[Ip-health] Antibiotic Resistance Coalition Newsletter Special Edition: UN Briefing on AMR

Reshma Ramachandran reshmagar at gmail.com
Wed Jun 22 06:10:11 PDT 2016


Dear colleagues,

Please find below a summary of a recent UN briefing held in New York by
ReAct-Action on Antibiotic Resistance, Dag Hammarskjöld Foundation, and *Every
Woman Every Child *on "Meeting the Multisectoral Challenge of Antimicrobial
Resistance". This briefing for country missions, intergovernmental
agencies, and other stakeholders was held in anticipation of the upcoming
High-Level Meeting on AMR during the UN General Assembly in September 2016.

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Also, for those interested in continuing to follow issues around
antimicrobial resistance, please feel free to sign up for the monthly
Antibiotic Resistance Coalition newsletter here <http://eepurl.com/6HOSn>.

All the best,
Reshma

---------- Forwarded message ----------
From: Reshma Ramachandran <rramach9 at jhu.edu>
Date: Wed, Jun 22, 2016 at 6:38 AM
Subject: ARC Newsletter Special Edition: UN Briefing on AMR
To: reshmagar at gmail.com


June 22, 2016
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*Every Woman Every Child*, ReAct-Action on Antibiotic Resistance, and the
Dag Hammarskjöld Foundation host a UN Briefing on "Meeting the
Multisectoral Challenge of Antimicrobial Resistance" in New York, NY on
June 6, 2016
[image: Meeting the Multisectoral Challenge of Antimicrobial Resistance]
<http://reactgroup.us8.list-manage.com/track/click?u=b1ffb75d8e01efb328f45485f&id=d7755be821&e=58eab65068>
Watch video coverage of the UN Briefing on "Meeting the Multisectoral
Challenge of Antimicrobial Resistance".

On June 6, ReAct-Action on Antibiotic Resistance in collaboration with the
Every Woman Every Child initiative within the office of the United Nations
(UN) Secretary-General and the Dag Hammarskjold Foundation hosted a
briefing on “Meeting the Multisectoral Challenge of Antimicrobial
Resistance”. The briefing aimed to raise the issue of antimicrobial
resistance or AMR to the top of the political and global agenda in
anticipation of a high-level meeting on this issue during the UN General
Assembly in September. Here, speakers and participants spoke of the impact
of AMR across sectors including human health, agriculture, and the
environment. This event, co-sponsored by the country missions of Sweden,
Netherlands, South Africa, Vietnam, Mexico, Argentina, and South Korea,
brought together a broad range of stakeholders from high-level government
representatives and intergovernmental organizations to private sector and
civil society representatives in human and animal health.

The urgency for global coordination to address this growing threat across
sectors has never been greater. Evidence continues to mount of resistance
to colistin, a last-line antibiotic in human medicine across countries in
Africa, Asia, Europe, and the Americas, linked to its use in food animal
production. At the same time, providers, patients, and producers continue
to face a dearth of new antimicrobials in the R&D pipeline further limiting
options for treatment of both humans and animals as resistance spreads.
Access to effective antimicrobials also continues to a barrier for
patients, particularly in low- and middle-income countries. As Nano Kuo,
Manager of Every Woman Every Child, stated in her opening remarks, “Simply
put, antimicrobial resistance is one of the most significant global
challenges we face today...We will need to galvanize action from across
sectors and multi-stakeholders, from the public and private sectors,
scientists, doctors, patients and consumers themselves and across the
multilateral system. It is clear AMR is not an issue that can be dealt with
in isolation.”

