfectiousdiseasekillersofpoorpeople.IncludingthemiscriticaltomakingtheAMRagendarelevanttotheglobalSouth.

• Progressprotection.HTMhasmadelotsofprogressinthepast10–15yearsandAMRisputtingthatatrisksoweneedtokeepithighontheagenda.

10ForthelatestWHOinformationonresistanceinthesethreediseasessee:a)GlobalMalariaProgramme.Artemisininandartemisinin-basedcombinationtherapyresistance:StatusReportApril2017.Geneva:WorldHealthOrganization;2017(www.who.int/malaria/publications/atoz/artemisinin-resistance-april2017,accessed31October2017).b)Q&Aonartemisininresistance[website]Geneva:WorldHealthOrganization;2017(www.who.int/malaria/media/artemisinin_resistance_qa,accessed31October2017).c)Multidrug-resistanttuberculosis(MDR-TB):2016Update.Geneva:WorldHealthOrganization;2016(www.who.int/tb/challenges/mdr/mdr_tb_factsheet.pdf,accessed31October2017).

There’s a wealth of experience and expertise waiting to be tapped.

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Cons • Riskofimbalance.TheIACGmustmaintaina

balancedapproachacrosshuman,animal,plantandenvironment—addingHTMtotheworkplancouldgiveunduefocus:whynototherse.g.rabiesoravianflu?

• Holisticapproachundermined.TheIACG’sworkmustsupportAMRsystemsandaOneHealthapproach;notbedisease-specific.

• AligningwiththeSDGs.AlltheissuesneedtobestrategicallylinkedwithinthebroaderSDGframework,andHTMisalreadymentionedintheSDGs.

3.3. RefiningtheworkplanIn2017,theIACGinvitedinputonitsworkplanthroughawebconsultation,whichresultedinaround80responsesfromarangeoforganizations.Takentogether,theseresponseshadthreehigh-levelrecommendationstomaketotheIACG:• Keeptothelanguageoftheresolutionthatestablishedthisgroup.• DefinetheboundariesofwhattheIACGcanandcannotachievethroughitsmandate.• Developatimelinewithmilestonesfordeliveringtheworkplan.Beyondthesehigh-levelrecommendations,respondentsalsohadseveralspecificsuggestionsforimprovingtheworkplan.SotoodidseveralIACGmembers.ConsiderationofalltheseattheParismeetingresultedina‘todolist’ofninetasksaimedatrefiningtheworkplaninlightoffeedback.Theserangefromusingstronglanguagetoclarifythegroup’sroletodefiningstakeholderengagement(seeFigure3).

Focusonmandate

Identifyuseoftools

Thinklong-term

Referencede-linkage

Addvalue

Drawupabudget

ClarifyroleofIACG

Considerstakeholders

Buildatimeline

Figure3:A‘todo’listforrefiningtheIACGworkplaninresponsetofeedbackanddiscussion.

We have patients in front of us, not diseases: we need to address their needs.

As a group, the IACG needs to be strategic about how to situate the issue of AMR in the broader political context.

HTMoutcomeINCLUDEHTM,BUTDON’TMAKEITTHEFOCUSFollowingdiscussion,theIACGdecidedtoincludereferencetoHTMinitsworkplan,butnottomakethesediseasesthefocusoftheirwork.TheagreedreferenceismadeinObjective1.1oftheworkplan:“1.1AdviseonwaystomainstreamAMRactionintotheSDGs,inawaythataddressesantibacterialresistanceaswellasresistancetoantimicrobialsusedtotreatotherinfectiousdiseases,suchasHIV,TB,andMalaria(HTM).Usingasystemsperspective,theIACGwilltakeintoaccountHTMexperience,includinglessonslearnedinawareness,advocacy,andcommunityengagement,andwillseekopportunitiestocollaboratewithHTMinitiativeswhereappropriate.”• .

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“

“

3.4. Countryvisits

The‘why’:whataretheobjectivesofthesevisits?• TofulfilthemandatesetdownbytheUNSG,andsupportedbyIACGco-chairs.• ToengageMemberStatesatalllevels.• Toraisehigh-levelpoliticalawareness.• TorecruitAMR‘champions’(atbothcountryandregional

levels)thatcanextendthereachanddeepentheimpactoflocal,nationalandregionalAMRinitiatives.

