2015 - 2019

ReAct Strategic Plan

OUR VISION

OUR MISSION

OUR GOALS�

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A world free from fear of untreatable infections.

Concerted action to develop equitable and ecologically grounded solutionsto contain ABR, that contribute to universal health coverage, poverty

reduction and global developmen

Convene, translate evidence and catalyze action on antibiotic resistance toreduce suffering and save lives;

Identify, innovate and promote solutions and best practices;

Partner, mobilize, and empower key communities andchampions for change.

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In the last seven decades, the use of antibiotics hashelped drastically reduce deaths due to a variety ofbacterial infections establishing these as the cornerstoneof all modern medicine. From treatment of bloodinfections and pneumonia to major invasive procedureslike heart surgeries and organ transplants, antibioticshave become indispensable.

The growing phenomenon of bacterial antibioticresistance (ABR) is now threatening to leave us withouteffective treatment of bacterial infections and rollingback important achievements of modern medicine.

The spread of ABR, coupled with the lack of novelantibiotics, is threatening health systems globally. It hasbeen fuelled by massive use and misuse of antibioticstogether with poor sanitation and lack of hygiene andinfection control. Polluted environments fromaquaculture, agriculture, wastewater from municipalities,pharmaceutical manufacturing and hospitals alsocontribute to ABR development and dissemination .ABR is currently considered one of the world's greatestpublic health threats and also an economic andenvironmental risk .

In the European Union alone approximately 25000patients died of resistant infections in 2007, while thesocietal costs of such infections are estimated at aboutEUR 1.5 billion each year .

In the United States, each year, at least 2 million peoplebecome infected with bacteria that are resistant toantibiotics and at least 23,000 people die as a direct resultof these infections. Estimates of the economic impact

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of antibiotic resistance in the country vary from as highas US$20 billion in excess direct healthcare costs, toUS$35 billion a year as additional costs to society for lostproductivity .

In Thailand, resistant hospital infections cause morethan 38.000 deaths and productivity loses of overUS$1.2 billion each year . In low and middle-incomecountries (LMICs), where the burden of infectiousdiseases is higher and data is scarce, the evidencesuggests that 70% of neonatal infections are resistant tofirst line antibiotics resulting in increased mortality andmultiplied costs . Worldwide, antibiotics are alsobecoming ineffective in treating gonorrhoea with 106million new cases/year globally .

ABR strikes hardest on the poor. In Sub-SaharanAfrica , infectious diseases remain a dominant cause oflives lost. The most lethal infectious childhood diseasesfrequently no longer responding to standard treatmentand effective drugs are often not affordable for lowincome communities. The consequences are devastating:every year, bacterial infections kill more than 2 millionchildren and 1.3 million adults die of tuberculosis .Already, we cannot safely treat multi-resistant strains oftyphoid fever , a major killer of children in LMICs.

The world can no longer afford to misuse antibiotics norcan we ignore the ever-increasing prevalence andincidence of resistant and multi-resistant bacterialstrains worldwide. ABR has become a threat to the healthof the entire globe and it is time to act before it becomestoo late.

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ANTIBIOTIC RESISTANCE

The Silent Tsunami

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4 2015 - 2019

ReAct Strategic Plan

ABOUT ReActThe idea of ReAct, an organization dedicated tomobilizing global action on antibiotic resistance, wasborn in 2004 following a meeting of concerned healthprofessionals, scientists and health activists at the DagHammarskjöld Foundation in Uppsala, Sweden.

ReAct articulated its vision after a second, bigger globalmeeting in 2005 and launched as a catalyst group, in2006. Though formally based at Uppsala University,Sweden, already from the onset ReAct was aninternational organization with representation fromEurope, Asia, Latin America, Australia and NorthAmerica, and in 2014, a ReAct node in Africa wasestablished. Although a small organization, ReAct hascovered the global scene, and at the same time involveddeeply in a number of specific regional, national andlocal processes.

