Global efforts to combat Antimicrobial Resistance€¦ · Strengthening the fight against...
Transcript of Global efforts to combat Antimicrobial Resistance€¦ · Strengthening the fight against...
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Global efforts to
combat Antimicrobial
Resistance
Dr Danilo Lo Fo Wong Senior Adviser AMR
On behalf of the WHO/Europe AMR Working Group
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
The antibiotic era
• Many antibiotics/antimicrobials developed
• Many millions of lives saved
• Complications of medical interventions avoided
• Life expectancy dramatically increased
• More productive livestock
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Antibiotic resistance
• A natural phenomenon
• Accelerated by misuse of antibiotics
• Claims lives, costs money, affects livelihoods,
undermines health programmes
• Few new antibiotics in the pipeline
• Threatens entering a post-antibiotic era
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Antibiotic resistance
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
The evidence is convincing: “The more we use them, the more we lose them”
From Albrich et al EID 2004
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Antibiotic resistance
• WHO meetings, consultations, workshops in 1971, 1977, 1981, 1982, 1994, 1996, 1997, 1998, 1999, 2002, 2004,
2008, 2009
• World Health Assembly resolutions in 1986, 1988, 1990, 1992, 1994, 1996, 1998, 2001, 2005, 2007, 2009
• WHO global strategy for containment of antimicrobial
resistance published in 2001
• Despite progress, strategies for containment not widely
implemented
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Antibiotic resistance
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Animal
FeedsMeat
Direct
Contact
EXTENDED
CARE
FACILITIES
HOSPITALIZED
HUMAN
Commercial
Abattoirs /
Processing
Plants
Rendering
FOOD
ANIMALS
SHEEP CATTLE
SWINE
POULTRY
VEALCALVES
Offal
COMPANION
ANIMALS
Vegetation,
Seed Crops, Fruit
Sewage
Drinking
water
Drinking
Water
Sea /
Lakes
SwimmingAQUACULTURE
Rivers and
Streams
EPIDEMIOLOGY EPIDEMIOLOGY
OF OF
ANTIMICROBIAL ANTIMICROBIAL
RESISTANCERESISTANCE
Industrial &
Household
Antibacterial
Chemicals
OTHER
FARMED LIVESTOCK
COMMUNITY
- URBAN-RURAL
WILDLIFE
SOIL
Handling
Preparation
Consumption
after Linton AH (1977), modified by Irwin RJ
Dead
stock
Farm Effluents and
Manure Spreading
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Broader concept of AMR
• Currently perceived as "medical" or "health“ issue
• Development of AMR involves
– Health sector (health systems, doctors, pharmacists ...)
– Communities (patients, families …)
– Agriculture sector (farmers …)
– Private sector (pharmaceutical companies…)
– Governments (regulatory authorities, politicians …)
• AMR is a social & economic issue
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Global report on surveillance
Most important findings of this report:
• Very high rates of resistance observed in all
WHO regions.
• Many gaps in information on pathogens of
major public health importance.
• Key tools to tackle AMR, e.g. surveillance
systems, do not exist in many countries
http://www.who.int/drugresistance/documents/surveillancereport/en/
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
*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 Nine
Selected Bacteria/Antibacterial Drug Combinations, 2013
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Renewed global efforts
• Centralized secretariat at WHO HQ (December 2011)
• WHO Global AMR Task Force
• AMR Strategic and Technical Advisory Group (STAG)
• High-level awareness raising, e.g. World Health Assembly
AMR Side Events
2012 – hosted by Sweden, Ghana
2013 – hosted by Sweden, UK
2014 – hosted by Netherlands, UK
and Turkey
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Global AMR Action Plan
• Resolution adopted at World Health Assembly (May 2014)
• Call for Global Action Plan by WHA 2015
• Stakeholder and public engagement
• Technical consultations
– AMR surveillance (December 2012, March 2014)
– STAG (September 2013, April 2014)
• High-level ministerial meetings
– Netherlands (June 2014), Norway (Nov 2014), Sweden (Dec 2014)
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Guiding principles
• Whole-of-society engagement
• Actions based on best available knowledge and
evidence
• Prevention first
• Access not excess
• Sustainability
• Incremental targets for implementation
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
European strategic action plan on
antibiotic resistance
2011–2016
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
European strategic action plan on antibiotic
resistance (2011 – 2016)
• WHO European action plan adopted by all 53 Member States
• Recognizing
– AMR neglected in many countries of the region
– No systematic AMR surveillance in large part
of the Region
– Need for intersectoral coordination
– International spread through travel and trade
– Need for international standards and data
sharing
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Action Plan Strategic Objectives
1. Strengthen intersectoral coordination
2. Strengthen surveillance of antibiotic resistance
3. Promote rational use and strengthen surveillance
of antibiotic consumption
4. Strengthen infection prevention and control and
surveillance in health care settings
5. Prevent emerging resistance in veterinary and food sectors
6. Promote innovation and research on new drugs
7. Improve awareness, patient safety, and partnership
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Country situation analysis
• Country situation analysis
– Visit key Ministries, institutions, agencies, laboratories
– Mission report with observations and recommendations
– Follow-up activities
• Goal
– Appointment of National AMR Focal Point
– Installation of Intersectoral Coordination Mechanism (ICM)
– Development of national AMR action plan
• Performed: Armenia, Azerbaijan, Belarus, Bosnia and
Herzegovina, Georgia, Kyrgyzstan, Tajikistan, Uzbekistan, Moldova, Turkmenistan
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
WHO supports countries to
complete the picture
Data source:
European Centre for Disease
Prevention and Control (ECDC).
