Carmen Pessoa presentation SRA Conference 3 April

The AMR Global Threat & The
Need For a Multifaceted Approach
 JPI AMR Strategic Research Agenda Launch
 Brussels, 3 April 2014
Carmem Lúcia Pessoa-Silva, MD, PhD
Health Security and Environment, WHO Headquarters, Geneva
[email protected]
Danilo Lo Fo Wong, MSc, PhD
Communicable Diseases, Health Security, and Environment
WHO Regional Office for Europe
[email protected]
“It is not difficult to make microbes resistant to penicillin ….
Alexander Fleming's Nobel Lecture, 1945
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JPI AMR Strategic Research Agenda Launch - April 2014
Today AMR exists at high-levels among broad
range of pathogens
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JPI AMR Strategic Research Agenda Launch - April 2014
Some diseases becoming untreatable
2011: Resistant gonorrhea strain found in Japan
Antibiotic susceptibility of gonorrhea, CDC Morbidity and Mortality Weekly Report
A strain of gonorrhea is that is resistant to all currently available
antibiotics has been identified in Japan…
The newly identified strain of the sexually transmitted infection, called
H041, is resistant to the last remaining drugs that treat gonorrhea,
known as cephalosporin-class antibiotics,
http://www.cbc.ca/news/health/story/2011/07/11/gonorrhea-resistant.html
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JPI AMR Strategic Research Agenda Launch - April 2014
Worse patient outcome & direct economic impact
 European Union
– 2.5 million extra hospital days in 2007
– 25,000 deaths per year
– Overall societal costs about 1.5 billion € per year
 Thailand
– >140,000 AMR infected patients per year
– > 30,000 deaths from blood infection
– 2.0 billion USD per year
 USA
– >2,049,442 illnesses & >23,000 deaths
– Up to $20 billion direct
– (Up to $35 billion additional indirect)
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JPI AMR Strategic Research Agenda Launch - April 2014
Overall economic impact much higher
WEF 2013 Global Risks Report
 Reduced consumer income,
employment, savings
 Increased national
investment & spending,
healthcare delivery
Roberts et al CID 2009; 49:1147-84.
 Gross domestic product
(GDP) losses: 1.4% to 1.6%
.
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JPI AMR Strategic Research Agenda Launch - April 2014
Expanding WHO strategy
over time
Technical guidance & recommendations
68 recommended interventions
• Patients &general community
• Prescribers and dispensers
• Hospitals
• Antimicrobials in food-producing animals
• National governments & health systems
• Drug and vacccine development
2001
• Pharmaceutical promotion
• International aspects of containing AMR
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JPI AMR Strategic Research Agenda Launch - April 2014
WHO disease-specific programs to contain AMR
Tuberculosis
(2006)
Artemisinresistance in
Malaria
(2011)
Antimicrobial
resistance in
N. Gonorrhoea
(2012)
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JPI AMR Strategic Research Agenda Launch - April 2014
Anti-HIV drugresistance
(2012)
Broader combinations of approaches
2011 World Health Day policy package: call for action
 Comprehensive national plans with
accountability and broader sectoral
engagement, including civil society
 Strengthening surveillance & lab capacity
 Access to essential medicines of assured
quality
 Rational use of medicines in all sectors
 Infection prevention & control
 Innovation, R & D for new tools
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JPI AMR Strategic Research Agenda Launch - April 2014
WHO Member States Reaction after WHD 2011
 Sep 2011: European Action Plan
 Sep 2011: Jaipur Declaration, SEAR
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JPI AMR Strategic Research Agenda Launch - April 2014
WHO Member States Reaction after WHD 2011
 May 2013 Governing body meetings
– Call for a report by the Secretariat on AMR
 WHO AMR Strategic &Technical Advisory Group (STAG) established:
– To advise on a global strategy to tackle the growing AMR challenge
– 1st meeting held on 19-20 September, 2013
 AMR STAG advised on the development of a global action plan
 Jan 2014 Executive Board: Massive support for draft resolution
– Member States to develop / strengthen national action plans
– WHO to lead the development of a broad-based global action plan for
submission to World Health Assembly in May 2015
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JPI AMR Strategic Research Agenda Launch - April 2014
Renewed efforts already started
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JPI AMR Strategic Research Agenda Launch - April 2014
Baseline country situation analysis
 Assessment of country situation in 120 MS in 2012 - 2013
– To assess policies and structures as suggested by WHD policy package
– Policy dialogue initiated with MS through the assessment
 Many gaps
–
–
–
–
–
Only 29 MS with a national plan to tackle AMR
Weak/lack of surveillance structure
Need for cost-effectiveness studies to inform policies
Lack of links between human and animal health/agriculture
Weak R&D structure
 Next steps
– Development of indicators at national level
– Development of tools for national stewardship
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JPI AMR Strategic Research Agenda Launch - April 2014
Towards a global action plan
&
Opportunities for collaboration
with JPI AMR
What might a global action plan (GAP) look like?
 Blue print relevant for all sectors
 Common reference to facilitate coherent actions among
many stakeholder
 Capture essential core elements
–
–
–
–
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Major concerns & issues
Objectives over defined periods
Gaps & key actions to close them
Measurable indicators of progress
JPI AMR Strategic Research Agenda Launch - April 2014
2014-15 GAP road map
 14-16 April 2014: 2nd STAG meeting
– Begin engaging stakeholders from all major sectors to identify
core elements of global plan
 Additional consultations to strengthen high-level
support & focus on most challenging areas
 Review by Member States at Regional Committees
 Discussion at World Health Assembly May 2015
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JPI AMR Strategic Research Agenda Launch - April 2014
Opportunities for Collaboration with JPI AMR
Elements to be addressed by GAP
Strategic Research Agenda JPI AMR
1. Comprehensive national plan with
accountability & civil society engagement
1. Development of novel antibiotics and
alternatives to antibiotics
2. Strengthen surveillance capacity
2. Strategies for development of new diagnostics
3. Ensure uninterrupted access to medicines
of assured quality
3. Standardisation and extension of surveillance
systems to establish a global surveillance
programme on ABR and AB use
4. Regulate and promote rational use of
medicines, including in animal and
husbandry, and ensure proper patient care
4. Transmission dynamics
5. Enhance infection prevention and control
6. Foster innovation and research &
development for new tools
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JPI AMR Strategic Research Agenda Launch - April 2014
5. The role of the environment as a source for the
selection for and spread of AMR
6. Designing and testing interventions to prevent
acquisition, transmission and infection caused
by AMR
WHO global AMR surveillance road map
1st Global Technical Consultation on AMR Surveillance, Dec 2012
1. WHO Global AMR Report (to be published April 2014)
2nd Global Technical Consultation on AMR Surveillance, March 2014
2. Standard surveillance methodologies with focus on ABR (target: 2014-2015)
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–
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To provide an up-to-date picture of the magnitude of ABR and to monitor trends
To assess the impact of ABR
To improve early detection of new resistance patterns
3. Collaborative platform for global surveillance (2014-2015)
4. Pilot surveillance studies (target: 2015-2016)
– To collect further information on AMR burden
– To test surveillance models and new tools in hard to reach areas (e.g., sentinel
surveillance, new & simpler diagnostic methods
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JPI AMR Strategic Research Agenda Launch - April 2014
Coming up soon!
(30 April)
Focus on antibacterial resistance
2014
Thank you!
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JPI AMR Strategic Research Agenda Launch - April 2014

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