ReAct was one of the first international networks toarticulate the complex nature of ABR and its drivers.ReAct became known for its holistic view of theproblem, reframing it from a purely medical andscientific issue. The early work of ReAct focused ondocumenting the issue more deeply and finding newsolutions to manage the problem of ABR, and tounderstanding how different local contexts needdifferent approaches.

Across the globe, ReAct now catalyzes action onantibiotic resistance by translating scientific evidence topolicy makers and the public. It works across disciplines,using its convening power to bring stakeholders togetherin developing ways forward, promoting best practicesand innovative solutions and advocating and mobilizingfor behavioral change.

As a credible source for strategic policy guidance, ReActhas successfully brought evidence about the problem ofantibiotic resistance outside the expert conference

rooms and managed to put the issue on the globalagenda. ReAct introduced the principle that the existingbusiness model needs to be changed to ensure that newantibiotics are rationally used and with equitable accessand affordability for all.

As it completed eight years in existence, ReActunderwent a major restructuring and review process. At aweeklong strategic meeting in 2013, ReAct reworked itsorganisational structure and developed three interrelatedprograms:

Empowerment, Engagement and network Extension(EEE)

Strategic Policy (SP)

Generation and Translation of Evidence (GATE)

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Challenges of tackling ABR

There are several obstacles to finding solutions to theproblem of ABR.

First, is the challenge of complexity of the problem.ABR is part of a larger ecological phenomenon and notamenable to easy technical interventions. All use ofantibiotics contributes to resistance, so the exact role ofantibiotic use in human health or animals and foodproduction in driving the spread of resistance in theecosystem must be properly understood and addressed.Also, a vast majority of bacteria are essential for life andthe health of humans, animals and the ecosystem andonly a very small percentage of them cause disease. Thisimplies that treatment of infectious diseases should beoptimized in a way that they do not make the cure worsethan the disease.

Secondly, antibiotic resistance is a problem on a globalscale, with resistance originating in one part of the worldspreading rapidly, in some cases in a matter of weeks.

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Intensified human mobility and food trade accelerate thespread of ABR across national borders, across differentbacterial species and from bacteria in animals to those inhumans. Responding to outbreaks of resistant infectionsinvolves coordination of efforts across nationalboundaries, varied health systems and involvinginternational agencies like the WHO.

Along with scale there is also the great diversity of social,economic, political and cultural contexts in which ABRemerges or spreads. For instance, while legal regulation ofantibiotic sales or usage has worked well enough in certainparts of the world, in other parts such restrictions aredifficult to implement in practice. Abuse or overuse ofantibiotics in just a few regions of the world is enough tooverturn achievements in containing ABR elsewhere.

Next is the issue of financial and scientific roadblocks tothe development of new classes of effective antibiotics.Developing new drugs is highly resource intensive andprivate industry does not seem to have the incentives to

get involved beyond a point. Partnerships between theprivate and public sector for such drug development aretoo few and far between. Even if a new drug isdeveloped, currently there are no strategies to minimizeunnecessary use to keep it effective for as long aspossible.

The absence of efficient and low cost diagnostics is alsoan obstacle to the ability of physicians to prescribeappropriate antibiotics or even take a decision not toprescribe at all.

While excessive use of antibiotics remains a majorproblem it is also the fact that in the poorer parts of theworld there is a lack of access to essential and effectivelife-saving antibiotics. Weak health systems and unstablecentral drug distribution systems contribute to shortageof essential medicines. Increasing resistance levels alsoresult in older, cheaper antibiotics losing their efficacy,while newer and significantly more expensive drugs areunavailable due to high costs.

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ReAct Strategic Plan

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In the first stages of its development (2006-2014) ReActworked in an exploratory way, which generatedinnovative approaches to changing behaviour andmanaging ABR. During this time, and in part because ofReAct´s work, the global ABR landscape it was workingin has changed. The awareness of the emerging healthand economic crisis created by ABR has increasedsignificantly.