European Antimicrobial
Resistance Surveillance network
(EARS-Net), 2010.
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
CAESAR Network (Central Asian and eastern European Surveillance of Antimicrobial Resistance)
• Network of national surveillance networks in non-EU MS
• Joint initiative
– European Society of Clinical
Microbiology and Infectious
Diseases (ESCMID)
– Dutch National Institute of
Public Health (RIVM)
• Close collaboration with ECDC
– Use methodology compatible to EARS-Net
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Expanding AMR surveillance
throughout Europe
European Centre for Disease Prevention and Control World Health Organization Regional Office for Europe
Countries submitting data to CAESAR
Countries visited for CAESAR participation
Countries to be visited for CAESAR participation
Countries participating in EARS-Net
European Antimicrobial
Resistance Surveillance Network
(EARS-Net)
Central Asian and eastern
European Surveillance of
Antimicrobial Resistance (CAESAR)
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Region-wide AM use data
• Technical workshops
– Training, data collection and
analysis of national AM use data
– Non-EU Member States
• Joined initiative
– University of Antwerp, Belgium
• Close collaboration ECDC
– Use methodology compatible
with EU Member States
Lancet Infectious Diseases 2014
Published Online, March 20, 2014
http://dx.doi.org/10.1016/S1473-3099(14)70071-4
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Expanding AM use surveillance
throughout Europe European Surveillance of Antimicrobial
Consumption Network (ESAC-Net)
WHO/Europe-ESAC Project
Group
European Centre for Disease Prevention and Control World Health Organization Regional Office for Europe
Countries which reported 2011 data to WHO
Countries in the process of collecting data
Countries invited to join
Countries participating in ESAC-Net
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Use methodology
compatible with
ESAC-Net
Enable data
comparison in the
European Region
Lancet Infectious Diseases 2014
Published Online, March 20, 2014
http://dx.doi.org/10.1016/S1473-3099(14)70071-4
Expanding AM use surveillance
throughout Europe
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Infection prevention and control
• Global Infection Prevention and Control
Network (GIPCN)
• SAVE LIVES: Clean Your Hands - WHO's
global annual campaign
• 2014 – link to AMR
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
AMR in the food chain
• Booklet: AMR from a food safety perspective
• National workshops
– Albania, Tajikistan, Uzbekistan, Turkmenistan
• Subregional workshops
– Balkans (Albania), Central Asia (Kazakhstan)
• Advisory Group on Integrated
Surveillance of AMR (AGISAR)
• Global Foodborne Infections Network (GFN)
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Liaise with innovation initiatives
• EC DG Research & Innovation
• Joint Programming Initiative AMR
• Innovative Medicines Initiative
Discussion on new business models
• ReAct – action on antibiotic resistance
• Antibiotic Action
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Materials:
• Infograph
• Website
• Video
• Press release
• Presentation
Activities
• Country events (press conferences, seminars)
• EC/ECDC/WHO twitter chat
Awareness day
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
• European Antibiotic Awareness Day (EAAD)
– In 2013, expanded to 44 countries in Europe
• 18 November 2014 theme: Self-medication
– “Everyone is responsible, everywhere”
• WHO focus
– “The role of pharmacist in encouraging prudent use of antibiotic
medicines and averting antimicrobial resistance”
• Global Twitter Chat: 24 hours
– US, Canada, Europe, Australia, New Zealand
– WHO Regional Offices
Expanding awareness
throughout Europe
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Campaign support
Call for proposals (April 2014)
- Template, SMART objectives, selection criteria
Proposal review (May 2014)
- Panel of expert partners (WHO, RIVM, ECDC, BAPCOC)
Grants awarded (ARM, BIH, GEO, KGZ, MKD, MNE, SRB)
- Implementation June 2014 to February 2015
Workshop (Q1 2015)
- Exchange experiences and expertise
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Partnership
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
Acknowledgments
• Division of Communicable Disease,
Health Security & Environment
– Guenael Rodier
– Cristiana Salvi
– Siff Malue Nielsen
• AMR Coordination
– Danilo Lo Fo Wong
– Nienke van de Sande-Bruinsma
– Saskia Nahrgang
• Food Safety
– Hilde Kruse
• Health Systems and Public Health
– Hans Kluge
• Health Technologies and
Pharmaceuticals
– Hanne Bak Pedersen
– Nina Sautenkova
– Ganna Bolokhovets
• Influenza & other Respiratory Pathogens
– Caroline Brown
• Vaccine Preventable Diseases &
Immunization
– Robb Butler
• Alert and Response Operations
– Ana Paula Coutinho
– Jukka Pukkila
Strengthening the fight against antimicrobial resistance in Bosnia and Herzegovina: current situation and future challenges, 29 October 2013
Symposium zum 7. Europäischen Antibiotikatag 18 November 2014, Vienna, Austria
No action today…
No cure tomorrow
Thank you for your attention