Course: Antibiotic Resistance - The Silent Tsunami  –  Part 4

Ongoing initiatives to fight antibiotic resistance

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Over the last few years, political commitment to address antibiotic resistance has markedly increased. Antibiotic resistance is now widely recognized as a major threat to global health and therefore countries and international actors increasingly recognize the need to work together to find sustainable solutions.

Below we’ve compiled a selection of ongoing initiatives to fight antimicrobial/antibiotic resistance. Given the complexity of the issue and the constantly changing landscape, it’s important to note that the list is not comprehensive.

Global Action Plan

In May 2015, the World Health Assembly (WHA) unanimously adopted the Global Action Plan on Antimicrobial Resistance (GAP). The goal of the plan is “to ensure, for as long as possible, continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way, and accessible to all who need them”.

To achieve this goal, the plan sets out five strategic objectives:
1. to improve awareness and understanding of antimicrobial resistance;
2. to strengthen knowledge through surveillance and research;
3. to reduce the incidence of infection;
4. to optimize the use of antimicrobial agents; and
5. to ensure sustainable investment in countering antimicrobial resistance.

According to the plan, all countries are committed to implement actions in their countries, in all sectors of society. The member states of the World Organisation for Animal Health (OIE) and the Food and Agriculture Organization of the United Nations (FAO) have also adopted resolutions on antimicrobial resistance, and WHO, OIE and FAO are all part of the ‘Tripartite’ collaboration, which addresses antimicrobial resistance at the global level from a ‘One Health’ perspective.

The GAP marks a transition from encouraging countries to develop national solutions towards a greater harmonization of national and international strategies. The need for immediate action and more concerted efforts was further emphasized by the inclusion of antibiotic resistance as a threat to global development in the UN’s Sustainable Development Goals (SDGs). This has brought more attention to the exploration of different high-level political fora, which in turn can support the implementation of the plan.

Other ongoing activities

In September 2016 antibiotic resistance was elevated for discussion at a high level meeting during the United National General Assembly. It was only the fourth time that a health topic received such high-level attention and the aim of the meeting was  to mobilise political will for joint, multi-sectoral political commitment and to increase political awareness about the scale of the problem. A political declaration, calling for coordinated global action, was adopted. In one of the paragraphs therein, Heads of States called for the establishment of an ad-hoc interagency coordination group (IACG) on antimicrobial resistance that should provide practical guidance for implementation of the adopted declaration and recommendations for improved global coordination of actions. The group, consisting of representatives from relevant UN agencies, international organizations and individual experts, will report back to the 74th session of the General Assembly which will take place in September 2019.

In addition to policy development, there has been an increase in work on new strategies for the promotion of research and development of novel antibiotics over the past years.

The WHO has done substantial technical work including by publishing a priority pathogens list, which identifies the most pressing pathogens for which a new antibiotic is urgently needed. Moreover, the WHO has published a qualitative review of the current pipeline and concluded that it is currently insufficient to meet the threat of resistance. Both of these initiatives serve as guidance to funders of antibiotics research and development on where to best direct their funding.

The WHO has also teamed up with the Drugs for Neglected Disease initiative (DNDi) in 2016 and has since created and launched the Global Antibiotics Research and Development Partnership (GARDP). So far the partnership has secured funding from a range of governments in Europe, South Africa and the humanitarian organization Médecines Sans Frontières (MSF).

Financial commitments on national and international levels to support drug and diagnostic development has also been created. One such example is the Longitude Prize, which is a £10 million prize fund with the aim to encourage development of new point-of-care diagnostics that will help to conserve antibiotics. CARB-X s a public-private partnership dedicated to preclinical antibiotic development. It involves seven partners in the United States and the United Kingdom, and it is backed with half a billion dollars in funding from the US and the Wellcome Trust in the UK.

The Innovative Medicines Initiative (IMI)  –  another public private partnership – brings together the European Commission and the European Federation of Pharmaceutical Industries and Associations (EFPIA) in collaboration on projects such as ENABLE and DRIVE-AB which are or, in the latter case, were dedicated to research on changing the business model for antibiotics R&D and to tackling the scientific challenges in developing new antibiotics active against Gram negative bacteria. The final report of DRIVE-AB was published in January 2018.

The Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) is another EU project which now includes 27 countries globally. JPIAMR aims to collaborate on a shared and coordinated research agenda to enhance multi-disciplinary collaboration and ensure that knowledge gaps are identified and filled.

As touched upon in the third part of the course, there is also increased awareness of the need to strengthen health care systems in order to address antibiotic resistance, especially by providing assistance for building surveillance capacities in low- and middle-income countries (LMICs). One such example is the US-led multilateral and multi-sectorial initiative the Global Health Security Agenda (GHSA). The GHSA is an effort between over 50 countries to enhance global capacities to prevent, detect, and respond to infectious disease threats in LMICs. The initiative was set up in 2014 in the wake of the ebola outbreak in West Africa. Based on a ‘One health’ approach and in line with the GAP, the GHSA supports work that is coordinated by WHO, OIE and FAO to develop an integrated and global package of activities, including combating antibiotic resistance.

“…we must come together to prevent, and detect, and fight every kind of biological danger – whether it’s a pandemic like H1N1, or a terrorist threat, or a treatable disease” — former US President Barack Obama

Moreover, antibiotic resistance is increasingly being perceived as a social problem that must be communicated more widely to the public. Following its adoption as a theme for the World Health Day in 2011, antibiotic awareness is now promoted through annual information campaigns surrounding the European Antibiotic Awareness Day (EAAD). The EAAD takes place on November 18 each year and was initiated by the ECDC to increase understanding of antibiotic resistance and with the aim to curb unnecessary antibiotic use in Europe. Since its inception in 2008, the campaign has grown and spread, with more and more countries joining the initiative.

In the wake of the increasingly influential EAAD, WHO has since 2015 promoted the World Antibiotic Awareness Week (WAAW) in a bid to further raise awareness among health care professionals and the public. The theme of the campaign is “Antibiotics: Handle with care”, reflecting the message that antibiotics are precious and non-renewable medicines that should be used only when necessary, only for treating bacterial infections and only after prescription by a certified health professional.

“While there is a lot to be encouraged by, much more work needs to be done to combat one of the most serious global health threats of our time” — Keiji Fukuda, Special Representative for Antimicrobial Resistance in the office of the WHO Director-General

Other important efforts over the recent years include the The UK Review on Antimicrobial Resistance (AMR Review). The review was commissioned by the UK Prime Minister in July 2014 and has the aim to explore and propose concrete actions to tackle antibiotic resistance at both the national and international level. To this end, the review has published a series of influential reports on different issues related to antimicrobial resistance and the final conclusions and recommendations for future actions were published in May 2016.

Initiated by Center for Disease Dynamics, Economics & Policy (CDDEP) in 2009, the Global Antibiotic Resistance Partnership (GARP) has the aim to provide a platform for developing actionable policy proposals on antibiotic resistance in low- and middle-income countries. In collaboration with currently eight countries (India, Kenya, South Africa, Vietnam, Mozambique, Nepal, Tanzania and Uganda), GARP has conducted national situation analyses focusing on antibiotic resistance and use, and developed recommendations on how to address the resistance situation in each country.

ReAct – Action on Antibiotic Resistance is an independent global network for concerted action on antibiotic resistance, which is hosted by Uppsala University. ReAct has nodes located on five continents (Europe, North America, Latin America, Africa and Asia) and has taken both regional and global approaches to mobilize policy action on antibiotic resistance. Their strategy has been to raise awareness on antibiotic resistance to a range of constituencies, develop networks with interested parties, and move forward towards developing national policy platforms with social mobilization in selected countries.

Find out more

Here, you’ll find links to all the AMR Review publications and an animation video about antibiotic resistance by JPIAMR.

Below, you can also find links to the global action plan by WHO, further information about the IACG provided by the WHO, a factsheet about the ‘Tripartite’ collaboration by WHO, FAO and OIE and an infographic about GHSA:

 

 

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