Antibiotic Resistance A Major Threat to the Sustainable Development Goals€¦ · Antibiotic...
Transcript of Antibiotic Resistance A Major Threat to the Sustainable Development Goals€¦ · Antibiotic...
10/25/2017
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Antibiotic Resistance – A Major Threat to the
Sustainable Development Goals
Otto CarsSenior Professor, Infectious Diseases
Founding Director ReAct-Action on Antibiotic Resistance, Uppsala university
ReAct North America
Baltimore, USA
ReAct Europe
Uppsala, SWE
ReAct LA
Cuenca, ECU
ReAct Africa
Nairobi, KEN
ReAct Asia Pacific
Vellore, IND
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ReAct- Action on Antibiotic Resistance
www.reactgroup.org
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Outline of this seminar
• What is antibiotic resistance?
• Why is it a threat to global health, economy andsustainable development?
• Q&A
• The current political landscape
• The need for global collective action
• Discussion
The global complacency has put the world at risk
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Antimicrobial resistance (AMR)
Microorganisms becoming resistant to medicines which makes them ineffective
• Resistance to medicines against HIV
• Resistance to medicines against malaria
• Resistance to medicines (antibiotics) against bacterial infection including tuberculosis=
Antibiotic resistance
Antimicrobial resistance (AMR)
Microorganisms becoming resistant to medicines, making them ineffective
• Resistance to medicines against HIV
• Resistance to medicines against malaria
• Resistance to medicines (antibiotics) against bacterial infection including tuberculosis=
Antibiotic resistance
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What Are Antibiotics?
• Antibiotics are small molecules that can enter bacteriaand stop their growth or kill them
• They do not work against viruses(common cold, influenza etc.)
% s
urv
iin
g
Penicillin
Untreated
Days
Penicillin
increased the
chance of
survival from 10%
to 90%
Patients with
pneumonia
and bacteria
in blood
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The Golden Age of Antibiotic Discovery Numerous bacterial infections became treatable
• Pneumonia
• Urinary tract infection
• Wound infection
• Blood infection ( sepsis)
• Abdominal infections
• Bone and joint
infections
• Chlamydia
• Gonorrhea
• .………
• ……....
Bacteria
• Have existed for 3.5 billion years
• Composes 30 % of the earth´s biomass
• Every gram of surface soil contains 50 million bacteria
• We carry roughly as many bacteria in our bodies as human cells.
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What is Antibiotic Resistance?
• Bacteria are experts in finding ways to avoid
the effect of an antibiotic.
• This could be achieved by mutations or transfer
of genes (from other bacteria) that either:
- stops entry of the antibiotic
- destroys it
- makes it difficult to reach its target
- pumping it out of the bacterial cell.
Where are antibiotics used?
• Human medicine
• Veterinary medicine
• Livestock production
• Aquaculture
• Plant protection
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Selection of antibiotic resistance
Why the global complacency ?
• ABR had/still has no disease face
• Lack of data on the global health and economic burden
• We have too late realized the ecological/environmental dimensions
• Misaligned financial incentives• Disincentives for collective action
• The global self-deception: There will alwaysbe new antibiotics
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The failing machinery….More that 70 years of antibiotic useMillions of tons….
Lack of New Antibiotics
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60% of antibiotics prescribed by general
practitioners in OECD countries are
used for inappropriate purposesCecchini M, Lee S. OECD Publishing, forthcoming
Of the estimated 154 million
prescriptions for antibiotics written in
doctor’s offices and emergency
departmentsin the US each year, 30
percent are unnecessary.US CDC, 2016
Rich countries continue to waste antibiotics
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Total antibiotic use in 2011 European countriesVersporten et al, Lancet Infectious Diseases, 20 March 2014
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Adapted from Källander, 2005
Access Excess
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We are facing a public health crisis
AntibioticResistance
DrugDevelopment
MorbidityMortality
Costs
Euro Surveill. 2015;20(45).
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The burden of antibiotic resistance disproportionally
falls on the developing countries
Mumhibili hospital, TanzaniaThe mortality rate from resistant bloodstream infection was 43%Blomberg et al. BMC Infect Dis. 2007 May 22;7:43.
Neonatal deaths due to resistantinfections are increasing214.000 newborn sepsis deaths Are attributable to bacteria that resistant to available antibioticsLaxminarayan et al Lancet. 2016;387:168–175.
Lack of access to essentialantibioticsAcross developing countries
fewer than a third of children
with suspected pneumonia
receive antibiotics”United Nations Children’s Fund
(UNICEF) June 2012
...the growing number of Syrians who have acquired bacterial infections that
are immune to almost all antibiotics. The only way to treat them is to amputate
their affected limbs and inject them with last-resort drugs.
