Lucy Boulanger, MDDivision of Global Health Protection

Centers for Disease Control and Prevention

Antimicrobial Resistance and Global Health Security

National Center for Emerging and Zoonotic Infectious Diseases

Division of Healthcare Quality Promotion

AMR Requires Global Action

Antimicrobial Resistance

AMR Knows No Borders

A health threat anywhere is a health threat everywhere

Global Aviation Network

Source: The Lancet 380:9857, 1-7 Dec 2012, pp. 1946-55. www.sciencedirect.com/science/article/pii/S0140673612611519Note: Air traffic to most places in Africa, regions of South America, and parts of central Asia is low. If travel increases in these regions, additional introductions of vector-borne pathogens are probable

*National data means data obtained from official sources, but not that data necessarily are representative for the population or country as a whole

Available National Data* on Resistance for 9 AMR indicators

WHO: Antimicrobial Resistance. Global report on surveillance 2014

WHO Global Report on surveillance 2014

Can National Reference Labs do AST?

NRL can do AST NRL participates in EQA

WHO Global Report on Surveillance 2014

Key points

Widespread high levels of AMR

– % of resistance among tested isolates

Significant gaps

– No global system on surveillance of antibacterial resistance (ABR)

– Lack of harmonized standards, data sharing, and coordination

Source: The Review on Antimicrobial Resistance, May 2016

http://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf

Yearly Deaths Attributable to AMR in 2050

Tackling Antimicrobial Resistance on Many Fronts

Global priorities & objectives

Country ownership and national commitments

Technical expertise

Foundational capacities

Healthcare provider buy-in; link to infection control and prevention

Patient awareness

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Global Action Plan on Antimicrobial Resistance

Five strategic objectives

1. Improve awareness and understanding

2. Strengthen the knowledge and evidence base through surveillance and research

Member States request WHO (2015 WHA Resolution)

“…develop and implement an integrated global program for surveillance of antimicrobial resistance across all sectors…”

3. Reduce the incidence of infection

4. Optimize the use of antimicrobial medicines

5. Develop the economic case for sustainable investment

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GLASS Guiding Principles

1. Foster national AMR surveillance systems

• In coordination with the national strategy for AMR

• Building upon existing surveillance structures

2. Gather epidemiological, clinical and microbiological data

3. Stepwise approach to meet local and global priorities

4. GLASS Early implementation focus on bacterial pathogens

• Priority specimens and bacterial pathogens in human

• Progressive inclusion of other types of other AMR-related surveillance (e.g., food chain, antimicrobial use, environment)

GLASS – N. Delhi, Feb 2016

Global Health Security Agenda

Vision: A world safe and

secure from global health

threats posed by infectious

diseases…

– GHSA launched in

February 2014 with leaders

from 28 countries, WHO,

OIE and FAO

– By September 2014: 44

countries joined the GHSA

– June 2015, G7 committed to

assist at least 60+ countries

Global Health Security – “...the activities required, both proactive and reactive, to minimize vulnerability to acute public health events that endanger the collective health of populations living across geographical regions and international boundaries” (World Health Assembly Report, 2007)

• In 2003, SARS cost $30 billion in only 4 months• The anthrax attacks of 2001 infected 22 people,

killed 5, and cost more than $1 billion to clean up • The 2009 H1N1 influenza pandemic killed 284,000

people in its first year alone • AIDS spread silently for decades

Where50 countries have committed to the global health security agenda

Global Health Security Agenda

“…the good news is today, our nations have begun to answer the call. Together, our countries have made over 100 commitments both to strengthen our own security and to work with each other to strengthen the security of all countries’ public health systems.”

President Barack Obama, 2014GHSA Summit Greeting Ebola Survivor Dr. Melvin Korkor from Liberia

Where is the US committed in 2016?

High Risk Non-Affected Ebola CountriesBeninGambiaGuinea BissauMauritaniaNigeriaTogo

GHS Phase 1BangladeshBurkina FasoCameroonCote d’IvoireGuineaEthiopiaIndiaIndonesiaKenya

LiberiaMaliPakistanSenegalSierra LeoneTanzaniaUganda Vietnam

GHS Phase IICambodiaDemocratic Republic of CongoGeorgiaGhanaHaitiJordanKazakhstan

LaosMalaysiaMozambiquePeruRwandaThailandUkraine

Action Packages to Achieve Targets

Antimicrobial Resistance

Zoonotic Diseases

Biosafety/Biosecurity

Immunization

National Laboratory Systems

Surveillance

Reporting

Workforce Development

Emergency Operations Centers

Linking Public Health with Law Enforcement

and Multisectoral Rapid Response

Medical Countermeasures and Personnel Deployment

Action Packages to Achieve Targets

Antimicrobial

Resistance

Prevent avoidablecatastrophes

5-Year Target:

• Integrated and global package of activities to

combat AMR

Desired Impact:

• Enhance infection prevention and control

• Prevent the emergence and spread of AMR,

especially among drug-resistant bacteria

• Strengthen surveillance and laboratory

capacity

GHSA Antimicrobial Resistance Action Package

Five-Year Target:

Develop an integrated and global package of activities to combat antimicrobial resistance, including:

• Each country has its own national comprehensive plan

• Strengthen surveillance and laboratory capacity at the national and international level

• Improved conservation of existing treatments and collaboration to support the sustainable development of new antibiotics, alternative treatments, preventive measures and rapid, point-of-care diagnostics, including systems to preserve new antibiotics

GHSA Antimicrobial Resistance Action Package

As Measured by:

• Number of comprehensive plans to combat antimicrobial resistance agreed and implemented at a national level, and yearly reporting against progress towards implementation at the international level

• Number of countries actively participating in a twinning framework, with countries agreeing to assist other countries in developing and implementing comprehensive activities to combat antimicrobial resistance, including use of support provided by international bodies to improve the monitoring of antimicrobial usage and resistance in humans and animals.

GHSA Antimicrobial Resistance Action Package

Desired National Impact:

• Comprehensive action to enhance infection prevention and control activities to prevent the emergence of AMR.

• Nations will • strengthen surveillance and laboratory capacity

• ensure uninterrupted access to essential antibiotics of assured quality

• regulate and promote the rational use of antibiotics in human medicine and in animal husbandry and other fields as appropriate

• support existing initiatives to foster innovations in science and technology for the development of new antimicrobial agents

JEE Scorecard for AMR

JEEs Completed and Planned March 2017

WHO link to published country reports:http://www.who.int/ihr/procedures/implementation/en/

GHSA Country Joint External Evaluations

• Provides an independent and transparent

assessment process, joint peer-based

collaborative approach highly appreciated

• Enable country and partners to identify

gaps and development needs and build an

implementation plan for closing the gaps

• Foster true cross-sector – ‘One Health’

approach to security in Ethiopia

• All countries assessed have agreed to

publish results www.GHSagenda.org

• Ethiopia already using findings to develop

national capacities

https://stm.fi/en/international-cooperation/ghsahttps://ghsagenda.org/assessments.html

Thank You.

For more information please contact Centers for Disease Control and Prevention

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Visit: www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or www.cdc.gov/info

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

National Center for Emerging and Zoonotic Infectious Diseases

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