Combating Antimicrobial

Resistance
Dr Klara Tisocki
Coordinator for Essential Medicines and Health Technologies,
WHO Regional Office for the Western Pacific

18 April, 2016, Manila

ADB seminar
Disclaimer: The views expressed in this paper/presentation are the views of the author and do not
necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of
Governors, or the governments they represent. ADB does not guarantee the accuracy of the data
included in this paper and accepts no responsibility for any consequence of their use. Terminology
used may not necessarily be consistent with ADB official terms.

Overview
The Global Threat of Antimicrobial
Resistance

Global Action Plan on Antimicrobial

Resistance
Ongoing Work in the Region to Contain
Antimicrobial Resistance
Feed-back from Tokyo AMR meeting
Summary

(Photo by CDC)

The miracle of antibiotics

Crude mortality rates for all causes, noninfectious causes and

infectious diseases over the period 1900-1996.
2. Armstrong GL et al, JAMA 1999;281(1):61-66

Antibiotics the pillar of basic

health care and modern medicine
Cancer
Treatment
Hip
Replaceme
nt

Gonorrhoe
a

Wound
infections

Modern
medicine
Organ
Transplants

Preterm
babies

Urinary
tract
infections

Complicate
d deliveries

Pneumonia

Antibiotics

Maternal and
child health

Blood
infections

Basic
health care

Antibiotics: precious but diminishing resource

A Global Health Security Threat

Antimicrobial resistance has an impact on the health of global
populations, food safety, the environment and the economy.
The prevention and control of antimicrobial resistance is complex
which requires multi-sectorial collaboration between:
human health care,
animal health,
agriculture, food safety, food production, and
environmental protection sectors.

AMR on the international agenda

Global Health Security Agenda: GHSA Antimicrobial Resistance Action Package
(GHSA Action Package)
APEC Enhancing Health Security International campaign program to control
antimicrobial resistance in the Asia-Pacific

ASEAN AMR is a priority in ASEAN post 2015 development Agenda

G7 Leaders statement on AMR June 2015

Berlin declaration of G7 Health Ministers October 2015 and

Asia Pacific Health Ministers meeting on AMR 16 April 2016
recommendation to go to G7 summit in Japan May 2016

September 2016: G20 Leaders Meeting , UN General Assembly

Estimates of Burden of Antibacterial

Resistance
European Union

Thailand

United States

population 500m

population 70m

population 300m

25,000 deaths per year

>38,000 deaths

>23,000 deaths

2.5m extra hospital days

>3.2m hospital days

>2.0m illnesses

Overall societal costs

( 900 million, hosp. days)
Approx. 1.5 billion per year

Overall societal costs

US$ 84.6202.8 mill. direct
>US$1.3 billion indirect

Overall societal costs

Up to $20 billion direct
Up to $35 billion indirect

Source: ECDC 2007

Source: Pumart et al 2012

Source: US CDC 2013

Global information is insufficient to show complete disease burden impacts and costs

The world stands on the edge of a postantibiotic era..

A post-antibiotic era means, in effect, an end to
modern medicine as we know it. Things as common
as strep throat or a childs scratched knee could
once again kill.

Dr Margaret Chan
(WHO)

Antimicrobial resistance- where do we fail?

Ecology
Avoidable infections due to inadequate public health

Evolution
Premature resistance due to inappropriate use

Economy
No new medicine due to inadequate market incentives

Final threat to Modern Medicine

No effective treatment for serious pathogens

Common Factors driving AMR across

different diseases including Tuberculosis
Health system factors
o poor surveillance, poor diagnostic capacity
o poor quality antimicrobial products, unregulated
prescribing/dispensing weak infection control, lack of rapid
diagnostic tools

Behavioural factors
o patients poor adherence, self-medication, cultural
preferences/beliefs
o unclear diagnosis, financial incentives, industry promotion
Medicines factors
o long drug half-life, cross-resistance between classes, treatment
length and complexity, monotherapy, lack of effective new
combinations
11

WHO Global Action Plan

endorsed at World Health Assembly on 27 May, 2015
Principles:
Whole-of-society engagement, including a one-health approach
Prevention first
o good sanitation, hygiene and infection prevention and control

Ensure Access
o preserve the ability to prevent and treat infections
Sustainability
o all countries to have a National Plan by 2017
Incremental targets for implementation
o different states for different countries

Global Action Plan Objectives

Strengthen the
knowledge and
evidence base of
AMR through
surveillance and
research

Optimize the
use of
antimicrobial
medicines in
human and
animal health

Reduce infections
through effective
sanitation,
hygiene and
infection
prevention

Develop, implement and monitor the

implementation of global and national AMR
action plans
Improve awareness and
understanding of AMR
through effective
communication, education
and training

Develop the economic case

and increase sustainable
investment in new medicines,
diagnostic tools vaccines and
other interventions

The need for political commitments

international cooperation
High level sustained political
attention to AMR globally,
regionally

International problem with

unknown magnitude
Multisectoral problem cross-sectoral interventions
Conservation of effectiveness of
antibiotics = global public good

Health security/ economic &

development threats

National cross-sectoral
commitments to implement
national plans on AMR
Sustained financing of
investments for new
products (diagnostics,
medicines)
Globally, regionally
coordinated efforts to
change attitudes,
behaviours, health system
practices to tackle AMR

AMR in SDGs? - It is not there!