• To‘roadtest’IACGthinkingandrecommendations.• TogathercolourandcontextfortheIACGfinalreport.• Tolearnaboutin-countrychallengesandopportunities.

The‘whatandhow’:whatwillavisitentailandhowwillitworkinpractice?

• AcountryvisitisanopportunityforIACGmemberstoseehowthetheoryofcombatingAMRworkson

theground,inthelocalcontext.• Visitsofferanopportunitytoreflectback

informationgatheredthroughdata-gatheringinitiativessuchastheJointExternalEvaluation(JEE)ortheOIEdatabase,inawaythatisusefulforcountriesindevelopingtheirNAPs.

• Allvisitsmustprovidesupportandencouragement;theyarenotcriticalassessments.

We’re trying to spark change but also to get country leaders to take their regions with them and build something bigger.

For countries that are struggling with the NAP process: how do we, as the tripartite or the IACG, support them?

CountryvisitsoutcomeUNDERTAKECOUNTRYVISITS,WITHAFOCUSONHIGH-LEVELENGAGEMENTIACGmembersagreedsuchvisitswouldbe:• short(1–2days);• prepared(supportedbyastrongcountrybriefingbeforehand);and• high-level(focusedonstrengtheningpoliticalwillandadvocacy).EachvisitshouldincludeaminimumofthreeIACGmembersandoneortwomembersoftheSecretariat.

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4. SubgroupsOnceIACGmembershadagreeduponafinalworkplan,theyconsideredhowtheywouldworktogethertoimplementit.Inparticular,theyagreedtheneedtosplitintosmallergroupstoadvanceanalysisofspecificissuesandchallengesanddeveloppreliminaryconclusionsandrecommendationsthatcanfeedintoIACG’splenarysessions.Tothatend,theIACGestablishedsix‘subgroups’,closelylinkedtotheFrameworkforAction(seeFigure6).AttheParismeeting,thegroupagreedthemembershipofthesesubgroups(seeAnnex3)anddefinedtheirscopeandaddedvalue,aswellaswaysofworking,includinghowtoengageexternalstakeholders.

Figure6.TheIACG’ssixsubgroups

4.1. KeyfeaturesofsubgroupsScopeSubgroupsareintendedtodrivetheIACG’sworkforward,andnottorepeatworkalreadybeingdonebythetripartiteorothers.Inmanytechnicalandpoliticalissuesthatthesubgroupswillgrapplewith,the‘what’hasalreadybeendefined,sotheywillfocusondetermining‘how’solutionscouldbeimplemented.RecommendationsonscopetoemergefromtheIACGdiscussioninclude:• Don’tduplicate.Subgroupsshouldnotduplicatework,

bothofotherorganizationsorothersubgroups.• Focusontheholes.Subgroupsshouldconcentratetheir

effortsonthecriticalgaps.

We must be informed by, but not re-do, the work of the tripartite.

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“• Ensureabalance.Subgroups’workshouldcutacrosshuman,

animal,plant,andenvironmentissues.• Alignwork.Subgroupsshouldlinktothecontentareas,

leversandenablersoftheIACGFrameworkforAction.• Keepaclearremit.Subgroupsshouldbeclearaboutboth

whattheyareandarenotdoing.

ExternaladvisorengagementAswellasIACGmembers,otherexpertsfromIACGmemberorganizations(referredtoasIACGtechnicaladvisors)willcontributetosubgroups.Subgroupsmayalsoconsultexternaladvisorsonspecificissues.However,inclusionoftheinputofthosenotaffiliatedwiththeIACGwillbecarefullyconsidered:allmembersofthesubgroupwillneedtoagreeontheinclusionofexternaladvisors,theseadvisorswillberequiredtoprovideaDeclarationofInterestbeforeengaginginIACGsubgroupwork,andtheirnamesandtypeofengagementwillbemadepublicontheIACGwebsite.Recommendationstoemergefromthediscussionsonengagementwithexternaladvisorsinclude:• Betransparent.Subgroupsshouldbeclearandtransparentaboutwhotheyareengaging,whenandhow.• Balanceexpertise.Subgroupsshouldselectexternaladvisorsfortheirexpertiseandexperience,adopting

aOneHealthapproachandensuringastrongbalanceacrossbothgenderandgeography.• Avoidconflictsofinterest.Subgroupsshouldfavourrepresentativesofassociationsratherthanindividual

organizations,toavoidconflictofinterests.• Limitroles.Subgroupsshouldlimitthefunctionsofexternaladvisorstoactivitiesandadvicewithinthe

subgroup(thatis,nodirectcontributionstothebroaderIACGgroup)toavoidtheriskofundueinfluence.• Consultwidely.Subgroupsshouldconsultwithabroadersetofstakeholdersoutsidetheroleof

advisors—through,forexample,webconsultations,interviewsetc.