The next 5 years of ReAct's work will be based onanalysis of the experience, knowledge and expertisefrom its own network as well as other networks andinstitutions with which ReAct works in closecollaboration. This analysis will form the basis for astrategic policy agenda and advocacy that responds to thechanging landscape and creates new proposals for areasthat have been neglected.

Engagement, Empowerment and

Network Extension (EEE)

There is a new paradigm emerging on the role of microbesin human health through work in microbiology,immunology, microbial ecology and biophysics that pointsto the need for an ecological approach to ABR and rejectionof the war metaphor in medicine or the treatment of thehuman body as a stand-alone machine.

Among these are new findings and understanding of thehuman and hospital microbiomes with implications forcurrent protocols on antibiotic use, role of nutrition andmaintenance of hygiene. All these together with new ideason greening of hospitals and decentralised healthcaredelivery – conceptualized as ReAct´s ReimaginingResistance - have potential for effectively dealing with ABR.

Similarly in the social sciences, there is new research, thathas implications for ABR, explaining the anthropological

basis of health–seeking behavior; the role of art instimulating innovation and also bringing about criticalawareness of complex themes; new communicationtechniques for dissemination of relevant information; andunderstanding the role of socio-economic determinants ofhealth.

ReAct´s EEE programme is about raising awareness,education, changing behaviour, empowerment andmobilising stakeholder-communities for action to addressthe urgent and global problem of ABR.

These in turn are necessary steps towards social change thatare pre-requisites for tackling every important health issueand no less necessary in order to halt and reverse the spreadthe global threat of ABR. A case can also be made forensuring appropriate use of antibiotics as a pilot forsuccessfully coming to grips with rational use of medicinesover all.

Over the next five-year period, the EEE programme´sgoals are the following:

To identify and disseminate best practices and newsolutions in the context of ABR and collaboration tovarious communities at grassroots, school, hospital,academic and policy levels.

To encourage a holistic approach to ABR as a problem ofhuman and ecosystem health, influenced by economic,social and cultural factors, and the deconstruction of themetaphor of war while recognizing the positive role ofmicrobes in human life and nature.

To address and manage the ABR problem bydeveloping, strengthening and extending local andregional action networks. To contribute to the creationof national plans to tackle ABR, by empoweringstakeholder communities, from consumers,practitioners to policy agents.

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CURRENT PROGRAMS

2015 - 2019

ReAct Strategic Plan

Complementary to its grassroots work, ReAct aims topromote and support initiatives that address the widersystemic and deeper structural issues involved with theproblem of ABR. Antibiotic resistance has taken centerstage in global health, from being debated at the WorldEconomic Forum to being highlighted in India'sChennai declaration. However, not all stakeholders havethe public's interest at heart.

For example, some pharmaceutical companies have usedthe shortfall in novel antibiotics to extend monopolyprotections on drugs and to call for premium pricing foran antibiotic course. ReAct has for many years workedactively on new business models and approaches toinnovation, both upstream in the pharmaceutical R&Dpipeline and downstream in the healthcare deliverysystem. For example, ReAct introduced key policy ideaslike delinkage into the policy dialogue to addressantibiotic resistance and to also take into accountspecific circumstances in LMICs, to ensure equitableaccess of effective antibiotics to all.

Over the next five-year period, the SP programme'sgoals are the following:

To advance ReAct's work on innovation by offeringstrategic consultation, developing white papers, andcontributing to policy convenings.

To build on ReAct's network of stakeholders bydeveloping tools, piloting projects or supporting anenabling environment for bringing forward and testingsuch innovations.

