4 WHO draft global action plan Five strategic objectives: 1. to improve awareness and understanding of antimicrobial resistance;2. to strengthen knowledge through surveillance and research;3. to reduce the incidence of infection;4. to optimize the use of antimicrobial agents;5. to 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.(to be presented at WHA May 2015)
5 Identifies 7 areas in which actions are most necessary: - making sure antimicrobials are used appropriately in both humans and animals- preventing microbial infections and their spread- developing new effective antimicrobials or alternatives for treatment- cooperating with international partners to contain the risks of AMR- improving monitoring and surveillance in human and animal medicine- promoting research and innovation- improving communication, education and training.
9 Specific objectives of AMR surveillance & AB use MonitorAntibiotic-susceptibility patterns common pathogensMagnitude and trends of AMREmergence of new AMRUse/overuse/misuse of antibioticsIn order toImprove quality, safety and costs of health careGuidance adequate antibiotic therapy – appropriate useSupport infection prevention & controlAwareness & advocacyBenchmarkingImprove laboratory capacity, expertise & quality
13 Intersectoral Coordination: Ministry of Health, Welfare and Sports & Ministry of Economic Affairs (Agriculture and Livestock)Health Council of the Netherlands report (2011): Antibiotics in food animal production and resistant bacteria in humans.Preventive use was prohibitedRestricted use of all critically important antibiotics (3rd choice)Last resort antibiotics excluded from veterinary useMandatory sensibility testing 3rd choice antibioticsIndependent Veterinary Drug Authority (2011): Monitor trends + bench- marking + transparencyAmendment to the law (2013): Antibiotics only with prescription from veterinarianGuidelines
16 Appropriate use of antibiotics AMR controlInfection controlAppropriate use of antibiotics
17 Control of AMR: infection control Infection prevention & hygieneProfessional guidelines for each settingSearch and destroy or control/containAwareness and sense of urgencyOutbreakmanagementEnforcement by the national health inspectorateProblem ownership/responsibilities
18 Control of AMR -> Appropriate use of antibiotics Right indication, right dose, adequate period, at the lowest cost, good qualityTreatment is correctly followed by the patient.Bacteria causing the infection need to be susceptible.Inappropriate use includes over-prescription, under prescription, and prescription and dispensing of unnecessary antibiotic combination(From: The evolving threat of antimicrobial resistance - Options for action, WHO 2012)Control: surveillance, awareness, problem ownership, responsibilities, professional guidelines, antibiotic stewardship, enforcement
21 TAP: when knowledge is not enough Guide to Tailoring AMR ProgrammesDesign tailored interventions instead of “spray campaigns”Describes an step by step approach and provides tools to assist national AMR programmes to increase prudent antibiotic useBased on TIP (Guide to Tailoring Immunization programmes)TAP is a conceptual model that combines several behavioural change theories, social marketing concepts with previous experience.TAP brings together several stakeholders from the start to gain ownership and to recognize the work that has to be done together in order to work towards the intervention togetherCurrent state: in development/pilot fase → Sweden, England, Netherlands
22 AMR Dutch EU presidency NL involvement in WHO GAP and GHSA (one of the leading countries)Minister of Health announced at the 3rd International One Health Congress in Amsterdam (March 2015): AMR will be one of my priorities during the Dutch EU presidency first half 2016Focus on One Health approach to AMR; measures needed in human health sector, animals, food and environmentFurther recommendations for the next EU AMR Action planNL is actively involved in fighting AMR, both nationally and internationally. Internationally we actively promote and are involved in the WHO Global Action Plan, we organised conference to develop GAP in June 2014, with a focus on human –veterinary cooperation. The draft GAP is on the agenda of the next World Health Assembly in May. We are one of the leading countries of the Global Health Security Agenda ‘AMR working package’. In March, we organised a high level meeting with the other leading countries to take this working package further.AMR is one of my priorities during the Dutch EU-presidency in I intend to focus on the need for a One Health approach to AMR in the EU.We want to use the evaluation of the current EU action plan as a starting point for our discussions.We will organise a One Health Ministerial conference on AMR with both ministers of Health and Agriculture, feb 2016.Aim is to develop strong recommendations that can be included in the next EU Action Plan for AMRWe will ask member states to present best practices from their country, on surveillance, infection prevention or prudent use of antibiotics in the human and veterinary sector.
23 Conclusions:No action today no cure tomorrowNo surveillance no control of AMR and use of antibioticsAMR control consists of infection prevention and appropriate us of antibioticsKnowledge is not enough for behavior changeOne health fits all (better safe then sorry)