WHO GAP AMR Newsletter No.11 May 15-30 2016

What is the discussion on AMR at the United Nations General Assembly and

why does it matter?

Special Representative Keiji Fukuda explains

Planning is underway for Heads of State and other critical stakeholders to discuss AMR at a high-level meeting at the United Nations General Assembly in September 2016. At this time, details (the “modalities”) are under discussion between Permanent Representatives of Member States in New York and the facilitator for the process, Ambassador Juan Camacho, of Mexico. Nonetheless, the importance of discussion at this level is already clear. In essence, AMR has presented the world with a long-simmering and now urgent challenge to health and health systems. However, the scope of the challenge is not limited to health alone: it directly involves many other sectors such as agriculture, food, development, health security and financing. This means that successfully addressing AMR can be done only through joint

awareness, cooperation and coordination between these many, varied stakeholders.

In 2015, WHO worked with many partners across sectors to draft a global action plan on antimicrobial resistance that was adopted by the World Health Assembly and almost immediately endorsed by the governing bodies of the Food and Agriculture Organization of the United Nations and the

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Rapid diagnostic test and shorter, cheaper treatment signal new

hope for multidrug resistant tuberculosis

patients

WHO has announced new recommendations aimed to speed up detection and improve treatment outcomes for multidrug resistant tuberculosis (MDR-TB) through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen.

Shorter treatment with better outcomesThe new treatment regimen can be completed in 9–12 months, unlike conventional regimens that take 18–24 months to complete and yield low cure rates. Costing less than half of the current conventional treatment, it is also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up. The

IMPLEMENTATION OF THE GLOBAL ACTION PLAN ON

ANTIMICROBIAL RESISTANCE

WHO GAP AMR Newsletter No.11 May 15-30 2016

World Organisation for Animal Health. This plan was a milestone because it used a multisectoral process to provide a consensus blueprint of what needs to be done. However, fully implementing the plan will require more.

The challenge now is to get multiple sectors and all countries to act in concert despite wide variations in awareness, capacities and conditions. Moreover, addressing AMR will require tackling and resolving many difficult issues related to financing; access to technologies and benefits sharing; trade; development of capacities within countries; closing gaps in knowledge through research, communications, education and advocacy; fostering changes in culture and expectations at the grass roots level; and developing realistic innovative new approaches for developing and dispensing new medicines and other technologies, and so on.

Will the UN General Assembly meeting do this? Not by itself, but engaging highest-level support will enable, facilitate and leverage stakeholders to implement the global action plan. The meeting cannot address all the issues related to AMR. However, it will become a critical milestone in a longer process. When we look back in 10 years’ time, I am sure that the combination of the global action plan and the high-level discussion at the UN General Assembly will be seen as essential steps forward for global public health.

Combating AMR in Asia-Pacific

At the Tokyo meeting on AMR on April 16, Ministers of Health from 12 countries of the Asia Pacific region agreed to: (i) improve the way information on AMR is collected and shared to guide effective policies and actions; (ii) strengthen and harmonize how they

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shorter regimen is recommended for patients diagnosed with uncomplicated MDR-TB and for individuals who have not yet been treated with second line drug. Fewer than 20% of the estimated 480 000 MDR-TB patients globally are currently being properly treated. More information here.

New rapid diagnostic test The most reliable way to rule out resistance to second-line drugs is a newly recommended diagnostic test for use in national TB reference laboratories. This test yields results in just 24-48 hours, down from the 3 months or longer currently required. More information on the test, including costs, can be found here.

Integrating science and policy for decisive action

on AMR

Scientists and policy makers from more than 30 countries came together at the Wellcome Trust in London on April 26-27 to develop positive steps to combat antimicrobial resistance at the national level and the global level. The objective of this policymaker-scientist summit was to explore the evidence base for specific policy interventions and obstacles to implementation. The meeting was underpinned by a clear analysis and synthesis of evidence and opinion about key interventions in animal and human health. Although evidence gaps have been cited as important barriers limiting action, Summit participants concluded that gaps will always exist and that the current evidence justified immediate action in many areas. Three key areas were identified for immediate action: (i) There is an urgent need to develop better local understanding of antibiotic use and resistance levels, in human and animal medicine. (ii) Antibiotic use in agriculture must be reduced, without compromising the meat production system’s capacity to meet increasing global demand. (iii) Public health systems need to be configured to optimize antibiotic use. A summary of the meeting is available here.

WHO GAP AMR Newsletter No.11 May 15-30 2016

regulate the production, sale and use of antibiotics and other antimicrobial medicines; and, (iii) take innovative approaches to stimulate research and development of new antibiotics, diagnostic tests, vaccines and other technologies. The Ministerial Communique will be presented at the G7 meeting in May, 2016 hosted by Japan. The ministerial meeting followed a two-day brainstorming session among experts and organizations representing public health, agriculture and animal health. It was organized by the Government of Japan and WHO, in collaboration with the Food and Agriculture Organization of the United Nations and the World Organisation for Animal Health and was attended by approximately 130 people. For more information, please click here.