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�To support ReAct's continued efforts to create a broadcivil society coalition by extending effective approaches toreach new constituencies--some outside of the traditionalhealthcare delivery system--to tackle antibiotic resistance.

management; how to engage champions; how antibioticsplay a vital role in vulnerable groups such as new-borns,malnourished children, and patients with weakenedi

Generation and Translation of Evidence

(GATE)

From rates of antibiotic use and resistance levels tounderstanding the knowledge, attitudes and behavioursof healthcare providers on ABR, there is a lack of datato inform policy makers of the gravity of the ABRsituation. Currently no organisation or entity is eithersystematically collecting or trying to address thesedeficits in a structured manner. With deeply rootedconnections across the globe, and its reach to civilsociety organizations focused on sustainable health anddevelopment ReAct is uniquely positioned to identifygaps in data, forge partnerships for collaboration, andplace ABR on the global health agenda.

Interventions to halt the spread of resistance can comefrom a variety of angles: infection prevention andcontrol; rational use of antibiotics, including howantibiotics are being used in community case

mmune systems, such as those with HIV. It can beoverwhelming to know where to find information and tokeep on top of it all. There is a need to follow not justarticles about ABR specifically but a multitude of diverseactions that individually play an intricate role in the globalABR situation. In order to synthesise clear messages andavoid false solutions, in-depth knowledge across thewhole field is required. This includes everything fromdetailed knowledge on how bacteria spread and sharegenes in order to pinpoint points of intervention, to theunderlying motivation of people to purchase and use

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Strategic Policy (SP)

”ReAct´s vision is

a world free from fear of

untreatable infections”

2015 - 2019

ReAct Strategic Plan

8

antibiotics when they are not needed. It is easy to confusemessages, so there is a need to clarify and inform on anumber of issues.

Over the years ReAct has emerged as a trusted globalsource of high quality, scientifically credible informationon ABR. This has contributed to the seriousness withwhich ReAct's policy messages are taken by a diverse setof stakeholders worldwide.

Over the next five-year period, the GATE programme'sgoals are the following:

To continuously monitor the field of antibioticresistance and extract knowledge generated fromresearch and policy papers, harvest insight and

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experiences from the implementation of interventions,and gather information on the evolving landscape ofABR. To analyse and translate relevant content into ausable form for others working in the field.

To disseminate translated evidence on antibioticresistance through an open source knowledge hub andinteract with stakeholders on topics from informationabout the global burden of antibiotic resistance toinnovative solutions and best practices on how to takeaction.

To identify gaps in information necessary to influencepolicy change, foster partnerships for collaboration,and convene meetings to catalyse stakeholderinteraction on ABR issues.

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ReAct Strategic Plan

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ReAct's latest global node, in Africa, was born in aworkshop held in Nairobi, Kenya from 9-11 April2014 at a gathering of 27 delegates from tencountries around the continent. The new ReActAfrica node builds on a long engagement ReAct hashad with various individuals, groups and institutionsworking on antibiotic resistance (ABR) in Africa.

Africa, has been a priority for ReAct's work as it bears avery heavy burden due to infectious diseases resultingin the deaths of over 3.5 million African children underfive every year. Over half of all maternal deaths occurin Africa, around 9 % of which are caused by sepsis dueto infection during childbirth or immediately after.

Africa also has a worrisome situation with pollution offood and water with antibiotics, leading to increasingbacterial resistance, due to either non-therapeutic useof antibiotics in animal husbandry or release ofwastewater from pharmaceutical and healthcarefacilities into the environment.

Since 2006, ReAct has built strong relationships andsucceeded in introducing ABR to the agendas of twoactive networks: the Ecumenical Pharmaceutical

Network (EPN) and INDEPTH. ReAct's overallnetworking strategy has been to identify and engage onABR with 'living' networks, organisations andindividuals in Africa that understand the process ofchange in relation to key issues facing the continent.

Dr Mirfin Mpundu of the Ecumenical PharmaceuticalNetwork (EPN), which will be hosting the ReActAfrica node, was appointed as the contact persontogether with Dr Martha Gyansa-Lutterodt, MOHGhana as deputy. A committee of three people hasbeen set up to assist them, representing CSO sector,academia, environment and health professionalsectors.