DeliverablesEachsubgroupistaskedwithsubmittinga2–4pageanalysis,includingpreliminaryrecommendations,tothebroaderIACGgroupatitsnextface-to-facemeetinginBangkokinJanuary2018.Toensureaclearandconsistentfinalsetofrecommendations,IACGmemberswillneedtoagreeacommonlanguageandphilosophyforsubgroupstouseindraftingrecommendations—eitherattheJanuary2018meeting,orbefore.

Our added value lies at the political and strategic level.

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5. Reporting

5.1. DraftingtheIACGreportsTheIACGismandatedtoreporttotheUNSGduringthe73rdsessionoftheUNGeneralAssembly,andplanstoprovideitsfinalreporttotheSecretary-GeneralforSeptember2019.TheIACGhascommittedtoprovidinganinterimreportwithpreliminaryrecommendationsinSeptember2018;thegroupintendstoconsultwithMemberStatesonhigh-levelaspectsofthisinterimreportaheadofsubmittingittotheSecretary-General.Adraftinggrouphasbeensetup,comprisingthechairsofIACGsubgroupsandsomemembersoftheSecretariat,workingwithinputsfromtheIACGasawholetodevelopaninitialsetofguidanceandpreliminaryrecommendationsthatwillbesignedoffbyconsensusoftheIACG.ThedraftinggroupintendstomeetinApril2018todevelopafirstdraftoftheinterimreportfortheIACGface-to-facemeetinginJune.

Figure4:Draftinggroupmembershipandtimelineforreportdevelopment

5.2. FinaldraftoftheworkplanBeforetheParismeetingclosed,IACGmembersagreeduponafinalversionofthe2017–19IACGworkplan.KeychangesfollowingthewebconsultationandIACGdiscussioninclude:• Anewguidingprincipleonnotduplicatingtheworkofothers(seeSection1.1above).• Moreexplicitlanguageonensuringacohesive,integratedresponse(Objective1).• ReferencetoHTM(Objective1.1).• Moreexplicitreferencetoengagingwithstakeholders(Objective1.3).• ClearerstatementofintendeduseoftheFrameworkforAction(Objective1.6).• Moredetailedmappingactivitiessetout(Objective2).• Inclusionofadvocacyforinnovativefinancingmodels(Objective3.1).

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• Moreexplicitlanguageondeliveryofavisionandroadmap(Objective4).• ReferencetotripartitereportingassourceforassessingGAPprogress(Objective4.1).• DeletionofObjective5(whichwasagreedtobeawayofworkingratherthananobjective).• Minoreditsthroughouttoimproveclarityandsense.ThefinalworkplancanbefoundinfullontheIACGwebsiteat:www.who.int/antimicrobial-resistance/interagency-coordination-group/IACG-AMR_workplan.pdf.SeeFigure5belowforatop-leveltimelineofeventsandactivitiesassociatedwiththeworkplan.

Figure5:Timelineofmeetings,countryvisits,deliverablesandbroadersetofactivities.

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“

6. Stakeholderspotlight

6.1. IACGandstakeholderengagementAllIACGmembersagreeontheneedtoengagethefullspectrumofstakeholders,andontheneedforstakeholderstoengageeachotheronkeyissues.TheyaresimilarlyagreedontheneedtoensureaclearandtransparentprocessforengagingstakeholdersinIACGwork,andontheimportanceofcontextandculture.Thetoolsandtacticsthatworkforengagementwithonegrouporinoneregionmaynotworkforothers.Takingstakeholderengagementasagiven,thequestionremains:“whoarewetryingtoengage,whyandhow?”Thewho-why-howpuzzlesummarisesthescopeofthehigh-leveldialogueaboutstakeholderengagementattheParismeeting(seeFigure7below).

Figure7:Threeprongstostakeholderengagement

AMR can be context-specific, so we must remember that the messages won’t always have the desired impact unless they are rooted in context and tailored to different audiences.

