[Ip-health] Fwd: TWN Info: UN Political Declaration on Antimicrobial Resistance Signals High Level Recognition

K.M. Gopakumar kumargopakm at gmail.com
Wed Sep 28 04:56:41 PDT 2016

*Title :* TWN Info: UN Political Declaration on Antimicrobial Resistance
Signals High Level Recognition
*Date :* 2016-09-27


TWN Info Service on Health, Sustainable Agriculture and UN Sust Dev.
27 September 2016
Third World Network
www.twn.my <http://www.twn.my%20>

*UN political declaration on antimicrobial resistance signals high level

New York, 26 September (Mirza Alas*) *– *On 21 September 2016 the United
Nations General Assembly (UNGA) adopted the political declaration on
antimicrobial resistance.

This is the 4th time in the history of the United Nations that a health
topic has come to the attention of the UNGA.

The political declaration, which had been negotiated for several months,
was approved by acclamation during the high level segment. Its adoption
provides recognition of the critical nature of antimicrobial resistance
(AMR) at the highest political level.

The declaration recognizes the World Health Organization (WHO) Global
Action Plan on AMR as the blue print of action.  It also acknowledges that
the lack of access to health services and antimicrobial medicines continues
to affect more people than resistance, and this constitutes a major
challenge for developing countries.

The document clearly states that research and development efforts should be
guided by need and by the principles of affordability, effectiveness,
efficiency and equity as well as be de-linked from the price and volume of

There are two calls for action in the text. The first one calls upon the
WHO “together with Food and Agriculture Organization (FAO) of the United
Nations and the World Organization for Animal Health (OIE), to finalize a
global development and stewardship framework. ” Preliminary discussions on
this framework have taken place in Geneva at the WHO Headquarters in early
2016 but this call for action gives an explicit mandate to continue the
negotiations that will define and structure how this framework would look

The second call for action requests the Secretary-General to establish an
ad hoc interagency coordination group co-chaired by the Executive Office of
the Secretary-General and the WHO. During the negotiations for the
political declaration civil society groups that were following the process
in New York told Third World Network that it was necessary that the UN,
with all its agencies, participated in creating actions within their
mandates to complement and support the WHO leadership in this issue due to
the fact that AMR is interconnected with many other aspects beyond human

During the opening segment of the high level meeting last week, that led to
the adoption of the declaration, there were interventions by the President
of the General Assembly, the Secretary-General of the UN, and the
Directors-General of WHO, FAO and OIE respectively.

The President of the General Assembly Ambassador Peter Thomson (Fiji)
emphasized the large impact that AMR will have and how it will affect the
implementation of the Sustainable Development Goals, highlighting the
importance of affordable and accessible medicines and vaccines.

UN Secretary-General Mr. Ban Ki-moon stressed the fundamental threat that
AMR posses to human health, food production and development and how this
could mean losing our ability to protect people and animals from
infections, and putting the achievement of the Sustainable Development
Goals in jeopardy. He further remarked that tackling AMR will require
long-term commitments from everyone and coordination, cooperation and
sustained financing. He further stressed that “commitments today must be
turn into action.”

Dr. Margaret Chan, Director-General of WHO, reminded the audience that this
is a global crisis that she referred to as a “slow motion tsunami”
especially for the achievement of the Sustainable Development Goals.  Dr.
Chan explained that recently WHO had to update its treatment guidelines for
syphilis, gonorrhea and chlamydia because of AMR.

She further emphasized that the emergence of resistance is out passing the
world’s capacity to produce new antibiotics.  Super bugs resistant to all
available medicines haunt hospitals and intensive care units around the
world. She also stressed that now is the time to see action and that the
pharmaceutical industry is reluctant to invest in antibiotics and therefore
incentives must be found.

Furthermore, Dr. Chan noted the important role that consumers play and how
doctors need to stop prescribing unnecessarily and how they need better
diagnostics and vaccines to prevent infections in the first place. She
remarked on the importance of not using critical antibiotics for humans in
animal husbandry.

Mr. José Graziano da Silva, Director-General of FAO, welcomed the political
declaration and pointed out that it provided further guidance, particularly
on the prudent use of antibiotics. He also noted that abuse, overuse and
misuse have exacerbated the problem of resistance and that it is time to
take responsibility to use antimicrobials in a sustainable way.  He called
for a phase-out of the use of antibiotics for growth promotion in livestock.