The new ReAct Africa node has decided to developstrategies to tackle three priority issues, which include:

Development and documentation of a holisticapproach to ABR containment in Africa.

Raising awareness on the need for good quality data.

Increasing awareness on ABR by adapting andpromoting the use of available information,education and communication materials.

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AFRICA´S NEW CHAMPIONS FOR ACTION ON ABR

2015 - 2019

ReAct Strategic Plan

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ACHIEVEMENTS

Transforming Agendas

Inspiring policy action

ReAct reframed the global debate on incentives forR&D for new antibiotics as a global public good byfocusing on push mechanisms rather than extendedpatents, encouraging collaborative R&D models, andintroducing open source drug discovery into theoptions for new business models. ReAct helped makethe hidden nature of the growing antibiotic resistanceepidemic more visible through articles in the scientificand popular press, new language and images in creativecommunication products, events and discussions.

ReAct seeded ideas and helped develop WHO'smonograph, ”The evolving threat of antimicrobialresistance: Options for action”, where two out of fiveexpert working groups were chaired by ReAct leaders.

ReAct catalyzed debate with diverse groups of globaland local level stakeholders on how systems ofprocurement, distribution, access and use need tochange to preserve the effectiveness of new andexisting antibiotics.

Moved the ABR issue from the European to the globallevel, successfully engaging 200 multisectoralstakeholders from around the world in a global meetingon ABR and the need for innovation in 2010. Theproceedings from the conference were published as aspecial edition of the journal Drug Resistance Updateswith more that 10,000 requests for full text articles injust over 12 months.

Taking the development of new drug innovationbusiness models one step further towards beingoperational, ReAct contributed the backgrounddocument for one topic of the Innovative Medicinescall entitled ”Driving Re-investment in R&D andResponsible Use of Antibiotics”.

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Supported the Ghana Ministry of Health in its multi-stakeholder AMR policy development process,following its participation in ReAct's 2010 globalmeeting.

Influenced policy makers through papers published,including two in the British Medical Journal, one onmeeting the challenge of ABR and the other on the 3Rs(sharing resources, risks and rewards) model forimproving innovation of antibiotics. ReAct is presentlyinvolved in guest editing and writing for a special issueon ABR for Lancet Infectious Diseases and a policyarticle on new norms for systems of distribution,access to and use of antibiotics.

Reframed ABR as an ecological issue that needs aholistic solution. For example, ReAct brought out theMicrobes and Metaphors report on ABR and initiatedthe Reimagining Resistance process as an inter-disciplinary issue involving medical professionals,microbiologists, environmental activists and artists.

Developed a closer understanding of implications ofnew research work in microbiology and microbialecology for ABR through interaction with topscientists in the US, Europe and Australia.

Changing the paradigm

”ABR is currently considered

one of the world´s greatest

public health threats

and also an economic and

environmental risk”

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ReAct Strategic Plan

132015 - 2019

ReAct Strategic Plan

Building networks

Supported an organic process of dialogue andmovement building in Latin America, Asia and Africa.ReAct's efforts have resulted in the emergence of anetwork of grassroots groups working on ABR indifferent parts of the world.

Fostered collaborations across countries and regionsthrough sharing of experiences. ReAct's CSO project, in6 countries and over 3 continents, empowers CSOs towork on ABR in their networks.

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Mobilised civil society to take ABR on their agenda. Inparticular ReAct played a key role in the formation ofthe Antibiotic Resistance Coalition in mid-2014,consisting of over two dozen civil society groups fromaround the globe committed to helping contain theproblem of ABR.

Succeeded in introducing ABR to the agendas of twoactive networks in Africa, the EcumenicalPharmaceutical Network and the INDEPTH network.Their involvement has led to the creation of ReActAfrica, the latest node in ReAct's growing globalnetwork.

