Antimicrobial Resistance

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April 2019: The UN Interagency Coordination Group (IACG) has submitted its final report to the UN Secretary General who will present his own report at the UN General Assembly in September, 2019.  The IACG was established to follow up  the landmark Political Declaration on AMR which was adopted by the General Assembly on 21st September, 2016. The declaration recognized the importance of delinking the cost of investment in R&D from the price and volume of sales so as to facilitate equitable and affordable access to new medicines, diagnostic tools and vaccines.

The background to the IACG recommendations in the report is based on the three  points:
• Antimicrobial resistance is a global crisis that risks reversing a century of progress in health.
• There is no time to wait. Unless the world acts urgently, antimicrobial resistance will have disastrous impact within a generation
• A sustained One Health response to antimicrobial resistance is essential to engage and unite all stakeholders around a shared vision and goals.

Read the complete report here

When Antibiotics don’t work any more– Martin Khor – TWN/South Centre  2018

• Landmark Asian AMR workshop – Penang, March 26-28, 2018: Brief Report
  Handle antibiotics with care November 2016- world antibiotic awareness week in the region
• Patients can’t get enough of antibiotics- Malaysia 2015
• WHO BULLETIN: An International Legal Framework to address AMR  5 February 2015
• Obama’s 2016 budget proposes historic investment to combat ABR
• Resistance in the news
• Needed: An international legal framework to address antimicrobial resistance. Editorial  WHO Bulletin
• What is a resistance gene? Ranking risk in resistomes.  Nature Reviews Microbiology
  
• Norway:  Successful work against MRSA in pigs  Jordbruksaktuellt
• Report of the ReAct South East Asia Regional Meeting: Community, Hospital and Policy Interventions to Manage and Control Antibiotic Resistance
  21 – 23 November 2014, Penang, Malaysia
  
• Malaysia November 2014.   Community engagement on rational use of antibiotics
  Towards national/ regional policy platforms to manage antibiotic resistance-among civil society – Engaging civil society organizations for social mobilization, health education and communication
• Centres for Disease Control and Prevention:
  Read  the Joint Statement on Antibiotic Resistance from 25 National Health Organizations and the Centers for Disease Control and Prevention here
  Untreatable: Report by CDC, Monday, September 16, 2013, detailing today’s drug-resistant health threats: Landmark report ranks threats, outlines four core actions to halt resistance can be read here
  
• Antibiotic use and antibiotic resistance – food animals in Malaysia – a threat to human and animal health. HAIAP/TWN/CAP Memo, October 2013. Click here
  
• Antibiotic resistance—the need for global solutions www.thelancet.com/infection Vol 13 December 2013
• Containing Antibiotic Resistance: A world-wide challenge  Ken Harvey 2012

Landmark Asian AMR workshop – Penang, March 26-28, 2018: Brief Report

The landmark Asian workshop on AMR was organized by the South Centre and TWN to help address the antimicrobial resistance (AMR) crisis that is affecting many Asian countries seriously. There has been progress in the last few years in recognizing this crisis. But for most countries the battle is only at the beginning stage, much more needs to be done, and several problems of implementing national plans need to be overcome if real progress on the ground is to be made.
This picture of the situation emerged at a South-east Asian regional workshop on AMR attended by 60 participants, including policy makers from 10 countries, as well as representatives of civil society, scientists and regional AMR focal points of the World Health Organisation and the Food and Agriculture Organisation.
The workshop, held in Penang (Malaysia) on 26-28 March 2018, was co-organised by the South Centre and the Third World Network, with the support of the Fleming Fund. The policy makers were from Indonesia, Thailand, Malaysia, the Philippines, Myanmar, Vietnam, Cambodia, Laos, China and India. NGOs from most of these countries, as well as Australia, also attended.
It was a landmark meeting for several reasons. Firstly, high-level policy and technical experts, most of them being focal points or coordinators of their national AMR committees, took part. Second, the government officials were AMR experts from both the human health and animal sectors, which is quite rare as usually international AMR meetings involve officials from only one sector or the other. The workshop thus lived up to the concept of a One Health approach. Thirdly, civil society groups involved in AMR or general health issues were also represented, enabling dialogues to take place between the governmental and non-governmental sectors. It was recognized that actions by both are crucial to generate public awareness and mobilise public support for AMR actions. Fourthly, the workshop provided the most up-to-date information on global and regional developments (provided by experts, including from the WHO, FAO and South Centre) as well as the state of policies and actions at national level.
Martin Khor, Executive Director of the South Centre, presented a comprehensive analysis of why developing countries are being affected the most from the AMR crisis and must join in the global effort to address it. However their interests and challenges while doing so should be recognized so that they can effectively implement their national plans. A highlight of the workshop was a session on the need for a One Health Approach to AMR. Dr Peter Collignon, Director of ACT Pathology at Canberra Hospital (Australia) spoke of the AMR situation in the human health, animal, aquaculture and environment sectors and their interconnectedness.