Antimicrobial Resistance -A Threat to the World’s Sustainable

Development Development dialogue paper, No.16 April 2016

Published as part of the Dag Hammarskjöld Foundation’s Development Dialogue Series, this ReAct publication examines how specific sustainable development goals (SDGs) are impacted by AMR and suggests how the issue can be

better integrated into international policy processes. Moving beyond the importance of effective antibiotics for the treatment of acute infections and health care generally, the authors discuss how antimicrobial resistance also impacts on environmental, social and economic targets in the SDGs.The paper stresses the need for greater international collaboration and accountability

distribution, and suggests steps towards an engagement of countries and United Nations agencies into the policy debate on a global intersectoral action. For the full report, click here.

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Towards a global agenda on health security

During the closing of the High-Level Conference on Global Health Security, on March 23, in Lyon, France, Francois Hollande, President of the French Republic, supported the creation of a global platform for preparedness and response to health emergencies, for which the pivotal hub could be the WHO Lyon Office. Other priorities identified were: (i) Improving global mechanisms for surveillance, alert, diagnostics, and plans for crises response; (ii) Managing crises by reinforcing the role of civil society, local experts, and affected populations; and (iii) Supporting research in life, human, and social sciences.

Incorporation of AMR into ICD-11

The ICD team within WHO is currently working on reviewing the current International Classification of Diseases ( ICD)-10 and the release of ICD-11 later this year. As AMR is a cross-cutting determinant, it does not usually appear in the ICD codes of a patients' medical records. However, in order to understand the magnitude of the health burden caused by AMR, AMR should exist in the principal diagnosis and/or complication of the patient at discharge from the hospital or in the cause of death. In this way, the AMR burden can be estimated from the patients' hospitalization data. To take this work forward the ICD team are now working in collaboration with STAG member, Visanu Thamlikitkul, and the AMR Secretariat. The revised ICD-11 is expected to be released in late 2016.

Correction

In the last issue of the newsletter, there was an error in identifying the first country to enrol in GLASS. In fact, Cambodia was the first country to enrol, whereas Georgia was the first country to express an interest in enrolling. Apologies to both countries.

WHO GAP AMR Newsletter No.11 May 15-30 2016

Please let us know of your upcoming events for inclusion in the newsletter. We also welcome your suggestions and comments. For all communications, please contact the Secretariat at whoamrsecretariat@who.int. Responsibility for newsletter contents rests with the AMR Secretariat Director: Marc Sprenger. Newsletter editor: Breeda Hickey.

Members of AMR Steering Group : Keiji Fukuda, Chair; Bruce Aylward, Flavia Bustreo, FWC; Marie-Paule Kieny, HIS; Ren Minghui HTM; Ibrahima-Socé Fall, AFRO; Marcos Espinal, AMRO; Jaouad Mahjour, EMRO; Nedret Emiroglu, EURO; Takeshi Kasai, WPRO; Roderico Ofrin, SEARO.

Members of Technical Coordination Group : Work stream leads HQ - Carmem Pessoa da Silva, Gilles Forte, Benedetta Allegranzi, Peter Beyer, Kate Medlicott, Awa Aidara-Kane, Martin Friede, Francis Moussy, Olivia Lawe-Davis and Karin Weyer.; Yahaya Ali Ahmed, AFRO; Pilar Ramon Pardo, AMRO; Ali Mafi, EMRO; Danilo Lo Fo Wong, EURO; Sirenda Vong, SEARO; Klara Tisocki, WPRO

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UPCOMING MEETINGS/EVENTS

May 16-20 Collection of antimicrobial consumption data AFRO training workshop

Ouagadougou, Burkina Faso

May 17 AMR breakfast side event at “Women Deliver” conference

Copenhagen, Denmark

May 18 Global Policy Group meeting WHO HQ

May 23-28 Sixty-Ninth World Health Assembly WHO HQ (Palais)

May24-26 AMRO National Action Plan workshop Lima, Peru

May 26-27 G7 Summit Iseshima, Japan

May 31 First meeting of Public Health Institutes active in the GHSA-AMR Action Package

Amsterdam, Netherlands

June 2-3 DRIVE-AB conference on new business models for AMR. Link to conference website here.

Amsterdam, Netherlands

June 8 Bio Convention “Where the Rubber Meets the Road: Implementing Commercial Incentives for Antibiotics”

San Francisco, USA

Dates tbc SEARO National Action Plan workshop Bali, Indonesia

June 27-28 GHSA meeting Bali, Indonesia

Jun 29-Jul 1 Wilton Park AMR meeting Sussex, U.K

July 21-22 RIMSA 17. 17th Inter-American Ministerial meeting on Health & Agriculture: One Health and the SDGs

Asuncion, Paraguay