Next week on January 22-27, the World Health Organization will hold its 142nd meeting of the Executive Board in Geneva. This year, discussions are likely to be dominated by the draft General Work Program for 2019-2023 that has been proposed by the new leadership of the WHO under Director General Dr. Tedros. A new target on reducing sepsis cases by 10% is introduced as a benchmark for the field of antibiotic resistance.
Alignment with the Sustainable Development Goals
The WHOs intention to work in alignment with the Sustainable Development Goals (SDGs) – in particular SDG 3 on health – is made very clear in the draft document. The quote “Health is a human right. No one should get sick or die just because they are poor, or because they cannot access the services they need” seems to indicate that issues such as affordable access to health care services and medicines are high on the WHO’s agenda the coming years.
Three new strategic goals
The draft work program has three overarching strategic goals:
- Advancing universal health coverage by ensuring that 1 billion more people are covered in the next five years.
- Addressing Health emergencies by making 1 billion people better protected.
- Promoting healthier populations by improving the health and well-being of 1 billion people.
Antimicrobial resistance becomes one out of five platforms of work under strategic goal three on Healthier populations and will likely fall under the responsibility of the new Assistant Director-General for Special Initiatives, Dr. Ranieri Guerra.
10% reduction in resistant sepsis cases
The WHO is proposing a new target to reduce the percentage of drug-resistant sepsis cases by 10% globally. Choosing sepsis allows almost all pathogens (aside from e.g. gonorrhea) to be covered in the work done by the WHO to achieve this indicator. Question marks remain, however, over how the WHO will measure reduction rates and progress.
The current available surveillance data on sepsis is insufficient, and while the Global Antibiotic Surveillance System, GLASS, is underway and will release its first progress report in the coming weeks, the available data are likely not enough to accurately assess the actual global burden of sepsis cases caused by resistant bacteria. In addition, some of the pathogens responsible for many sepsis cases, including neonatal sepsis, are not included on the list of pathogens that GLASS surveys.
In order to achieve the goal on 10% reduction the following areas should be addressed as a matter of urgency:
- Overall country support and reporting to GLASS needs to increase.
- Substantial increase in international funding made available to strengthen laboratory capacity in Low and Middle-income countries to enable them to participate in and report to GLASS.
- The key pathogens list for surveillance in GLASS should include e.g. Group A and B streptococci, which are major causes of postpartum infections and neonatal sepsis.
The Global Antimicrobial Resistance Surveillance System was launched by WHO in 2015 in an effort to standardize surveillance of antimicrobial resistance. Borne out of the WHO Global Action Plan, it aims to strengthen country-level surveillance systems and integrate data for analysis and sharing. One important aspect of the GLASS monitoring system is the shift from only reporting data from individual isolates towards including epidemiological, clinical and population level data.
- The first GLASS progress report is planned to be made available on the website on the 29th of January, 2018. A technical webinar to present the findings of the report is planned for January 26th.
- In December 2017, 49 countries were enrolled in GLASS. Of these, 24 are high income countries, 20 middle-income countries and 6 low-income countries.
- In its early implementation phase, GLASS collects data on surveillance systems and eight key pathogens from blood, urine, stool and urethral/cervical swabs:
– Acinetobacter baumannii
– Escherichia coli
– Klebsiella pneumoniae
– Neisseria gonorrhoeae
– Salmonella spp.
– Shigella spp.
– Staphylococcus aureus
– Streptococcus pneumoniae