Strategy and Policy Cohesion: “The One Health Agenda: will it deliver” Elizabeth J. Phillips, MD, FRCPC,FRACP, FACTM Professor & Director, Centre for Clinical Pharmacology & Infectious Diseases Institute for Immunology & Infectious Diseases, Murdoch University John A. Oates Chair in Clinical Research Professor of Medicine & Pharmacology Director of Personalized Immunology Oates Institute for Experimental Therapeutics Vanderbilt University School of Medicine

“Drugs Don’t Work” Allan Roses, December 2003 VP of Genetics (GSK) >90% of drugs have efficacy in 30-50% of people

Overview of Global and National Response  Social, financial and environmental depth  Education and communication  National antimicrobial resistance response documents supporting commitment  Global antimicrobial response  Implementation – what are the measurable outcomes

The AMR One Health Policy Toolkit: Animal-Human Interface  Awareness  Surveillance (obstacles to data collection) and antimicrobial stewardship in agriculture  Education and Communication  Evidence base (decreased AMR after voluntary withdrawal) and ongoing effectiveness monitoring  Broad agricultural implications and complexity of the “AMR web” (aquaculture, the plant connection)  Alternatives to antimicrobials in agriculture  Industry and regulatory issues

Globalisation & Governance of AMR  Challenges in developing world parallel those in developed world – political & cultural considerations  Defining extent of problem, educational compaigns  Conservation of antibiotics and promote stewardship and infection control  Challenges of global demand for animal protein (antimicrobial consumption in agriculture) – need incentives to change practice, non-antibiotic approaches, infection control  AMR shows no boundaries

One Health Approach  Broadly engage –Doctors, veterinarians, farmers, industry and community  Consistent approaches –Infection prevention, optimize antibiotic utilization in human and animal sectors, new treatments and diagnostic methods  Simple messages –What can be done now? –Reinforce positive achievements, raise awareness of risk, attention to health science, social, environmental and economic issues and uncertainties surrounding all Australian Colloquium 2013

Driver’s and Consequences of Antimicrobial Resistance

Multidisciplinary Toolkit  System change  Training and education  Evaluation  Reminders (eg workplace)  Safety climate  Adapt to culture Dr. Didier Pittet

Allegranzi, Lancet ID Oct 2013

Partnership, Leadership & Innovation  The Human health and social care sector  Livestock, food retail and veterinary sectors  Research councils, other research funders and academics  Pharmaceutical industry  Local governments, professional boards, scentific and other advisory committees UK 5 year antimicrobial resistance strategy

WHO Global Action Plan  Building Block 1: AWARENESS  Building Block 2: IDENTIFYING and OPERATIONALIZING INFECTION PREVENTION APPROACHES  Building Block 3: OPTIMIZING ANTIMICROBIAL USE IN HUMAN & ANIMAL HEALTH & AGRICULTURE  Building Block 4: CLOSING KNOWLEDGE GAPS  Building Block 5: INNOVATION  Building Block 6: COSTS AND INVESTMENT

US National Goals, Sept 2014  1. Slow Emergence of AMR  2. Strengthen National One-Health Surveillance Efforts  3. Advance development of rapid diagnostic tests to identify and characterize AMR.  4. New Antibiotics, therapeutics and vaccines  5. Global effort on AMR prevention, surveillance, control and antibiotic R&D.

Canadian AMR Response  ACTION 1: establish and increase surveillance in both animal and human settings  ACTION 2: promote appropriate antibiotic use in animal and human settings  ACTION 3: work with animal agriculture sector (antibiotic stewardship in veterinary medicine)  ACTION 4: promote innovation October 2014

Where to go from here?  Definition and measurement of problem, awareness and broad and global engagement  Build on existing success and models that have a proven track record  What can we do now and defining priorities  What are the short and long-term measurable outcomes  Diagnostic test development  Antibiotic pipeline (a lengthy process that will not modify behavior or attack root of the problem)  Other approaches (vaccine, non-antimicrobial)

Lancet ID 2013

US National Goals (A partnership between healthcare, public health, vetinary medicine, agriculture, food safety and federal, academic and industrial research)