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”Innovative Incentives for Effective Antibacterials”held in September 2009, as part of the Swedish EUPresidency where it brought knowledge of ABR toimportant new audiences, including CSOs andpolicymakers – especially in the EU.

The council conclusions following the Swedishpresidency instructed the Commission to produce anaction plan on ABR in 24 months. ReAct also helpedmove the issue from the European to the globallevel, successfully engaging 200 multisectoralstakeholders from around the world in a globalmeeting in Uppsala, Sweden on ABR and the needfor innovation in 2010.

ReAct also advocated for inclusion of antibiotics asa focus into the Innovative Medicines Initiative(IMI), which was set up to kick-start collaborationbetween companies and between industry andacademia/public sector for ”unprecedented sharingof information”. The result has been IMI's NewDrugs 4 Bad Bugs programme, that represents aunique partnership between industry, academia andbiotech organisations to combat antibiotic resistancein Europe by tackling the scientific, regulatory, andbusiness challenges hampering the development ofnew antibiotics.

PUTTING ANTIBIOTIC RESISTANCE HIGH ON THE EU AGENDA

In September 2009, the report ”Bacterial challenge:time to react”, on the burden of antibiotic resistantinfections, was launched by ECDC an EMA. Itestimated that in 2007 approximately 25000 patientsdied of resistant infections in the EU, Iceland andNorway. Secondly, it revealed that the societal costsof such infections were estimated at about EUR 1.5billion each year. It also contained an account offacts and figures that allowed reasonable predictionsof the gap between bacterial resistance in the EUand the likely availability of new treatments thatwould be effective against multidrug-resistantbacteria in the near future.

The Director of ReAct had visited the CEO of bothECDC and EMA to discuss the need for scientificevidence for the drying pipeline and data on thehealth and economic burden of resistant infections,which resulted in the collaborative report whereReAct provided critical data and proposed much ofthe original methodology.

The ECDC-EMA-ReAct report provided a solidbasis for the global debate by successfully developinga robust method to document and characterize thegap in the R&D pipeline and the burden of resistantinfections in Europe. It also became an importantbackground document to the expert conference on

PUTTING ANTIBIOTIC RESISTANCE HIGH ON THE EU AGENDA

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ReAct Strategic Plan

152015 - 2019

ReAct Strategic Plan

2004 The idea of ReAct is born at a

meeting organized by the Dag

Hammarskjöld Foundation

2005 Global meeting on ABR

of health professionals,

social activists, scientists,

media professionals in

Uppsala

2006 First

program with

Sida funding

begins

2007

ReAct Latin

America initiated

2008 Reimagining

Resistance

launched, Cuenca

Declaration on ABR,

Ecuador

2009

ReAct South East

Asia initiated

2010 Global Innovation

Conference, Uppsala

2012 Civil Society

Organisation project

launched

2011 Intense work is started

to ensure that rational use,

but also equitable access

and affordability of antibiotics

is considered in global

dialogues

2013

ReAct undertakes

restructuring, ReAct

African Network

underway

2014 ReAct Africa

initiated, Antibiotic

Resistance coalition

created

Selected ReAct Achievments

From the start and throughout its existence, ReAct'smain funder has been SIDA (the Swedish InternationalDevelopment Cooperation Agency).

Over the years, substantial contributions have also beenreceived from a number of other sources. For examplethe Swedish Ministry of Health and Social Affairs andUppsala University.

The Kjell and Märta Beijer Foundation, Marie-ClaireCronstedt Foundation, PAHO, WPRO, universitydepartments and CSO´s in the regions have contributed

FUNDINGfunds for specific projects.ReAct recognizes the need for a comprehensivefundraising strategy and is in the process of developing afull strategy. The final plan is expected to be ready by endof 2014. ReAct does not accept any funding from thepharmaceutical industry.