Through a video message, Ambassador Juan Jose Gomez Camacho, Permanent
Representative of Mexico to the United Nations and chair of the upcoming
High-Level Meeting on AMR, reaffirmed Ms. Kuo’s remarks in that AMR would
jeopardize “the call to action of the UN Secretary General - to end
preventable deaths of women, child, and adolescents in a generation.” He
expressed confidence that briefing discussions would point towards
potential recommendations to reverse AMR across sectors that would lend
valuable input towards preparations for the high-level meeting in
September. Lord Jim O’Neill, Commercial Secretary to the Treasury and
Chairman of the United Kingdom Review on AMR (UK Review on AMR), then took
the floor to give an overview of the 10 recommendations detailed in the
their final report, released in May 2016. These recommendations, spanning
across human and animal health, call on Member States as well as other
stakeholders including intergovernmental agencies, industry, and civil
society to play a part. This rich set of proposals includes:

   - a Global Innovation Fund for Early Stage and Non-Commercial R&D;
   - late stage market entry rewards of $1 billion USD per drug;
   - a “pay or play” proposal for the pharmaceutical industry;
   - top-up payments for diagnostics for low- and middle-income countries;
   - targets to lower antimicrobial use in agriculture over 10 years;
   - restrictions on critically-important antimicrobials in food animal
   production;
   - improved transparency of antimicrobial use in the food industry;
   - a global surveillance network for monitoring antimicrobial resistance
   in food animals;
   - increased use of vaccines and other alternatives in food animals; and
   - a strengthened veterinary workforce -- so critical to effectively
   manage the use of these drugs in food animal production.

[image: ReAct Europe]Dr. Anthony So, director of the Johns Hopkins Center
for a Livable Future and the Strategic Policy Program of ReAct-Action on
Antibiotic Resistance, then opened the panel session of the briefing, which
included leading figures across both human and animal health from
governments, academia, and civil society. Starting with a discussion on the
impact of AMR on human health, he introduced two leading figures in the
access to medicines movement -- Director-General Precious Matsoso for the
National Department of Health for South Africa and Mr. Rohit Malpani,
Director of Policy and Analysis for the Médecins Sans Frontières’ (MSF)
Access Campaign. Director-General Matsoso, who also serves on the UN
Secretary-General’s High-Level Panel on Access to Medicines, highlighted
the challenges of ensuring access, not excess, to effective antimicrobials,
in terms of availability and affordability. Both she and Mr. Malpani, also
called for coordination between the different global policy processes and
proposals on innovation including the UN High-Level Panel on Access to
Medicines and the World Health Organization (WHO) Consultative Expert
Working Group on Financing R&D.

Mr. Malpani outlined some limitations to UK Review on AMR’s recommendations
in ensuring affordable access. These include not always fully supporting
delinkage and limiting the principle to stewardship, particular diseases,
or only low- and middle-income countries; calling for advance market
commitments for diagnostics and vaccines that may not safeguard sustainable
access; and recommending billion dollar incentives geared towards towards
pharmaceutical companies without assurances of affordability. He also
highlighted the importance of ensuring access to vaccines, such as the
pneumococcal vaccine where universal coverage is estimated to result in a
47 percent reduction in antibiotic use for those with the pneumococcal
infection. Both Mr. Malpani and Director-General Matsoso also urged country
governments and the WHO to take a leadership role to set priorities for R&D
framework to address AMR “that puts patients’ needs first”.
Transitioning to second half of the panel with speakers offering a
perspective from civil society and case studies from an industrialized and
developing countries in curbing AMR in food animal production, Dr. So began
by acknowledging that these drugs have a dual market in both humans and
animals. He noted that uses of critically important antimicrobials for
non-therapeutic indications including for growth promotion, for
prophylaxis, or for offsetting poor hygienic conditions “risk squandering
these precious resources”. The next panel speaker, Mr. Steven Roach, Food
Safety Program Director for Food Animals Concerns Trust and Senior Advisor
to the Keep Antibiotics Working Coalition pointed out that the emergence of
colistin resistance falls into a well-known pattern of growing resistance
to other medically-important antimicrobials due to their use in food animal
production. He agreed with the UK Review on AMR’s recommendation for
setting targets for antimicrobial use, but added that it must be done so
cautiously so that “reductions do not cause disparate impacts and harm
small producers or create unfair advantages for some countries.” Mr. Roach
also called for international consensus in banning the use of such
critically-important drugs like colistin.