Dr. Monique Eloit, the Director-General of the World Organization for
Animal Health (OIE), reminded the audience that this is the health threat
of the century but that the situation is not inevitable, and that prudent
use and good practices and alternatives do exist. She noted that research
into new molecules has to be boosted and that there is a need for
sustainable change in current practices as well as adequate legislation for
control and distribution of antibiotics. Tools are needed for the One
Health approach as well as strong and long-term commitment. Investment in
health and veterinary systems is key, stressed Dr. Eloit.  (One Health
calls for actions that link the health of humans, animals and the

The High-Level Meeting then proceeded in two parallel sessions. One
comprised of two panels with the participation of governments, civil
society and industry while at the same time a parallel session took place
where countries made their statements in support of the declaration.

The panel session was divided in two parts and had a moderator who directed
questions to the participants so they each had a few minutes to respond.
The first panel was on the *relevance of addressing AMR for the achievement
of the Sustainable Development Goals*, in particular the health-related

The first panelist was Ms. Veronika Skvortsova, Minister of Health Care of
the Russian Federation. She emphasized the complex actions needed around
AMR and the need for an inter-sectoral approach. She underlined that Russia
has a national action plan that is based on inter-sectoral approach and
which contains several targets including the reduction of the use of
antibiotic in the food production chain and a federal law for state control
on prescription of antibiotics.

The second panelist was Mr. Martin Khor, Executive Director of the South
Centre. The moderator asked him what were his major concerns regarding AMR.
Noting than resistance has spread to many diseases, Mr. Khor explained that
vested interests have prevented the action that must be taken.  He pointed
out that this crisis will be more severe in developing countries where most
cases will take place, and these countries do not have the money, the
capacity, the diagnostics and the laboratories to face this crisis. Mr.
Khor emphasized the need to make sure that developing countries have access
to the antimicrobials that already exist and to the new ones.

The next panelist was Dr. Cleopa Mailu, Cabinet Secretary for Health of
Kenya. Dr Mailu remarked that food security is a major concern and that AMR
affects animal health, agriculture and human health and that this would
have repercussions for food sufficiency. He further elaborated that AMR
means easy eradication of gains in HIV, TB and Malaria. AMR with low
investment in R&D means the possible resurgence of increasing mortality

The following panelist was Mr. Vytenis Andriukaitis, European Union
Commissioner for Health and Food Safety.  Mr. Andriukaitis emphasized the
need to ban antibiotics that are used for growth promotion. He underscored
the importance of the One Health approach and the need to bring different
actors together such as veterinarians, the pharmaceutical industry and
environmentalists.  In the case of the EU, growth promoters are banned. He
also noted the need to see local and global actions and to have
coordination and international cooperation.

The fifth panelist was Dr. Joanne Liu, the International President of
Médecins Sans Frontières (MSF). The moderator asked about the role of MSF,
and Dr. Liu pointed out that MSF is working in over 70 countries and
fragile states and they are in the front line.  She said that as a
physician, “ I am running out of options to treat infections.” She provided
the example of treating someone for war wounds but then later having the
patient die of a bone infection.  She stressed that AMR is a medical
emergency and we need to get our mind into that, further noting that AMR
should not be seen as a security threat but as a public health emergency,
and public responsibility should be accepted for it.

The last panelist in the first round of the panel was Sir Andrew Witty, CEO
of GlaxoSmithKline (GSK). He explained that there has not been a new class
of antibiotics for decades and stressed the technical difficulties in
finding new antibiotics.  He said that GSK is working on a new compound and
that they are moving to phase 3 clinical trials with good prospects. Sir
Andrew also asserted that it was important to work together and highlighted
the recent industry road map on tackling AMR, which includes conservation,
and stopping pollution from production. He also spoke about exploring the
de-linkage model and more sustainable methods of development.

Sir Andrew added that there are huge lessons to learn from the HIV AIDS
crisis and there has been huge progress by getting 17 million people into
treatment. He noted that there has been an advance in a new policy
framework, for instance GSK is not longer asserting patents in low-income

[A participant in the audience told TWN that the Least Developed Countries
have an exception under the World Trade Organization agreement on
intellectual property rights from granting pharmaceutical patents in their
own countries until 2033.]

For the second section of the panel Ms. Skvortsova said that the discussion
that had taken place was not a scientific one and that modern science was
needed for intervening and changing the way microbes are being tackled.

