WHO Global Action Plan on AMR; Relevance for NORHED Prof. Gunnar Skov Simonsen MD, PhD Department of Microbiology and Infection Control University Hospital of North Norway Faculty of Health Sciences UiT – The Arctic University of Norway
The goal of the global action plan is to ensure, for as long as possible, continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way, and accessible to all who need them It is expected that countries will develop their own national action plans on antimicrobial resistance in line with the global plan
The action plan should reflect 5 principles ü Whole-of-society engagement including a One Health approach § All sectors and disciplines should be engaged in implementation ü Prevention first § Optimal approach to limit suffering, AMR and costs ü Access § Essential balance between access and restrictions ü Sustainability § Need for political commitment, collaboration and local adaptations ü Incremental targets for implementation § Flexibility in interventions, monitoring and reporting
Strategic objectives ü Improve awareness and understanding of antimicrobial resistance through effective communication, education and training ü Strengthen the knowledge and evidence base through surveillance and research ü Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures ü Optimize the use of antimicrobial medicines in human and animal health ü Develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions
1. Communication, education and training WHO Action Plan ü Steps need to be taken immediately in order to raise awareness of antimicrobial resistance and promote behavioural change, through public communication programmes that target different audiences in human health, animal health and agricultural practice ü Making antimicrobial resistance a core component of professional education, training, certification, continuing education and development in the health and veterinary sectors NORHED ü Increased awareness at governmental and institutional levels through situational analysis and development of masters and PhD programmes
2. Surveillance and research WHO Action Plan ü Particularly important gaps in knowledge that need to be filled include: § Information on incidence and prevalence of AMR across pathogens to guide treatment, inform actions and monitor interventions § Understanding of how resistance develops and spreads § The ability rapidly to characterize newly emerged resistance in microorganisms and elucidate the underlying mechanisms § Understanding social science and behavior ……… including studies to support effective antimicrobial stewardship programmes in human and animal health and agriculture § Research, including clinical studies …… .. on treatments and prevention for common bacterial infections, especially in low resource settings
2. Surveillance and research (cont.) WHO Action Plan Basic research and translational studies to support the development of § new treatments, diagnostic tools, vaccines and other interventions § Research to identify alternatives to nontherapeutic uses of antimicrobial agents in agriculture and aquaculture § Economic research, including the development of models to assess the cost of antimicrobial resistance and the costs and benefits of this action plan
2. Surveillance and research (cont.) NORHED ü Human capacity building needed to develop research and evidence base ü Establishment of reference laboratory necessary for characterization of resistant bacteria and surveillance of AMR ü Masters and PhD projects designed to provide basic knowledge on § Epidemiology of AMR in hospitals and community § Prevalence of AMR in food supply § Studies of antibiotic use, supply and expenditure § Knowledge and attitudes to antibiotics and antimicrobial resistance among students, healthcare workers and patients
3. Sanitation, hygiene and infection prevention WHO Action Plan ü Better hygiene and infection prevention measures are essential to limit the development and spread of antimicrobial-resistant infections and multidrug-resistant bacteria ü Sustainable husbandry practices, including the use of vaccines, can reduce infection rates and dependence on antibiotics as well as the risk that antibiotic-resistant organisms will develop and spread through the food chain NORHED ü Human competence building including specific on-line masters course on infection control
4. Optimize use of antimicrobials WHO Action Plan ü Data on antibiotic use are collected and analysed in many high- and middle-income countries and OIE is developing a database on antibiotic use in animals. However, data are lacking on antibiotic use in human beings at the point of care and from lower-income countries ü More widespread recognition of antimicrobial medicines as a public good is needed ü Effective, rapid, low-cost diagnostic tools are needed for guiding optimal use of antibiotics ü Regulation of the use of antimicrobial agents is inadequate or poorly enforced in many areas, such as over-the-counter and Internet sales
4. Optimize use of antimicrobials (cont.) NORHED ü Masters and PhD projects specifically address obstacles for rational antibiotic prescription and interventions to promote stewardship ü The system level is addressed through situational analyses involving stakeholders from the ministerial level as well as drug regulators, educational institutions, the healthcare sector, veterinary services and environmental agencies
5. Develop economic case for investment WHO Action Plan ü The economic case must reflect the need for capacity development, including training in low-resource settings, and the need for the evidence-based use of interventions across human and animal health care systems including medicines, diagnostic tools and vaccines NORHED ü Need for human resources, awareness, political commitment and basic information about epidemiology and burden of AMR
Conclusions ü There is close alignment between NORHED and the WHO Action Plan ü NORHED supports Malawi and Mozambique with key assets in their effort against AMR by ü Raising awareness within government and relevant sectors ü Human capacity building through sustainable education programmes ü Providing basic information needed to formulate policies ü Establishing core infrastructure for surveillance and research ü Facilitating situational analyses where key stakeholders initiate the process of developing national action plans on AMR
«The single most important obstacle for Malawi in the work against drug resistance is the lack of evidence base. Before discussing resources we must focus on human capacity building and evidence». Godfrey B. Kadewele Registrar and Chief Executive Officer Malawi Pharmacy, Medicines and Poisons Board
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