The next two panelists than offered lessons from their countries in
monitoring and reducing antimicrobial use in livestock and aquaculture.
First, Dr. Jaap Wagenaar, Professor of Clinical Infectiology of Utrecht
University
<http://reactgroup.us8.list-manage.com/track/click?u=b1ffb75d8e01efb328f45485f&id=2e7524d235&e=58eab65068>,
spoke of the Dutch experience in lowering antimicrobial use in agriculture
by 70 percent in the Netherlands, the second largest exporter of
agricultural products in the world. Key elements of their successful policy
included setting specific reduction targets, mandating transparency of use
through registration of farms in centralized databases to enable
surveillance, and benchmarking and defining antimicrobial use targets
across sectors by the independent Veterinary Medicines Authority. In 2011,
the government placed a ban on prophylactic use of antimicrobials and
required that these drugs be exclusively administered by veterinarians,
unless the farm was able to comply with strict conditions.

Offering a perspective from a developing country, Dr. Yong-Sang Kim,
Director of Animal Health Management Division for the Ministry of
Agriculture, Food and Rural Affairs, outlined the South Korean
government's’ efforts to curb antimicrobial use. Following national uproar
due to a published survey by a local consumer advocacy organization of high
levels of resistance to antimicrobials in livestock and fish products
linked to the inappropriate use of these drugs, the government issued a
series of regulations over 10-year period to address AMR. These included
banning antimicrobials in a stepwise manner in feed, mandating veterinary
oversight to administer these drugs, and strengthening national
surveillance. To address staunch opposition from the farming sector due to
concerns around increased production costs and increased incidence of
disease, the government provided financial support to encourage good animal
husbandry practices to offset the use of these drugs. Also contributing to
the success of these efforts, the government also garnered strong support
from local consumer advocacy organizations highlighting the need for broad
stakeholder engagement to address this complex issue.
[image: Meningitis vaccine launch in Burkina Faso, 2010 - Amy
MacIver/PATH]Following
this truly multisectoral set of speakers, Dr. Anthony So invited
discussants Dame Sally Davies, Chief Medical Officer for the United Kingdom
and Dr. Keiji Fukuda, WHO Assistant Director-General and Special
Representative on AMR, to offer their reflections. Dame Davies stressed
that the upcoming High-Level Meeting on AMR would only be as powerful as
Member States and other stakeholders in the room wish it to be, adding
“[let’s] not let AMR be the reason that the Sustainable Development Goals
don’t deliver.” Dr. Fukuda called for broad stakeholder engagement in the
UN process and the opportunity for leadership among Member States on this
issue.

Participants at the briefing were then invited to deliver interventions
from the floor. Remarks were given by a broad range of stakeholders
including from country mission representatives, intergovernmental agencies,
civil society, and the private sector. Ms. Carla Mucavi, Director of the
Liaison Office to the UN Food and Agriculture Organization spoke of the
burden of AMR mostly affecting those rural poor who live in close contact
in animals and poor sanitary conditions. She noted that smallholder farmers
are typically women, who are exposed to resistant pathogens for which there
is no medicines available. She iterated FAO’s commitment to the One Health
approach with WHO and OIE to combat AMR in agriculture and aquaculture.
Mr. Lucas Wiarda, Global Marketing Director and Head of the Sustainable
Antibiotics Program of DSM Sinochem also voiced his company’s commitment to
adopt more sustainable manufacturing practices to prevent antimicrobial
pollution that contributes further to resistance. He called for leadership
from policymakers to set regulations on these practices as well as industry
to adopt better manufacturing practices. Ms. Jean Halloran, Director of
Food Safety at Consumer Reports, expressed her frustration around the lack
of action despite recognition of the issue across sectors. Besides calling
for hospitals to make public their infection rates, she noted that the
experience of the Netherlands is particularly instructive in that
antimicrobial use in food animals is needed at the level of facilities,
farms, and plants. She concluded by saying that she felt encouraged by the
briefing discussions and the global mobilization that would occur in
September at the UN High-Level Meeting on AMR. Dr. Otto Cars, founder of
ReAct-Action on Antibiotic Resistance also raised concerns that the
incentives being discussed were too focused downstream instead of where the
true scientific bottleneck lies upstream in antimicrobial drug development.