Doctors Without Borders Special Hospital for
Reconstructive Surgery in Amman
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HUMAN MORTALITY BURDEN
WHO Ebola Situation Report 12 August
2015
WHO/GIP, data in HQ as of 17
July 2015
http://www.cidrap.umn.edu/news-perspective/2012/06/cdc-
estimate-global-h1n1-pandemic-deaths-284000
ANTIBIOTIC RESISTANCE> 500.000AVIAN FLU
H5N1449
EBOLA11,298
SWINE FLUH1N1
284.000
Antibiotic resistance – figure is a world-wide
projection based on data from EU,US
and Thailand (WHO Global Reoprt of
Surveillance)
Transforming our world: the 2030 Agenda for Sustainable Development
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Antimicrobials are fundamental
components of all health systems
Non-human use of antibioticsThe tension between food safety and food security
Increasing demand for animal protein
Projected increase of the consumption of antimicrobials in the food animal sector by 2/3 until 2030
Need for regional and context specific transformation strategies towards sustainable practices and alternatives to antibiotics
Van Boeckel TP, Brower C, Gilbert M, Grenfell BT, Levin SA, Robinson TP, et al. Global
trends in antimicrobial use in food animals. Proc Natl Acad Sci U S A. 2015 Mar
19;112(18):5649–54.
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Clean water and sanitation
2.4 billion people in the world lacks
access to toilets and 1.8 billion are
using drinking water that is
contaminated with feces
Poverty and inequality
Access to essential
antibiotics is a
prerequisite to
reduce inequalities
Chandy, S: The Journal of Infection in
Developing countries. Vol 8, sept 2014
The median overall cost to treat a
resistant bacterial infectionin India: 700 USD
The time a rural male casual worker
in India has to work to earn this
amount: 442 days
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US$100 trillion by 2050*
The costs for antimicrobial resistance reach
far beyond the health sector
* Review on Antimicrobial Resistance. Review on Antimicrobial
Resistance:Tackling a crisis for the health and wealth of nations. (2014).
AMR containment represents a high-yield investments with the annual rate of return reaching 88% per year.Cost of inaction: loss at 1.1% to 3.8% global GDP by 2050 (World Bank)
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Overconsumed resource Fossil fuels Antibiotics
Consequence of overconsumption Climate change Antibiotic
resistance
Affects everyone YES YES
High income countries can reduce use
without negative consequences
YES YES
Demand of the resource from LMICs is
increasing
YES YES
Transformation towards sustainability is
urgent
YES YES
Non- renewable resource YES ?
Sustainable alternatives exist YES NO
Global agreement exist YES NO
Can we learn from climate change?
Antimicrobial Resistance
The current political landscape
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20152001
Towards a global response
1. Improve awareness and understanding of antimicrobial resistance
2. Strengthen the knowledge and evidence base
3. Reduce the incidence of infection;
4. Optimize the use of antimicrobial medicines
5. Develop the economic case for sustainable investment
Five strategic objectives of the Global Action Plan
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Global Status of National Action Plans
No response
No national action plan
Under development
Plan approved
Operational plan with monitoring arrangements
Plan with fund, is being implemented
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Political declaration on the UN General Assembly High level meeting 21 sept 2016
“…….to provide practical guidance for approaches needed to ensure sustained effective global action to address antimicrobial resistance…….”
“The Ministers emphasized the need to support, as a matter of
urgency, research and development of antimicrobials, especially
new antibiotics, vaccines, diagnostic tools and innovation,
including in traditional and herbal medicine. They highlight that
this must be done while ensuring that R&D efforts are needs-
driven, evidence-based, and a shared responsibility, and that
these efforts must be guided by the core principles of affordability,
effectiveness, efficiency, and equity through delinking research
and development costs from prices and sales volume”.
Antimicrobial resistance (AMR) has
featured prominently in the Declaration
issued by Ministers of Foreign Affairs of
the Group of 77 and China at their 40th
annual meeting, held at the United
Nations (UN) in New York on 22
September 2017.
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Innovation Access Conservation/Stewardship
A systems view needed
Towards a new financial model for R&D of novel antibiotics
• Needs driven - based on analysis of pipelinevs resistance and its burden
• Incentives that stimulates R&D of priority antibiotics
• Solving the scientific challenges
• Collaboration and knowledge sharing
• De-linking return of investment from price and volume sales
• Controlled use and distribution
• Equitable global access and affordability
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Current ongoing processes
• CARBX ( US Government, Wellcome Trust)
• Innovative Medicines Initiative ( IMI) New Drugs for Bad Bugs
( EU commission and European Pharma)
• G20 Innovation Collaboration hub
• WHO Development and Stewardship Framework
• GARDP (Partnership between Drugs for Neglected Disease initiative DNDI & WHO )
Antibiotics
Fundamental systems changes needed
Marketing
Volume sales
Misaligned financial incentives
Irrational use of antibiotics
Insufficient prevention
Cultural beliefs, misperceptions
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Some challenges
The world´s response has been too slow, too weak and too narrow!
Politicial will and financial commitments have so far been insufficient:
- Antibiotic effectiveness should be seen as a global resource
- Transformation of health and agricultural systems needed
Communication challenges for long term behavioural change
Meeting the challenges1. Including LMICs in all processes on devising ways to manage
AMR
2. Mainstreaming AMR into all relevant SDGs
3. Specific AMR indicators in health system strengthening
programs
4. New economic models for urgently needed
antimicrobials diagnostics and vaccines
5. Funding for AMR capacity building in LMICs
6. Mobilizing civil society
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Solutions require commitment
from
all research and policy areas
Human medicine Veterinary medicineAgriculture
Environment
Research and education
Natural sciences
Social/behavioural sciences
Law, ethics ….
Trade
Security Development aid /Foreign policy
Finance
“Given these global coordination issues, there is a
clear role for a binding international legal framework
to encompass the issues of access, conservation and innovation “