From the reports of the breakout groups and from the earlier country presentations, the following main points can be drawn:

• • There has been quite a lot of progress in making a start in combatting AMR, with countries already formulating their national action plans and having a national AMR committee.  However, while some countries have incorporated both the health and agriculture/animal sectors in their AMR committee, others have only the health ministry.

• • While the health ministries have embarked on a number of activities such as surveillance and infection control, the agriculture/livestock sector in many countries have still to catch up with regards to actions.

• • One encouraging sign is that Indonesia has banned the use of antibiotics as growth promoters in livestock since January 2018, whereas Vietnam imposed a similar ban a few years ago and in Thailand there has been a ban on antibiotic use as growth promoters in chickens since 2006.

• • In most countries, little work has been done on the environmental component of the spread of AMR.  This is an area requiring much more work.

• • While plans and guidelines have been formulated in a number of areas, implementation in most countries is still inadequate.  This is because of various factors, depending on the country concerned.  The factors include that there is lack of priority and lack of political interest or will;  lack of financial and human resources;  too few equipment needed for diagnostic work;   lack of champions and of a systematic stewardship program at national or local level.

• • There is still inadequate understanding of the AMR issue in the animal sector in many countries.  The WHO guidelines on antibiotic use in animals is a useful and important reference focusing on human health aspect.  This should be supplemented by guidelines jointly issued by WHO, FAO and OIE, so as to involve all the relevant international organisations.

• To increase the speed of implementation and of progress, a fund or funds to help developing countries to coordinate their AMR actions and to build their technical and organisational capacity should be made available with sufficient resources.

To read the complete report go to: https://www.twn.my/title2/health.info/2018/hi180502.ht

Handle antibiotics with care November 2016

Antibiotic Awareness Week is an annual, global event to raise awareness about the serious health issue of antibiotic resistance. The week encourages people around the world to use antibiotics responsibly. This year, Antibiotic Awareness Week is from 14 – 20 November 2016. The theme is ANTIBIOTICS – HANDLE WITH CARE.

During the global campaign, the aim is to create behavioural changes that drive down inappropriate antibiotic prescribing in Australia by health professionals and misuse of antibiotics by the public. The campaign reminds everyone that:

• Misusing antibiotics can cause harm
• You could be passing on antibiotic resistant bacteria
• Antibiotics are a precious resource that should be handled with care

Many creative Antibiotic Awareness Week activities are being held in countries throughout or region.  We look forward to reports and pictures.

Patients can’t get enough of antibiotics
April 26, 2015. Malaysia, The Star online
http://www.thestar.com.my/News/Nation/2015/04/26/Patients-cant-get-enough-of-antibiotics-Demand-continues-to-rise-in-Malaysia-despite-warnings-on-dan/

PETALING JAYA: Repeated warnings on the dangers of antibiotic abuse have fallen on deaf ears as private healthcare providers continue to indulge patients who ask for it for every ailment.
Multi-drug resistant organisms have spooked patients worldwide, but in Malaysia, the demand for antibiotics continues to rise.
Malaysians very likely rank among the world’s highest antibiotic users, said Universiti Sains Malaysia (School of Pharmaceutical Sciences) Prof Mohamed Azmi Ahmad Hassali. Read more here