The Kenyan minister stressed that the majority of deaths that will happen
because of AMR will occur in developing countries and there is an urgent
need to put in place national action plans to tackle this problem. He
further underlined the importance to take steps for the implementation of
the content of the declaration and the needs for developing countries to
have surveillance, rapid diagnostic tests and vaccines. Dr. Mailu raised
the need for creating awareness and education.

Mr. Khor of South Centre pointed out that the adoption of the declaration
and the WHO Global Action Plan (2015) on AMR are good steps but he warned
that this has happened before and that governments and international
organizations have to step up and take leadership. He noted for example the
Jaipur Declaration signed in 2011 with 18 action points but that the
implementation has been slow. He stated, “ We don’t want a declaration with
no action … this is as serious as climate change.”

Mr Khor asked about implementation about what are the barriers and how do
we overcome this barriers. In the case of developing countries there are
many competing priorities.  Emphasizing the need to have leadership from
the north to help the south to help themselves, he said that it is
necessary to have implementation with resources, finance, technical
equipment, ability to phase out and transition cost.  A key issue that was
highlighted during his intervention was the question of whether developing
countries will have access to new antibiotics or will face issues such as
in the case of the HIV epidemic and the treatment for hepatitis C where the
prices have been so high that there is no access for many. Mr. Khor agreed
that a delinking model is necessary but that it has to be linked to access
to medicines and affordable prices.

Dr. Liufrom MSF stressed that there is an urgent need for action, and that
the political declaration is not enough because there are many resolutions
that have been passed and things have not changed much. She emphasized that
it is critical that there is civil ownership to push the governments into

The last question of the moderator for the panel was about their role and
the best way they could see for addressing the challenge.

Dr. Mailu, the minister from Kenya, explained that the stage is set. In the
case of Kenya his role is providing the leadership as the Ministry of
Health and to move forward with the national action plans and the
multi-sectoral coordination.

Mr. Khor from the South Centre emphasized three things:

1. To reach out to governments in developing countries to convince them
that this is a serious issue and help them to develop their national action

2. To reach out to international organizations particularly the WHO and FAO
to assist with the scientific data capacity, and

3. To empower civil society so they see this as an important issue, then it
will resonate in society and the community. Civil society can tell
politicians “this is what we want you to do.”

The message from the EU Commissioner for Health and Food Safetyreflected on
the need to show leadership to build broader coalitions on public health
issues, to coordinate on actions and provide guidelines and regulations,
and to promote more viable and economical models for new antimicrobials.
Mr. Andriukaitis also highlightedcooperation and implementation as well as
obligations to act.

Ms. Skvortsova of the Russian Federation reaffirmed her commitment to work
at the global, national and regional level and the duty to coordinate
single inter-sectoral programs and work with all authorities as well as to
provide assistance.

The GSK CEO said that they will continue to sustain innovation and
reflected that what gets measured gets done. He provided the example of the
Neglected Tropical Diseases initiative and how with clear targets it was
possible to see who was going to deliver what.

Dr. Liu talked about the need to improve medical practices. Doctors want to
do the right things but they need the right tools to do it, therefore
access to vaccines, access to medicines that will treat our patients is
critical.  She also stressed the need to mobilize political support to get
things done and ensure that physicians are part of the solutions.

Panel 2 was organized around addressing the *multi-sectorial implications
and implementation challenges of AMR*.

The moderator asked the panellists about the ways to implementation and
what works.

The first intervention was from Ms. Erna Solberg, Prime Minister of Norway,
who spoke of the advantages of being a small country where people talk to
each other and where media can play an important role in changing people´s
attitudes.  She gave the example of a TV Report on the use of antibiotics
in chicken and how that impacted consumers who then demanded change, and
then there was a policy response to eliminate antibiotics in chickens. Ms.
Solberg called for an international ban on use of antibiotics as growth
promoters. Another example that she mentioned was about fisheries in Norway
and how industry developed a vaccine in response to the policy against use
of antibiotics.

The second speaker was Dr. Jim Kim, the president of the World Bank, who
highlighted the profound economic impact that AMR will have. He spoke on
the importance of proper stewardship while also having access. Furthermore,
he underscored how the underinvestment in health systems continues to be a
problem and the need to look at incentives.

Mr. David George Velde, Board Member of the World Farmers’ Organization and
Vice- President of the United Sates National Farmer´s Union spoke about
producing basic food commodities and the processing chain before food
arrives to ultimate consumers. Mr. Velde noted the important role of
agricultural production to address AMR, to the extent there is public
benefit to be gained. Producers also have concerns for their health and
that of their families and there is need to avoid disproportionate burden
on production aspects of food producers.