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“

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“6.2. Stakeholdercontributions:AnimalhealthAcrosstheworld,individualsandorganizationswithintheanimalindustryaremakingmajoreffortstocombatAMR.TheParismeetingprovidedanopportunityforIACGmemberstolearnaboutthechallengesandissuesfacedbythissectorandtohearrepresentativestalkabouttheirperspectivesonAMRandsharetheirprioritiesforIACGguidance(seeTables4and5below).Watchthestakeholderengagementsessioninfullatwww.youtube.com/watch?v=lWd8tGB6DNg.

6.2.1. LivestockKeystakeholdersPresentationsweremadebyrepresentativesfrom:

• InternationalDairyFederation(IDF):www.fil-idf.org• InternationalMeatSecretariat(IMS):www.meat-ims.org• InternationalPoultryCouncil(IPC):www.internationalpoultrycouncil.com• InternationalEggCommission(IEC):www.internationalegg.com• FederationofEuropeanAquacultureProducers(FEAP):www.feap.info

DiscussionhighlightsI. TacklingAMRinlivestockrequirescommunication,incentivesandregulation• Membershiporganizations,whichhavenoenforcementauthority,mustrelyongoodcommunication

toolstoinfluencebehaviourchange.• Successstoriescanbepowerfultoolsofpersuasion. • Theindustryneedsstrongregulation.• Incentivescanalsohelppromoteresponsibleuseandthe

privatesectorhasaparttoplayhere—largecompaniesareagoodvehicleformotivatinggoodbehaviourbyimplementinghighstandardsthroughtheirsupplychains.

II. Stakeholdersinthissectorareincrediblydiverse• Productionsystemsvaryinsize,speciesandlocalenvironment.• AddressingAMRwithinsuchdiversityrequiresacarefulbalanceofinterests.

III. Thesectorneedsacoordinated‘OneHealth’approach,rootedinscience• Inmanycases,theboundariesbetweenhuman,animal,

foodandenvironmentareveryblurred—especially,forexample,inaquaculture.

• CooperationacrossallsectorsiscriticaltosuccessintacklingAMR. • Anycooperativeapproachmustbefreeofblameandbias,rooted

inevidence,andbuiltoncomparabledata.

The first step in tackling AMR is often trying to explain in simple terms what it is and why it’s so important.

We want [cooperation] that is based on science—this is the common language that we all speak.

If you bring people to the table and build confidence, you get a lot more done.

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IV. Concertedeffortisrequiredto“leavenoonebehind”• Forlargecountry-basedmembershiporganizations,itcanbedifficulttoreachouttothe‘back-yard’

villageproductionsystemsthatexistinlargenumbersacrossLMICs.• Reducingantimicrobialuseresultsinchallengesandconsequencesthatvaryacrossdifferentcontexts.• WhateversolutiontoAMRisproposed,itmustconsiderthebillionpoorpeoplethatdependonlivestock

fortheirlivelihoodsaswellastheirnutritionalandfoodsecurity.• Changewilltaketimeandsoaphasedapproachmaybebest.Priority NotesTransparency • AtransparentmechanismforconsultingwiththeIACGAglobalview • Keepinginmindthat“whatwedoaffectseveryoneelse”Continuedinvolvement • AllowingkeystakeholderstocommentonIACGtechnicalcontentMorescience • EspeciallyontheimpactofantimicrobialsreleasedintheenvironmentMonitoringguidance • Awaytomonitorantimicrobialuse(includingtypeofagent)Table4:RecommendedprioritiesforIACGactionandguidancefromlivestockstakeholders

6.2.2. PharmaceuticalandthewiderR&Dagenda Keystakeholders Presentationsweremadebyrepresentativesfrom:

• HealthforAnimals:https://healthforanimals.org• USDAAnimalResearchService:www.ars.usda.gov/alternativestoantibiotics

DiscussionhighlightsI. Donotneglecttheenvironment • ThefateofproductsintheenvironmentisanimportantaspectofAMRthatdemandsrigorouscriteriafor,

andscrutinyof,manufacturingpractices.II. Focusonpracticalsolutions • Aportfolioofalternativestoantibioticsmaybe

neededtoachieveoptimumhealthanddiseasemanagementfordifferentanimalproductionsystems.