WHO BULLETIN: An International Legal Framework to address AMR
5 February 2015
In an editorial of the February issue of the WHO Bulletin a group of authors including ReAct’s Otto Cars and Anna Zorzet discuss the complexity in global containment of antimicrobial resistance. The draft Global Action Plan on Antimicrobial Resistance , expected to be adopted at the World Health Assembly in May 2015, represents significant progress but “ more is required if the world is to grapple effectively with this huge and complex problem,” states the editorial. The authors identify a need for a binding international legal mechanisms to address three main areas the global action should be focused on, namely access, conservation and innovation.
Read more 

Resistance in the news
2 February 2015
Resistance in the News is a selection of recently published articles with relevance to antibiotic resistance and antibiotic use. The articles, selected by one of ReAct´s media monitoring sources, have been published in various internet media and on-line scientific journals. The list is by no means complete and does not necessarily reflect the opinion of the ReAct network.

Sweden
The total sale of antibiotics continued to decrease in 2014 as compared with 2013.  Data from the Public Health Agency  Folkhälsomyndigheten and Dagens Medicin
Extensive measures stopped the outbreak of VRE in Gävleborg  Folkhälsomyndigheten

International
ECDC/EFSA/EMA first joint report on the integrated analysis of the consumption of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals. The use of certain antimicrobials in animals and humans is associated with resistance to these antimicrobials in bacteria from animals and humans. There are also important differences in the consumption of antimicrobials in animals and in humans between European countries  ECDC press release and the full report

Needed: An international legal framework to address antimicrobial resistance. Editorial  WHO Bulletin

What is a resistance gene? Ranking risk in resistomes. An opinion article where the authors propose rules for estimating the risks associated with genes that are present in environmental resistomes by evaluating the likelihood of their introduction into human pathogens, and the consequences of such events for the treatment of infections
Nature Reviews Microbiology

Norway:  Successful work against MRSA in pigs  Jordbruksaktuellt

USA – Economics of Antibiotic Use in U.S. Swine and Poultry Production
Choices Magazine  Australia: “ In a study researchers examined hospital patients’  knowledge and attitudes toward hospital-acquired infections and their participation in infection control. While 80% of hospital patients reported that they were willing to help hospital staff with infection prevention, many felt that they would not feel comfortable asking a healthcare worker to sanitize his or her hands
Infection Control and Hospital Epidemiology
.………………………………………………………………………………………………………………………………

Report of the ReAct South East Asia Regional Meeting: Community, Hospital and Policy Interventions to Manage and Control Antibiotic Resistance
21 – 23 November 2014, Penang, Malaysia
Shila Kaur
ReAct South East Asia (ReAct SEA) recently brought together 35 participants from the region to a meeting in Penang, to discuss community, health and policy interventions to manage and control antibiotic resistance (ABR). From 21 – 23 November 2014, scientists, doctors, researchers, heads of departments from ministries of health and hospitals as well as civil society representatives from Indonesia, Malaysia, Philippines, Singapore, Thailand, Timor-Leste and Vietnam spent two and a half days sharing experiences, and learning from each other successful interventions for adaption and adoption in their respective country settings.   Read the complete report here

What is antibiotic (or antimicrobial) resistance? Antibiotic or antimicrobial resistance occurs when microorganisms such as bacteria, viruses, fungi and parasites change in ways that render the medications used to cure the infections they cause ineffective. When the microorganisms become resistant to most antimicrobials, they are often referred to as superbugs.
Source: World Health Organisation

Antimicrobial Drug Resistance:  Report by the Secretariat to be presented at the 67th World Health Assembly in Geneva May, 2014
The report was prepared in March 2014 as a provisional agenda item for the 2014 Wold Health Assembly. Recommended next steps: Intersectoral engagement National plans Knowledge and information Medicines regulation Prevention of infection Technology innovation Service innovation The Health Assembly was invited to adopt the draft resolution recommended by the Executive Board in resolution EB134.R13. Read the complete report here