SDG GOAL 12: Sustainable production & consumption

SDG GOAL 3: Health & UHC

SDG GOAL 2: Hunger and food security

Antimicrobial Resistance

Awareness
and
Advocacy

Building resilient health system to contain

AMR - UHC

UHC

One Health a multisectoral approach to AMR

UHC

One Health

Containment of AMR as a Development Agenda

UHC

One Health
SDGs

National, Regional and Global actions to

contain AMR

UHC

One Health
SDGs
GOVERNANCE OF AMR as a development agenda

UHC

One Health
SDGs
GOVERNANCE OF AMR as a development agenda
Nationa
l

National Action
Plan on AMR

Region
al
Harmonization of
surveillance and
regulations

Global
Enhance R&D
(new antibiotics and
diagnostics)

Governance of AMR Philippines

AO 42 series of 2014 Creation of an Inter-Agency Committee for the Formulation

and Implementation of a Nat Action Plan to Combat AMR in the Philippines
Co Chairs: Dept of Health and Dept of Agriculture

Members: Dept of Trade and Industry, Dept of Interior and Local Govt, Dept of
Science and Technology

Key Stakeholders

Other Government Sectors: Dept of Education, Commission on Higher Education

Academe: association of deans, national student groups

Professional Societies: Professional Regulatory Boards and med societies

Civil Societies and Patient Organizations: Med Transparency Alliance, Phil Assoc
of Patient Organizations

Pharmaceutical Industry organizations

Governance of AMR Japan

Prime Ministers Office
- Ministerial Meeting on Measures on Emerging Infectious
Diseases
Cabinet Secretariat (CAS)
- Coordination Office of Measures on Emerging Infectious
Diseases
- Office of Healthcare Policy

FSC/CAO

MHLW

MAFF

MEXT

MOFA

MOE

Food Safety
Commission,
Cabinet Office

Ministry of Health,
Labour and
Welfare

Ministry of
Agriculture,
Forestry and
Fisheries

Ministry of Education,
Culture, Sports,
Science and
Technology

Ministry of
Foreign Affairs

Ministry of the
Environment

NIID

NCGM

PMDA

AMED

NVAL

National
Institute of
Infectious
Diseases

National
Center for
Global
Health and
Medicine

Pharmaceutic
al and Medical
Devices
Agency

Japan
Agency for
Medical
Research
and

National
Veterinary
Assay
Laboratory

NARO

FAMIC

National
Food and
Agriculture Agricultural
and Food
Materials
25
Research
Inspection
Organization
Center

FRA

JICA

Fisheries
Research
Agency

Japan
International
Cooperation
Agency

Progress on National comprehensive action

plan on AMR in the Region
1. Launch of National Plans on AMR :
Japan April 2016
Philippines - (2015)
Australia (2015)
Cambodia (2015)
Fiji (2015)
Viet Nam (2013)
2. In progress:

Republic of Korea

Samoa

Cook Island

Lao and others

Progress on AMR
2. Support antimicrobial stewardship training
Philippines
Lao Peoples Democratic Republic
Mongolia

3. Actions towards the Development of a

Global AMR Surveillance System GLASS
Target: assess impact and trends of AMR

Surveillance standards defined

Surveillance manual developed

Information platform soon to be launched

Country enrolment to start in 2016

WHOs ongoing work in the Region

4. WHO promoted World Antibiotic Awareness Week 16-22
November 2015:
2015 Theme - Antibiotics: Handle with Care
21+ Countries in the Region participated

Ministerial Communique
Control of Antimicrobial Resistance requires coordinated
strategies involving multiple sectors:
o
o
o
o

Human health
Animal health
Agriculture, food safety, food production
Environmental protection sectors

Call for collective action at the national, regional and global

level

Asia Pacific

Technical Consultation on AMR in Asia 14-15

April, Tokyo, Japan

Tokyo AMR Communique, Health Ministers 12 countries

Acknowledge the urgent need for:
Increased advocacy, education and awareness-raising activities involving all
stakeholders in relevant sectors about AMR and the responsible use of antimicrobials;
Accelerated progress towards universal health coverage (UHC) to ensure access
to quality essential health-care services and to promote access to safe, quality,
effective and affordable antimicrobial medicines, diagnostics and vaccines for all,
including antimicrobials under proper measures to preserve their effectiveness;
Cross-cutting, multisectoral One Health approaches in all countries, involving
different stakeholders, such as human and veterinary medicine, agriculture,
aquaculture, the environment and others, as appropriate to enable collaborative action
to minimize AMR and attain optimal health for humans and animals;
Global, regional and national cooperation and collaboration to preserve the
effectiveness of antimicrobials as a global public good;
Implementing and monitoring regulations, including production, distribution and use
of vaccines, diagnostics and antimicrobials for both human and animal use;
Accelerated research and development (R&D) in AMR, including the development
of new antimicrobials, diagnostics and vaccines;

Tokyo AMR Communique, Health Ministers 12 countries

Do hereby declare launching an Asia-Pacific One Health

Initiative on AMR to jointly identify and tackle challenges posed by
AMR in the Asia-Pacific region by drawing a roadmap to actualize the
regional frameworks on AMR in the following priority areas of work:
Surveillance system and laboratory network;
Health-care management;
Antimicrobial access and regulation;
Research and development;

Summary
The antimicrobial resistance threat is already affecting
all countries.
Every day people die from infections that do not
respond anymore to antibiotics.

Collaborative action is needed by public health

officials, politicians, scientists, healthcare professional,
agriculture sector, and health care industry

We all have the responsibility to

take action.

Thank you

Dr Klara Tisocki
Coordinator Essential Medicines and Health Technologies
WHO Western Pacific Regional Office
tisockik@wpro.who.int
www.wpro.who.int/topics/drug_resistance/en/

36