• Thereisscopeforimprovementwithbetterfeedandcontrol,butbiosecurityisnottheonlysolution.

“ We excel at preventive medicine and biosecurity, but animals will get diseases… so we must have tools to treat them.

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III. Adoptamulti-prongedapproach • ThereisacriticalneedtoincentivizeR&Dfornewantibioticsas

wellforalternativestoantibiotics,includingvaccines,especiallyforuseinagricultureandaquaculture.

• Atthesametime,betterregulationisneeded—toensurestrongveterinaryservices,legislation,counterfeitcontrols,andprescribingsystems.

Priority NotesScience-basedsolutions • Investinscience-basedinformationabouttransferpathways

• FocusenergyonactionstoreduceoverallAMREducation • Increasingunderstandingamongbothconsumersandhealthworkersof

howtouseantimicrobialscorrectlyandhowtohandleandcookmeatproducts

Publicinvestment • Investmenttoovercomeregulatory,financial,technicalhurdlestoanimalvaccination;andreinforcepublicveterinaryservices.

AparadigmshiftinR&D • IncentivestoprimeaproductdevelopmentpipelinethatiscurrentlydryAportfolioofalternatives • Managinghealthanddiseasesfordifferentanimalproductionsystems.Table5:RecommendedprioritiesforIACGactionandguidancefrompharmaceuticalandR&Dstakeholders.

We thrive under regulation because we are used to it.

“

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Annexes AnnexI.MeetingagendaFourthmeetingoftheInteragencyCoordinationGrouponAntimicrobialResistance(IACG)Venue:OIEHeadquarters,Paris Date:16-17October2017DAY1,16October08.30–08.45 Welcome08.45–09.15 DialoguewithDrMoniqueEloit,Director-General,OIE09.30–10.45 Updateson:CalltoActionconference;AMRmappingexercise;G20R&Dcollaborationhub

andGARD-P;UNGAsideeventonAMR;PresentationonCodex10.45–11.00 COFFEE 11.00–12.00 Presentationsanddecisionpoints:(1)M&EFramework(2)WorkplanlinkswithHTM12.00–13.00 WORKINGLUNCH:MeetingwithFrenchGovernmentonupdatetoNationalActionPlan13.00–14.30 Subgroups:Plenarydiscussion,followedbybreakoutsessionsforthesixsubgroups14.30–15.00 COFFEE15.00–15.30 SessionwiththeCo-chair,WHODirector-GeneralDrTedrosAdhanomGhebreyesus15.30–16.30 Plenarydiscussion:Synthesizingkeypointsfrombreakoutsession16.30-18.00 High-levelpresentationofworkplancomments18.00 Wrapupandcloseofmeeting18.30–20.30 CocktailreceptionhostedbyOIEDAY2,17October08.30–09.00 Welcomeandquickrecapofday1;run-throughofagenda09.00–11.00 Breakoutsession2:Grouptodivideintosub-groupsagain11.00–11.30 COFFEE11.30–13.00 Planfutureworkandmeetings,andfollow-updiscussionsonBangkokPMACmeeting13.00–14.00 LUNCH14.00–15.30 Presentationsbylivestockindustryrepresentatives,followedbyQ&A15.30–16.00 COFFEE16.00–17.00 PresentationsbyanimalpharmaceuticalandR&Drepresentatives,followedbyQ&A 17.00 Wrapupandcloseofmeeting18.30–20.00 High-levelstakeholderengagementeventatUKEmbassyinParis,France.

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AnnexII.Listofparticipants CO-CHAIRS MsAminaJMohammed DrTedrosAdhanomGhebreyesusDeputySecretary-General Director-GeneralUnitedNations(couldnotattend) WorldHealthOrganization MEMBERSDrHananBalkhyExecutiveDirectorMinistryofNationalGuardHealthAffairsKingdomofSaudiArabiaDrEnisBarisWorldBankUnitedStatesofAmericaProfessorOttoCarsSeniorProfessor,InfectiousDiseases,SeniorAdviser–ReACTSwedenProfessorJunshiChen*SeniorResearchProfessorChinaProfessorDameSallyDavies*ChiefMedicalOfficerUnitedKingdomofGreatBritainandNorthernIrelandDrLyalyaGabbasovaMinistryofHealthofRussianFederationRussianFederationMrMinelikAlemuGetahunWorldIntellectualPropertyOrganization(WIPO)SwitzerlandMsMarthaGyansa-Lutterodt*MinistryofHealthGhana