”

”

ABR strikes hardest on

the poor. Bacterial infections

kill more than 2 million

children every year

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ReAct Strategic Plan

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In Latin America, ReAct has taken an ecologicalperspective of antibiotic resistance (ABR), whichcalls for a holistic approach to health. This approachhas helped ReAct network with other civil societygroups in the region that share similar values and tocreate processes that enable people to participate andthrough this to understand how their contribution ispart of the solution.

From being fearful of microbes due to ignorancenow the children have a much more informed andnuanced understanding as also an appreciation ofbacterial contribution to life on the planet” saysGustavo Cedillo Zea, Vice-rector of the UnidadEducativa Juan Montalvo, one of the schools wherethe ReAct project was implemented.

School children in Cuenca, Ecuador held a veryspecial press conference in June 2014 to tell themedia about the book of stories on microbes theyhave written. The glossily printed 44-page book wasthe culmination of a process where children fromfive schools in the city of have learnt about microbesfrom the staff of ReAct Latin America (RLA).

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The children, through their enthusiasm, have in turn'infected' their own families and neighbourhoodswith knowledge of ABR and microbial life. Thetargeting of children as a vehicle in raising awarenesson ABR is not surprising given that, along with theMedical Faculty of the University of Cuenca, RLA'sclosest collaborator in the region has been the Childto Child Centre (CCC) in Ecuador. The CCC useswhat is called the 'Child to Child' approach to helpchildren become health promoters for otherchildren, their families and their communities and tobe active researchers and advocators.

An important characteristic of the work of RLA,has been its ability to frame the issue of antibioticresistance in terms of its larger social, economic andecological dimensions” says Dr Arturo Quizhpe,Coordinator, RLA and till recently Dean of theFaculty of Medical Sciences at the University ofCuenca.

Through this innovative approach, hard set fears andbehaviours can be changed, and ReAct's aims tospread awareness of it globally, through itsinternational networks.

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MAKING CHANGE THROUGH CHILDREN

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The example of ReAct South East Asia

Starting in 2006 with just a few contacts in a couple ofcountries the ReAct network in South East Asia (SEA)today has spread widely involving a wide variety ofindividuals and institutions tackling the problem ofantibiotic resistance (ABR). With partners andassociates in Singapore, Malaysia, Vietnam, TimorLeste, Thailand and the Philippines, ReAct SEA hasdeveloped a significant network linking championstrying, in very different contexts, to transformeverything from national level policies to communityoutreach programs on ABR across the region.

“The process was simple – one person referring toanother and all wanting to be part of a larger, crossborder network that would help strengthen their workin their home countries towards addressing the ABRproblem” says Mary Murray, ReAct's Global NetworkCoordinator. Mary together with Michael Chai, ReActSEA coordinator, leveraged their knowledge of theregion and friendships with key health activists to set inmotion the activities that led to ReAct SEA's fastgrowth.

For example, in one such ReAct-organised meeting,held in Bangkok in 2010, participants shared countrysituation analyses and case studies of positiveinitiatives. Among them were the Antibiotic Smart Useproject in Thailand that seeks to target three commondiseases which do not treatment with antibiotics andthe story of developing an Antibiotic StewardshipProgram in Singapore collaboratively between 3hospitals and now a 6 hospital initiative.

ReAct facilitated study tours as a follow up, to bothThailand and Singapore, by interested practitioners in

the region. This in turn led to the adaptation andadoption of the Thai ASU project in Indonesia (calledSUA there) by Yayasan Orangtua Peduli (YOP), agroup working on rational use of medicines and to theinitiation of an Antibiotic Stewardship project at theUniversity Malaya Medical Center in Penang. In 2012,YOP along with other groups from Thailand andMalaysia agreed to participate in ReAct's global CSOproject to build the capacity of CSOs working withwomen and children, and the environment, to addressthe issue of ABR.

