News and Opinions  –  2018

Antibiotic Resistance Coalition, including ReAct, responds to IACG discussion papers

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During the summer the UN Interagency Coordination Group (IACG) released six discussion papers for public consultation to solicit feedback on the work of IACG to inform its future deliberations. Members of the Antibiotic Resistance Coalition (ARC), including ReAct, convened to discuss and submitted responses to the first set of discussion papers.

A few take aways from the ARC responses are that Research & Development and access need better coherence with UN Political Declaration on AMR, National Action Plans on AMR need to mainstream antimicrobial resistance into broader development areas and Surveillance and Monitoring is needed to inform public health actions and to trigger policy change. Further down you can also read how the ARC responses relate to other stakeholders' responses.

The first three discussion papers from IACG, open for public consultation.

The first three discussion papers were on:

  1. Invest in Innovation and Research and Boost R&D and Access.
  2. National Action Plans.
  3. Surveillance and Monitoring for Antimicrobial Use and Resistance. Over fifteen ARC members endorsed one or more of these joint submissions. Responses from other stakeholders came from the Member States, CSOs, NGOs and other organizations, private actors including industry and individuals.

IACG has made all the incoming comments on the papers publicly available.

There is another three papers that ARC is currently responding to. These papers are on Communications and Behavior Change, Future global governance and Stewardship.

R&D and access need better coherence with UN Political Declaration on AMR

Responding to the paper on innovation, R&D (Research & Development) and access, ReAct and other ARC Members asserted the need for better policy coherence with the UN Political Declaration on AMR that gave rise to the IACG and that stated R&D should be “guided by the principles of affordability, effectiveness and efficiency and equity, and should be considered as a shared responsibility.” The response also called for greater coordination of priority-setting and financing for R&D and access. We noted that all parts of that portfolio should strive to adhere to principles of delinkage, transparency of R&D costs, fair return on public investment, and an end-to-end approach in safeguarding access and stewardship. An end-to-end approach in R&D would mean that upstream incentives are coupled with access and stewardship downstream from bench to bedside.

In financing access to health technologies to address AMR, we believe that extending the mandate of already existing funds, such as UNICEF, Global Fund, UNITAID, GAVI, would be most efficient and effective in the short term. In the long term, as the capacity and structures grow within the existing mechanisms, there might be an opportunity to split off these parts into a self-sustained and dedicated AMR fund.

Response from Other Stakeholders

Other stakeholders agreed that extending the mandate of current funds would be essential to not make the field more siloed, but emphasized that extension of mandate should always go hand-in-hand with more funding. Also the ‘Pay or Play’ mechanism to fund R&D was revived by two important stakeholders, a tax by which pharmaceutical companies have to or pay for antimicrobial resistance research to a fund, or do research themselves. Pooled procurement of antimicrobials at the global level was supported by many. Supporting pooled procurement would reduce prices and act as a way to enlarge market opportunities for companies involved in antimicrobial resistance.

Most countries and NGOs agreed that currently, push and pull mechanisms seem to be portrayed in an unbalanced way and that pull incentives are not a priority. To reduce the cost of R&D it was also put forward that innovative clinical trial models should be created, regulation should be changed if necessary and that standards should be harmonized among countries to lower costs. Besides the work on R&D of new antibiotics, stakeholders argued that others forms of R&D should play a bigger role, like vaccines. Emphasis was also laid on the research into practice and behaviour as well as the importance of the training of more researchers, especially in the Global South. One member state raised the important issue that we fund not only novel research, but also the improvement and implementation of existing interventions and technologies.

Consolidated Comments from Member States, CSOs, NGOs and other organizations, private actors including industry and individuals.

National Action Plans – mainstream AMR into broader development areas

In the joint ARC response to the National Action Plans (NAP) discussion paper, ReAct broadly agreed with the importance of mainstreaming antimicrobial resistance into broader development areas in universal health coverage, sustainable development, food production and environmental health for NAP implementation. Effective antimicrobial resistance mainstreaming into multi-sectoral national and global programmes requires greater understanding and communication of the One Health approach. For sustainable financing for NAPs, the ARC response encouraged support for the implementation of stepwise approaches, prioritization of resources, and access to essential antibiotics. In addressing coordination mechanisms, the response highlighted the shared responsibility of all countries including high-income and low-and middle-income countries and the need for international targets, coordination and monitoring for accountability.

Response from Other Stakeholders

The consolidated comments from other stakeholders highlighted the strategic importance of mainstreaming antimicrobial resistance into broader development areas and One Health approach in National Action Plans implementation. The challenges including the lack of political commitment, resources and practicality of cross-sectoral collaboration were also widely discussed. A few suggestions called for political involvement from heads of government to push forward priority setting and coordination across line ministries and multiple sectors. Wider intergovernmental political forums – such as the African Union Summit, BRICS Summit – could be explored to include AMR as a standing agenda for commitment and accountability of political leadership. Some responses also argued for stronger economic evidence including the cost of inaction on AMR to assist decision makers in prioritization of antimicrobial resistance.

Consolidated Comments from Member States, CSOs, NGOs and other organizations, private actors including industry and individuals.

Surveillance and Monitoring needed to inform public health actions and to trigger policy change

In the response to the surveillance and monitoring paper, ReAct and other ARC members stressed the importance of surveillance and monitoring to inform public health action and to trigger policy change in a range of areas from healthcare delivery to food systems. Effective surveillance and monitoring is dependent on the availability of data, laboratory infrastructure, and standardized instruments. ARC members highlighted the need for greater support for low- and middle income countries (LMICs), harmonization of data for cross-country comparison, and integrated AMR surveillance across sectors. We also pointed out that data transparency must follow from availability, to enable analysis, comparison, and as part of an accountability mechanism. Surveillance data will be instrumental for cross-country and cross-setting comparisons and serve as a basis for a prioritization framework for policy interventions and in channeling global resources to where need for investments would be greatest. For these purposes, we stressed the need for sustained investments into building surveillance and monitoring systems.

Response from Other Stakeholders

From the feedback by other stakeholders there was a broad agreement that the main obstacles towards surveillance and monitoring for antimicrobial use and resistance are the challenges of standardization, harmonization and integration of data. A recurring theme was that surveillance heavily relies on a functioning health system and the requirement of well integrated laboratory functions. To meet this need the key is to invest in building national infrastructure and capacity, especially in low- and middle-income countries. Apart from a few responses there is not much reflection on the different objectives of surveillance and monitoring and its importance for informing decision making and taking action. The objectives will also steer the scope of surveillance and whether it should be comprehensive across all bacteria and antibiotics, or limited to the most frequent pathogens. For surveillance to be an area which is prioritized and invested more in countries need to more clearly agree on the objectives and the benefits of surveillance. Some called for case studies to demonstrate the economic case for investing in surveillance systems, this could likely be taken on within existing work of the Tripartite.

Consolidated Comments from Member States, CSOs, NGOs and other organizations, private actors including industry and individuals.