HAIAP and ReACT
HAIAP is particularly concerned about the increase of antimicrobial resistance (AMR). In partnership with ReACT and other concerned organisations HAIAP is helping develop and promulgate strategies to minimise the increase of AMR.
In October 2013, ReAct organised a first meeting with a number of civil society organisations (CSOs) to widen the circle of stakeholders working with antibiotic resistance. This meeting was followed by a larger one in Geneva, and on May 1st, 2014, the Antibiotic Resistance Coalition was born with ReAct as a proud member. That day, the coalition launched a declaration on antibiotic resistance, and ‘the fantastic commitment and support from all has greatly exceeded our expectations’ says Anna Zorzet, Manager at ReAct. You can see the Declaration from the Antibiotic Resistance Coalition´s Declaration on Antibiotic Resistance here

Declaration:  New Antibiotic Resistance Coalition urges immediate action
In a declaration launched May 22, during the 67th World Health Assembly in Geneva, ReAct and partners in the new Antibiotic Resistance Coalition (ARC), a group of civil society organisations working in human, environmental and agricultural health, urges immediate global action to tackle the rapidly accelerating threat of antibiotic resistance. Press release from the Antibiotic Resistance Coalition <http://www.reactgroup.org/arc-press-release.html>

May 28, 2014  Antibiotic Resistance Coalition (ARC)
A new, international Antibiotic Resistance Coalition (ARC) has been established, comprising civil society stakeholders from six continents working in the health, agriculture, consumer and development sectors. ARC is advocating for policy change and taking action to prevent the post-antibiotic era from becoming a bleak reality. At the 67th World Health Assembly in Geneva last week, ARC issued a comprehensive civil society declaration on antibiotic resistance (available at: www.reactgroup.org/arcdeclaration, calling, in part, for international leadership and action to: ‘Prohibit the promotion and advertising of antibiotics;  Promote new, needs-driven and open research and development models based on the principle of de-linkage (divorcing price from research and development costs and sales volumes);  Phase out the use of antimicrobials for routine disease prevention in livestock, and end their use, altogether, for growth promotion;  Build robust systems, in all countries, to monitor and report antibiotic use and resistance trends in humans and animals; and Improve public awareness to support an ecological understanding of human-bacteria interaction and behaviour change around antibiotic use.’ ARC was pleased that, as a first step, WHA67 passed the resolution, ‘Antimicrobial Resistance, Including Antibiotic Resistance’ (available at: http://apps.who.int/gb/ebwha/pdf_files/EB134/B134_R13-en.pdf)
which now mandates the World Health Organization to develop a global action plan on antimicrobial resistance.

ARC had urged Member States, to pass the resolution in a press release www.reactgroup.org/arc-press-release.html earlier in the week, and in an intervention (https://apps.who.int/ngostatements/content/165-stichting-health-action-international) prior to the vote.

ARC urges organisations and individuals that are concerned about antibiotic resistance, particularly those in civil society, academia, research and patient organisations, to sign on to its declaration on antibiotic resistance.
To do so, please email: signon@arcdeclaration.org

The ARC resulted from a series of discussions and meetings organised by the following steering group members: Anthony So (ReAct / Duke University’s Program on Global Health and Technology Access), Niclas Hällström (What Next Forum), Martin Khor (South Centre), Tim Reed (Health Action International), Peter Maybarduk (Public Citizen), Eva Ombaka (ReAct / Health Action International) and David Wallinga (Healthy Food Action). Initial funding for the formation of the Coalition was provided by ReAct and the South Centre.

About the ‘Collective Responsibility for Controlled Distribution and Use’ policy process
Having successfully argued for a different business model for research and development (R&D), ReAct initiated a debate about how future antibiotics could be distributed and used in a way that would minimize the risk of development of resistance. When new antibiotics are developed, the following questions must be answered: – What policies must be put in place to minimize the development of antibiotic resistance (ABR)? – How can we ensure that new antibiotics are made globally accessible and affordable to all those who need them? – How should new antibiotics be distributed to balance the need for access against the risk of inappropriate use? Read more here in
The World’s Collective Responsibility to Conserve Antibiotic Effectiveness.
This document builds upon the ideas and proposals generated in response to the above questions at two roundtable discussions on ‘ExploringWays to Preserve Future Novel Antibiotics’, organized by ReAct in October/November 2011 in NewDelhi and in Antalya, Turkey which aimed to begin a global debate on the questions set out above.

