Global efforts to combat Antimicrobial Resistance€¦ · Strengthening the fight against...

Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013

Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria


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



The evidence is convincing: “The more we use them, the more we lose them”

From Albrich et al EID 2004




• 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



Animal

FeedsMeat

Direct

Contact

EXTENDED

CARE

FACILITIES

HOSPITALIZED

HUMAN

Commercial

Abattoirs /

Processing

Plants

Rendering

FOOD

ANIMALS

SHEEP CATTLE

SWINE

POULTRY

VEALCALVES

Offal

COMPANION

ANIMALS

Vegetation,

Seed Crops, Fruit

Sewage

Drinking

water

Drinking

Water

Sea /

Lakes

SwimmingAQUACULTURE

Rivers and

Streams

EPIDEMIOLOGY EPIDEMIOLOGY

OF OF

ANTIMICROBIAL ANTIMICROBIAL

RESISTANCERESISTANCE

Industrial &

Household

Antibacterial

Chemicals

OTHER

FARMED LIVESTOCK

COMMUNITY

- URBAN-RURAL

WILDLIFE

SOIL

Handling

Preparation

Consumption

after Linton AH (1977), modified by Irwin RJ

Dead

stock

Farm Effluents and

Manure Spreading



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/



*National data means data obtained from official sources, but not that data necessarily are representative for the population or country as a whole

Available National Data* on Resistance for Nine

Selected Bacteria/Antibacterial Drug Combinations, 2013



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

– Visit key Ministries, institutions, agencies, laboratories

– Mission report with observations and recommendations

– Follow-up activities

• Goal

– 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 Centre for Disease Prevention and Control World Health Organization Regional Office for Europe

Countries submitting data to CAESAR

Countries visited for CAESAR participation

Countries to be visited for CAESAR participation

Countries participating in EARS-Net

European Antimicrobial

Resistance Surveillance Network

(EARS-Net)

Central Asian and eastern

European Surveillance of

Antimicrobial Resistance (CAESAR)



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

Published Online, March 20, 2014

http://dx.doi.org/10.1016/S1473-3099(14)70071-4



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

Countries in the process of collecting data

Countries invited to join

Countries participating in ESAC-Net



Use methodology

compatible with

ESAC-Net

Enable data

comparison in the

European Region

Lancet Infectious Diseases 2014

Published Online, March 20, 2014

http://dx.doi.org/10.1016/S1473-3099(14)70071-4

Expanding AM use surveillance

throughout Europe



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



Materials:

• Infograph

• Website

• Video

• Press release

• Presentation

Activities

• Country events (press conferences, seminars)

• EC/ECDC/WHO twitter chat

Awareness day



• 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

Expanding awareness

throughout Europe



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

http://www.escmid.org/

http://www.nivel.nl/en



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

Global efforts to combat Antimicrobial Resistance€¦ · Strengthening the fight against...

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