1. | Antimicrobial Resistance: Global Surveillance Global Action Plan to combat antimicrobial resistance

2. | Antimicrobial Resistance: Global Surveillance Focuses on antibacterial resistance (ABR) Information gathered include: Surveillance of ABR according to WHO regions National and published data on 7 bacteria Systematic reviews of evidence of health and economic burden in 5 bacteria/ resistance combinations Identification of gaps Antimicrobial Resistance Global Report on Surveillance 2014 (I)

3. | Antimicrobial Resistance: Global Surveillance Name of bacterium/ resistance Examples of typical diseases No. of 194 MS providing national data No. of WHO regions with national reports of 50 % resistance or more Range of reported proportion of resistance Escherichia coli Urinary tract infections, blood stream infections -vs 3 rd gen. cephalosporins845/60-82 -vs fluoroquinolones905/63-96 Klebsiella pneumoniae Pneumonia, blood stream infections, urinary tract infections -vs 3 rd gen. cephalosporins856/62-82 -vs carbapenems692/60-68 Staphylococcus aureus Wound infections, blood stream infections -vs methicillin “MRSA”835/60.3-90 Bacteria Commonly Causing Infections in Hospitals and Communities

4. *National data means data obtained from official sources, but not that data necessarily are representative for the population or country as a whole Available National Data* on Resistance for Nine Selected Bacteria/Antibacterial Drug Combinations, 2013

5. | Antimicrobial Resistance: Global Surveillance Deaths (%) Outcome (number of studies included)ResistantNot resistantRR (95% CI) Escherichia coli resistant to: 3 rd gen. cephalosporinsBacterium attributable mortality (n=4)23.612.62.02 (1.41 to 2.90) FluoroquinolonesBacterium attributable mortality (n=1)00 Klebsiella pneumoniae resistant to: 3 rd gen. cephalosporinsBacterium attributable mortality (n=4)2010.11.93 (1.13 to 3.31) CarbapenemsBacterium attributable mortality (n=1)2713.61.98 (0.61 to 6.43) Staphylococcus aureus resistant to: Methicillin (MRSA)Bacterium attributable mortality (n=46)26.316.91.64 (1.43 to 1.87) Risk of Death is Higher in Patients Infected with Resistant Strains

6. | Antimicrobial Resistance: Global Surveillance Estimates of Burden of Antibacterial Resistance European Union population 500m 25,000 deaths per year 2.5m extra hospital days Overall societal costs (€ 900 million, hosp. days) Approx. €1.5 billion per year European Union population 500m 25,000 deaths per year 2.5m extra hospital days Overall societal costs (€ 900 million, hosp. days) Approx. €1.5 billion per year United States population 300m >23,000 deaths >2.0m illnesses Overall societal costs Up to $20 billion direct Up to $35 billion indirect United States population 300m >23,000 deaths >2.0m illnesses Overall societal costs Up to $20 billion direct Up to $35 billion indirect Source: ECDC 2007Source: US CDC 2013 Thailand population 70m >38,000 deaths >3.2m hospital days Overall societal costs US$ 84.6–202.8 mill. direct >US$1.3 billion indirect Thailand population 70m >38,000 deaths >3.2m hospital days Overall societal costs US$ 84.6–202.8 mill. direct >US$1.3 billion indirect Source: Pumart et al 2012 Global information is insufficient to show complete disease burden impact and costs

7. | Antimicrobial Resistance: Global Surveillance 1.High proportions of resistance were reported in all regions to common treatments for bacteria causing infections in both healthcare settings and in the community 2.Antibacterial resistance has a negative effect on patient outcomes and health expenditures 3.Treatment options for common infections are running out 4.Despite limitations, the report demonstrates worldwide magnitude of ABR and surveillance gaps Summary: Antibacterial Resistance

8. | Antimicrobial Resistance: Global Surveillance Resolution on AMR World health Assembly May 2014... To develop a draft global action plan to combat AMR... to ensure that all countries... have the capacity to combat AMR. –Takes into account existing action plans and all available evidence and best practice –To apply a multisectoral approach by consulting..... Submit to 2015 Health Assembly through the Executive Board January 2015 –November 2014

9. | Antimicrobial Resistance: Global Surveillance Consultation on draft GAP (1) Online consultation held between 4 July and 1 September 2014 –Open to Member States, organizations –130 contributions received from all relevant sectors Member States, Government agencies and organizations: 54 NGOs and civil society: 40 Private sector: 16 Academia: 16 Other (International organizations): 4

10. | Antimicrobial Resistance: Global Surveillance Consultation on draft GAP (2) Strengthen tripartite collaboration –FAO, OIE, WHO –Worked together on development of global action plan Shared actions for the collaboration 16 October consultation with Member States –http://www.who.int/drugresistance/memberstatemeeting/en/http://www.who.int/drugresistance/memberstatemeeting/en/ 17 October 3 rd meeting of WHO Advisory Group Additional Member State consultations scheduled –Optimizing use of medicines (Oslo, November) –Global surveillance (Stockholm, December) –Research agenda (Brasilia, 1Q2015)

11. | Antimicrobial Resistance: Global Surveillance Consultation on draft GAP (2) Technical consultations Infection prevention and control Innovation, R&D of new medicines Diagnostics Surveillance December 2012 – led to global report March 2014 – establishment of working groups September 2014 – working group meetings

12. | Antimicrobial Resistance: Global Surveillance Five strategic objectives: Improve awareness and understanding Strengthen the knowledge and evidence base Reduce the incidence of infection Optimize the use of antimicrobial medicines Develop the economic case for sustainable investment Commitments to report progress

13. | Antimicrobial Resistance: Global Surveillance Implementing, monitoring and evaluation  Countries should develop and implement national action plans  “building blocks”  National priorities, circumstances  WHO will develop a framework for monitoring and evaluation  WHO to report every 2 years  Others to develop own action plans and report within normal reporting cycle

14. | Antimicrobial Resistance: Global Surveillance Global Surveillance: Resolution WHA67.25 Urges Member States to: Monitor extent of antimicrobial resistance To develop AMR surveillance systems In patients in hospitals Outpatients in all other healthcare settings and the community Animals and non-human usage of antimicrobials

15. | Antimicrobial Resistance: Global Surveillance Global Surveillance: Draft global action plan for WHA68 Develop a national surveillance system for AMR that: Includes a national reference centre with the ability to systematically collect and analyse data on a core set...... Includes at least one reference laboratory capable of......operating to agreed quality standards Shares information so that national, regional and global trends can be detected and monitored

16. | Antimicrobial Resistance: Global Surveillance Thank you