Antimicrobial Resistance: Global Report on Surveillance –  WHO April 2014
The World Health Organisation’s (WHO) first worldwide report into antimicrobial resistance has found the problem is no longer just a serious prediction for the future, but is happening now. The report makes a clear case that resistance to common bacteria has reached alarming levels in many parts of the world, indicating that several of the available treatment options for common infections are becoming ineffective. The report says as well as superbugs in hospitals, everyday infections such as pneumonia and urinary tract infections are becoming harder to treat. The WHO, along with partners across many sectors, is developing a global action plan to mitigate antibiotic resistance.  It will involve the development of tools and improved collaboration around the world to track drug resistance, measure its impact, and design solutions. ‘Strengthening global surveillance will be a critical aspect of such planning as it is the basis for informing global strategies, monitoring the effectiveness of public health interventions and detecting new trends and threats,’ the report says. To download the report click here

Malaysia November 2014
Community engagement on rational use of antibiotics
Towards national/ regional policy platforms to manage antibiotic resistance-among civil society – Engaging civil society organizations for social mobilization, health education and communication
Following the written agreement between Action on Antibiotic Resistance (ReAct) South East Asia, Discipline of Social & Administrative Pharmacy (DSAP, under Universiti Sains Malaysia’s School of Pharmaceutical Sciences) and Yayasan Bina Ilmu (YBI), a civil society organization, an introductory workshop was launched at Jalan Makloom 1Malaysia Community Hall in Sungai Pinang, Penang on July 18^th, 2012.
The workshop aimed to engage the local community members, who are predominantly from the lower to middle income group, on managing antibiotic resistance. YBI serves 8 villages within the area and focuses on various aspects of education, health and community welfare.
By highlighting the issues related to antibiotic use and resistance, the workshop marked the first step towards awareness raising on antibiotic use and resistance among the community. Thirty YBI leaders were guided on ways they can play an ‘ambassador role’ in spreading the message to others within their community.

The duration of this project is 3 years.

Training-of-the-Trainer (TOT) Workshops
A three-day series of TOT workshops were organized for 30 community members/leaders from 9–11 November 2012 at the same community hall.
Participants were provided information training materials(teaching guidelines and a module, “What you should know about antibiotics”, books and pamphlets) on antibiotics and antibiotic resistance that they can disseminate to fellow community members and other interested communities.
Following the success of this event, the participants were motivated to organize their own antibiotic smart use campaigns.
In 2013, monthly sessions were set up with the trainers to ensure a smooth and up-to-date knowledge transfer to community members. All the materials were also translated into Bahasa Melayu and made available for public use.
Knowledge Sharing
A series of focus group discussions were undertaken by Ms. Nadja Trygg, a Master of Public Health Sciences student from the Medical Management Centre of Karolinska Institute, Sweden, doing a case study on civil society organization projects in Malaysia.
The focus group discussions revealed that community leaders want better engagement between health personnel and its community for successful empowerment of health knowledge to the public.
In view of the study findings, policy recommendations will include:

1. A better understanding of the population’s social and environmental context by health educators and
2. Enhanced public education on issues related to antibiotic resistance (ABR) at the grass root community level.

The results were presented as reports and the recommendations were embedded into the working plan of the project.

In October 2013, Mr. Sharrieffuddin represented USM to present the findings and a progress update at a conference organized by ReAct in Ecuador, Latin America.
Back in the homeland, 40 community leaders from all over Penang Island were invited to attend a forum on ABR. The progress on the project were presented and plans are in line to expand it to another community.
Collaboration Efforts
Since the start of this project, DSAP and YBI has been utilizing their contacts in engaging other institutions/organizations to create a large and strong network. Among the institutions/organizations are:

• Penang State Information Department
• Malaysia Community (Makloom and Bayan Lepas Branch, Kedah Tg Tualang Branch)
• Pharmaceutical Services Division, Ministry of Health (MOH) Malaysia
• Penang Malay Association (PEMENANG)
• Penang General Hospital, Penang
• Malaysian Pharmacy Students’ Association (MyPSA)
• Kepala Batas Community College, Penang
• Family Health and Development Association (FHDA)
• Penang Dental College
• Batu Uban MP Office (Dr. T. Jayabalan