*Co-Convener

MrElliotHarrisUnitedNationsEnvironmentProgrammeUnitedStatesofAmerica(Couldnotattend)MsAnaHinojosaWorldCustomsOrganizationBelgium(Couldnotattend)MsJaanaHusu-KallioMinistryofAgricultureandForestryFinlandDrHajimeInoueWorldHealthOrganizationSwitzerlandMrMartinKhorSouthCentreSwitzerland(Couldnotattend)DrLuizLouresJointUnitedNationsProgrammeonHIV/AIDSSwitzerlandDrJuanLubrothFoodandAgricultureOrganization(FAO)ItalyDrMarcoMarzanodeMarinisWorldFarmersOrganization(WFO)ItalyDrLelioMarmora

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ExecutiveDirectorUNITAIDSwitzerlandDrGerardMoulinNationalAgencyforVeterinaryMedicalProducts(ANSES)FranceMrMarkPearsonOrganizationforEconomicCooperationandDevelopment(OECD)FranceDrStefanPetersonUnitedNationsChildren’sFund(UNICEF)NewYorkUnitedStatesofAmericaDrDonaldPraterFoodandDrugAdministrationUSA

DrJarbasBarbosadaSilvaNationalHealthSurveillanceAgency(ANVISA)BrazilDrMatthewStoneWorldOrganizationforAnimalHealth(OIE)FranceDrMarijkeWijnroksGlobalFundtofightAIDS,TuberculosisandMalariaSwitzerland(Couldnotattend)MsChristianeWolffWorldTradeOrganizationSwitzerland

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AnnexIII:Subgroups Forallsubgroups:technicaladvisorsandexternalstakeholdersengagedinsubgroupworkwillbeconfirmedinduecourseandlistedontheIACGwebsite. Subgroup1:Communication,publicawareness,behaviour-change,professionaleducationandtrainingMembersinclude:

• MsMarthaGyansa-Lutterodt,MinistryofHealth,Ghana(Chair)• DrHajimeInoue,WHO• MsAnaHinojosa,WCO

Subgroup2:NationalActionPlans,includingmonitoringandsupportMembersinclude:

• MsJaanaHusu-Kallio,MinistryofAgricultureandForestry,Finland(Chair)• DrMatthewStone,OIE• DrLyalyaGabbasova,MinistryofHealth,RussianFederation• ProfOttoCars,ReAct• MrElliotHarris,UNEP

Subgroup3:Reduceneedforantimicrobialsandunintentionalexposure,andoptimisinguseMembersinclude:

• DrHananBalkhy,MinistryofNationalGuardHealthAffairs,KingdomofSaudiArabia(Chair)• DrJarbasBarbosadaSilva,NationalHealthSurveillanceAgency(ANVISA),Brazil• DrJuanLubroth(FAO)• DrMarcoMarzanodeMarinis,WorldFarmersOrganization• ProfessorJunshiChen,ChinaNationalCenterforFoodSafetyRiskAssessment,China• DrGerardMoulin,ANMV,ANSES,France• MsChristianeWolff,WTO

Subgroup4:Investininnovationandresearch,andboostR&DandaccessMembersinclude:

• DrLelioMarmora,UNITAID(Chair)• MrMarkPearson,OECD• MrMinelikGetahun,WIPO• ProfessorDameSallyDavies,DepartmentofHealth,UK• DrMarijkeWijnroks,GlobalFundtofightAIDS,TuberculosisandMalaria• MrMartinKhor,SouthCentre,Switzerland

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Subgroup5:SDGalignment,globalgovernancepast2019andUNroleandresponsibilitiesMembersinclude:

• ProfessorDameSallyDavies,ChiefMedicalOfficer,UK(Chair)• ProfOttoCars,ReAct• DrEnisBarisWorldBank• MsNanaTaonaKuo,EOSG• DrLuizLoures,UNAIDS• MsMarthaGyansa-Lutterodt,MinistryofHealth,Ghana

Subgroup6:SurveillanceandmonitoringforantimicrobialusageandresistanceMembersinclude:

• DrDonaldPrater,USFDA(Chair)• DrLyalyaGabbasova,MinistryofHealth,RussianFederation• MrElliottHarris,UNEP