Apart from the active networking another reason forReAct's success in the region has been its ability tooffer a global and more holistic perspective to the issueof ABR, helping break the somewhat insular thinkingprevailing till its intervention. ReAct has offered thisbigger picture and the levels of the issue: innovation,the need for an ecological approach, emphasis onprevention and public awareness and the paradigmshift taking place in knowledge of microbialbehaviour.

Interest in working with ReAct has now extended toother parts of Asia also. For example, at the NationalMedicine Policy conference in Sydney, in 2012,participants at a workshop on AntimicrobialResistance from Australia, India, China, Korea, SriLanka, Mongolia and some of the small island nationsof the Pacific, showed keen interested in becomingpart of the ReAct network in this region.

The possibilities are there to expand the network froma SEA one to an Asia Pacific ReAct network in the next3-5 years.

NETWORKING CHAMPIONS FOR CHANGE

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i ABR is the ability of bacteria to survive the antibiotics designed to killthem, through a variety of mechanisms, including bacterial adaptation toantibiotic exposure.

ii

Pruden A et al. EnvironHealth Perspect (2013);121: 878-885; and

WHO (2000):http://whqlibdoc.who.int/hq/2000/who_cds_csr_aph_2000.4.pdf

iii . Howell L et al. World EconomicForum: http://reports.weforum.org/global-risks-2013/; and

US Centers for DiseaseControl and Prevention: http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf; and

Foreign Commonwealth Office (2013):https://www.gov.uk/government/news/g8-science-ministers-statement

iv Technical Report.ECDC/EMEA (2009):http://www.ecdc.europa.eu/en/publications/Publications/0909_TER_The_Bacterial_Challenge_Time_to_React.pdf

v http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf

vi

A Preliminary Study. Phumart P et al. Journal ofHealth Systems Research. (2012);6 (3): 352-60.

vii .Grundmann H et al. Drug Resistant Updates (2011);14:79-87

viii

WHO (2012), Media Centre,. Geneva.http://www.who.int/mediacentre/news/notes/2012/gonorrhoea_20120606/en/

ix aGlobal Health Action (2013):

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x UNICEFProgress Report 2013.http://www.unicef.org/publications/files/APR_Progress_Report_2013_9_Sept_2013.pdf; and WHO (2013):http://apps.who.int/iris/bitstream/10665/91355/1/9789241564656_eng.pdf?ua=1

xi Cooke FJet al. Travel Med Infect Dis. (2004);2(2):67–74

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References

ReAct Strategic Plan, 2015-2019

Version:

Editors:

Photo credits:

Sep 18th, 2014

Anna

Page 2 - Photoshare, Page 19 - Patricia Geli

Design: Christel Törnros, ReAct

Zorzet and Satya Sivaraman, ReAct

�

�

�

�

We view effective antibiotics as an essential

public good.

We support access for all in need and excess for

none t

We are committed to the prevention of infection

We promote context specific solutions t

How well we protect antibiotics

from misuse today and in future has a major

impact on our common wellbeing. Presently

antibiotics are an exhaustible resource.

o ensure this public resource benefits

everyone who needs it.

in all our advocacy and actions, in particular the

provision of primary health care and influencing

the social and economic determinants of

infection.

o

account for the diversity of systems of health

care, cultural practices, resource availability,

geography, community and family circumstances

and other relevant factors. While some solutions

can be adopted globally, many require local

development or adaptation with champions for

change providing necessary leadership.

that replaces

the dominant war metaphor of bacteria as our

'enemy', with a new understanding of the

essential role of microbes and microbial ecology

in the health of humans and all forms of life.

o f t h e p r i vate

pharmaceutical industry and do not accept any

financial support from it.

�

�

We take an ecosystem approach

We a r e i n d e p e n d e nt

ReAct Statement of Principles

ReAct - Action on Antibiotic Resistance

Uppsala University, Box 256, 751 05 Uppsala, Sweden

Phone: +46 (0)18 471 66 07 Email: react@medsci.uu.se

www.reactgroup.org