Future Plan
DSAP and YBI plan to gather support from all stakeholders and establish/submit a memorandum on antibiotic resistance to Ministry of Health (MOH) Malaysia for better policies/actions.
Contact details:
Assoc. Prof. Dr. Mohamed Azmi Ahmad Hassali
Deputy Dean (Student Affairs & Networking)
School of Pharmaceutical Sciences,
Universiti Sains Malaysia,
11800 Penang,
Malaysia
Tel      :+604-6534085
Fax      :+604-6570017
Email : azmihassali@usm.my / azmihassali@gmail.com

 

 

Philippines 2014
This year, the Philippine President passed an administrative order creating an inter-agency department for Anti Microbial Resistance  – not just the Department of Health, but for the whole of government. Now the government is planning for a strong intersectoral response for addressing AMR.  Click here to see the administrative order.

See also

Centres for Disease Control and Prevention:
Since their introduction into medicine in 1941, antibiotics have saved millions of lives and transformed modern medicine. As a result, bacterial infections have become easily treatable, and the horizons for surgeries, transplants, and more complicated life-saving procedures have expanded. But increasing antibiotic resistance is leading to higher treatment costs, longer hospital stays, and unnecessary deaths. The more we use antibiotics, the more we contribute to the pool of antibiotic- resistant microbes. The development of resistance is an inevitable byproduct of exposure to antibiotics. All antibiotic use, whether warranted or not, places selection pressure on bacteria, and some organisms that possess genetic mutations will survive antibiotic treatment. Over time, resistance threatens to return us to an era where simple bacterial infections will once again be deadly. Read  the Joint Statement on Antibiotic Resistance from 25 National Health Organizations and the Centers for Disease Control and Prevention here

Untreatable: Report by CDC, Monday, September 16, 2013, detailing today’s drug-resistant health threats: Landmark report ranks threats, outlines four core actions to halt resistance can be read here

Containing Antibiotic Resistance: A world-wide challenge Ken Harvey 2012 Presented at the Asian Institute of Medicine, Science & Technology (AIMST), Sept 25-28, 2012
To download the presentation click here

Antibiotic use and antibiotic resistance – food animals in Malaysia – a threat to human and animal health. HAIAP/TWN/CAP Memo, October 2013. Click here

Antibiotic resistance—the need for global solutions www.thelancet.com/infection Vol 13 December 2013
Ramanan Laxminarayan, Adriano Duse, Chand Wattal, Anita K M Zaidi, Heiman F L Wertheim, Nithima Sumpradit, Erika Vlieghe, Gabriel Levy Hara, Ian M Gould, Herman Goossens, Christina Greko, Anthony D So, Maryam Bigdeli, Göran Tomson, Will Woodhouse, Eva Ombaka, Arturo Quizhpe Peralta, Farah Naz Qamar, Fatima Mir, Sam Kariuki, Zulfi qar A Bhutta, Anthony Coates, Richard Bergstrom, Gerard D Wright, Eric D Brown, Otto Cars

The causes of antibiotic resistance are complex and include human behaviour at many levels of society; the consequences affect everybody in the world. Similarities with climate change are evident. Many efforts have been made to describe the many different facets of antibiotic resistance and the interventions needed to meet the challenge. However, coordinated action is largely absent, especially at the political level, both nationally and internationally. Antibiotics paved the way for unprecedented medical and societal developments, and are today indispensible in all health systems. Achievements in modern medicine, such as major surgery, organ transplantation, treatment of preterm babies, and cancer chemotherapy, which we today take for granted, would not be possible without access to effective treatment for bacterial infections.  Within just a few years, we might be faced with dire setbacks, medically, socially, and economically, unless real and unprecedented global coordinated actions are immediately taken. Here, we describe the global situation of antibiotic resistance, its major causes and consequences, and identify key areas in which action is urgently needed. To see the complete article click here

Containing Antibiotic Resistance: A world-wide challenge
Ken Harvey 2012
Presented at the Asian Institute of Medicine, Science & Technology (AIMST), Sept 25-28, 2012.   To download the presentation click here