Dr. Paulyn Jean B. Rosell-Ubial, Secretary of the Department of Health of
the Philippines pointed out that there is a need for international
standards to follow. Local planning and implementation of these standards
is most important.

Ms. Martha Tellado, the President and CEO of Consumer Reports, remarked
that awareness and transparency are critical and there is urgent need to
recognize that the basic common goal is public health. Implementation
requires leadership of scale and we have not seen it. Norway has launched
remarkable best practices but the question is how do these migrate to other
countries. For example in the United States 80 percent of antibiotics are
used to prevent animal diseases and in the farm; half of the world’s
antibiotics are consumed by farm animals. In studies on food chains her
organization conducted with responses from consumers and the market, 9 of
25 global chains pulled back on chicken with antibiotics, but only chicken
and only in the US. She called for better information so consumers can make
better choices.

Dr. Jorge Lemus, Minister of Heath of Argentina, spoke about the experience
in his country where adequate legislation is required.  Two challenges were
raised.  First, hospital infections have seen a significant growth of up to
12 percent where misuse of antibiotics and the lack of hospital control are
key issues. Secondly, Argentina is a large chicken and beef producer and
there is not enough surveillance and control yet. Argentina set up a
national control agency in health and agriculture ministry. One of the
serious problems is how to increase surveillance and action, particularly
when it comes to resources in order to deliver real action. He further said
that that as a big meat producer it is important for Argentina to have
adequate control and international regulations are needed.

On the moderator’s question about how hospitals can be more transparent,
Dr. Jim Kim responded that good surveillance and standard setting are
needed. The World Bank is supporting Africa´s network of laboratories.
There needs to be accountability by regulators and by patients coming to
hospitals. Hospitals will have in their interest to publicize good
performance in this area.

The representative from the World Farmers’ Organization responded to the
questions about innovative ways, referring to an advertisement in the US
showing poultry producers using herbs in water supply to help control
disease. He also underscored that indiscriminate use in the livestock
industry is driven by large agroindustry managing hundred of herds, as
opposed to small family-run herds. He also said that the dynamics of the
food industry of huge mergers and acquisitions, radically concentrating
power in the food system, are driving managing practices that drive AMR.

The representative from Consumer Reports further noted that we have an
opportunity that farm to table movements are becoming more popular, and
that consumers want to be connected to food production and this is creating
some reaction already.

Dr. Lemus from Argentina agreed that there is a need to empower the
consumer but for this there is a need to have specialized informational
campaigns. The Pan American Health Organization/WHO needs to create an
expert movement to empower countries in these communication campaigns. If
imports are controlled in third parties, exporting countries will respond
to maintain market access. There is a need also to work with national
agencies of evaluation of technology to guide the use of antibiotics.

The World Bank noted that we are not starting from scratch and that there
has been work done already that can be used, for example on vaccines. Dr.
Kim further emphasized the need to have targeted specific interventions of
surveillance in the agriculture sector to understand what the patterns are
of the use and lack of access in developing countries.

On conclusion of the panel session the second part of the day was dedicated
to hear country statements.  At the end of the evening the Chair read the
official Communiqué that signaled the clear recognition of AMR as a serious
threat to the entire world and to address it there is a need for
multi-sectoral action. The following points were highlighted: Now it is
time to get down to work. The Global Action Plan exists and countries have
agreed to implement it. The need for innovation and education and
sustainable financing in order to stop AMR as well as country level support
are recognized. It will be critical that all actors adopt a long-term
perspective. AMR is a global health issue that requires our urgent
attention, and we need to build further political and public awareness. To
enable us to achieve the SDGs it is clear that we do not have time to
waste. The political declaration and Global Action Plan put in monition
necessary steps to move forward to address the AMR challenge. It also
recognized that there is a clear need to put words into actions and ensure
a universal push to transform our world and that no one is left behind.

With these remarks the High Level Meeting on Antimicrobial Resistance was

According to several civil society organizations that attended the panel,
while the declaration is a good step and recognition at the highest level
of this critical issue the declaration had few commitments on the
mobilization of funds to support developing countries. It did not make
specific commitments in the animal health sector. The declaration calls for
a report back in 2018 at the UNGA and hopefully some of the commitments
discussed in this meeting can be truly realized.


[*]With inputs from Viviana Muñoz of South Centre

*Author :*

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