Panelists were also invited to give final reflections. Of note, Mr. Roach
of Food Animals Concerns Trust pointed to the ongoing efforts of consumer
advocacy organizations in moving the food industry to source meat products
raised without the routine use of antimicrobials, thereby shifting the
market demand. While such efforts have been successful in the United
States, these practices have not been adopted globally for these same
retailers with large franchises abroad. Funds for global awareness
campaigns as has been proposed by the UK Review on AMR might be more
strategic if allocated to these consumer advocacy organizations already
engaged in such efforts.
[image: ReAct Europe]In closing this panel, Dr. So pointed again to the
need for global coordination across sectors to effectively address AMR. He
noted that:





*Tackling antibiotic resistance will take: More than just drugs—we’ll need
diagnostics and vaccines as well; More than focusing incentives on one
company, one drug at a time—we need financing that will transform how we
innovate, delink return on investment from volume-based revenues, offer a
portfolio of promising products, and rethink how we deliver these health
technologies to those in need; More than just the efforts of the Health
Ministry—we’ll need a whole-of-government commitment; More than just the
efforts of health care providers and patients—we’ll need our agricultural
sector to do its part in curbing non-therapeutic use of antimicrobials. A
One Health approach.  And more than just those of us who have worked
tirelessly on this issue for years—we’ll need all of you.*

He then invited Nana Kuo to facilitate the closing remarks from H.E.
Gabriel Wikstrom, Minister for Public Health, Healthcare, and Sports of
Sweden and Ambassador Mateo Estrémé, Deputy Permanent Representative of
Argentina to the United Nations. They both reaffirmed the need for
collective action from all stakeholders through the UN, but also
tailor-made approaches so that addressing AMR across countries can be
realized.
Resource Materials on AMR (distributed at UN briefing)

   1. *Curbing Antimicrobial Resistance in Food Animal Production*
   <http://reactgroup.us8.list-manage1.com/track/click?u=b1ffb75d8e01efb328f45485f&id=8ae5da24c2&e=58eab65068>
   - ReAct-Action on Antibiotic Resistance and Johns Hopkins Center for a
   Livable Future
   2. *Antimicrobial Resistance: A Threat to the World's Development Agenda*
   <http://reactgroup.us8.list-manage.com/track/click?u=b1ffb75d8e01efb328f45485f&id=60652b8f2a&e=58eab65068>
(Dag
   Hammarskjöld Foundation’s Development Dialogue Series) - ReAct-Action on
   Antibiotic Resistance
   3. *A Framework for Costing the Lowering of Antimicrobial Use in Food
   Animal Production*
   <http://reactgroup.us8.list-manage.com/track/click?u=b1ffb75d8e01efb328f45485f&id=d11c12aabb&e=58eab65068>
(Commissioned
   Paper for the UK Review on AMR) - ReAct-Action on Antibiotic Resistance and
   Johns Hopkins Center for a Livable Future

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Note: The ARC Newsletter will periodically capture key meetings and
developments, as well as news and resources, on antibiotic resistance for
Coalition members and partners. This newsletter is prepared and published
through ReAct North America/Strategic Policy Program at Johns Hopkins
Bloomberg School of Public Health. The ARC Declaration on Antibiotic
Resistance can be found here
<http://reactgroup.us8.list-manage.com/track/click?u=b1ffb75d8e01efb328f45485f&id=1aebb5e1ac&e=58eab65068>.
Please share items for consideration for inclusion in future newsletters by
writing to Reshma Ramachandran at rramach9 at jhu.edu.






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-- 
*Reshma Ramachandran, MD MPP*
Assistant Scientist (Research Faculty), Environmental Health Sciences
Johns Hopkins Bloomberg School of Public Health
ReAct-Action on Antibiotic Resistance Strategic Policy Program
National Physicians Alliance FDA Task Force Co-Chair
e: reshmagar at gmail.com
m: +1-786-271-1531
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