The document outlines the World Health Organization's draft global action plan to combat antimicrobial resistance. It acknowledges that antimicrobial resistance is an increasingly serious global health threat. The plan was requested by a World Health Assembly resolution to ensure all countries have the capacity to address antimicrobial resistance. The draft plan includes strategic objectives, guiding principles, targets, and engagement with various stakeholders to develop a coordinated global response to antimicrobial resistance. It will be submitted to the 2015 Health Assembly for approval.
Global action plan to combat antimicrobial resistance
1. Global action plan to combat
antimicrobial resistance
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2. Antimicrobial resistance (AMR)
Increasingly serious global public health threat
Winning the battle in some areas
– Reduced AMR in some countries
– Attention on infection control, use of medicines
– Supported by increasing engagement with agriculture
– Some increase in investment
But losing the war
– AMR everywhere and increasing
– Major knowledge gaps
– Fragmented response
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3. World Health Assembly resolution on AMR
Resolution WHA67.25 requests the Director-General “to develop a draft
global action plan to combat antimicrobial resistance ...
to ensure that all countries ... have the capacity to
combat antimicrobial resistance”.
– Take account of existing action plans and
all available evidence and best practice
– Apply a multisectoral approach through consultation
Planned to be submitted to 2015 Health Assembly
through the Executive Board (January 2015)
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4. Draft global action plan
Includes:
– context, including current progress
– main concerns or priorities for action
– guiding principles and values
– key targets and quantifiable objectives
– monitoring and reporting of progress
– key stakeholders (roles and responsibilities)
– support functions and mechanisms (including WHO role).
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5. Draft global action plan
Based on 6 guiding principles
– Whole-of-society engagement
– Actions based on best available knowledge and evidence
– Prevention first
– Access, not excess
– Sustainability
– Incremental targets for implementation
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6. 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 business case for sustainable investment
Commitments to report on progress and monitor impact
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7. Consultation and
multisectoral engagement
Regional committee sessions
Consultation with Member States, 16 October 2014, Geneva
Consultations led by Member States
– Netherlands, June 2014 – One Health
– Brazil, October 2014 – research and knowledge gaps
– Norway (7 sponsor countries), November 2014 – optimizing use
– Sweden, December 2014 – establishing global surveillance for AMR
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8. Consultation and
multisectoral engagement
Meetings of WHO’s Strategic and Technical Advisory Group on Antimicrobial
Resistance (STAG)
– September 2013, April 2014, October 2014
Bilateral and multilateral engagement
– World Bank, Food and Agriculture Organization of the United Nations (FAO),
World Organisation for Animal Health (OIE) and others to address
the economic impact
A web-based consultation for input in draft action plan
– July–August 2014
– 2nd web call, January 2015
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WHO will lead the development of a draft global action plan that reflects the commitment, perspectives and roles of all relevant stakeholders, and in which everyone has clear and shared ownership and responsibilities.
The action plan is based on six guiding principles:
Whole of society engagement. Antimicrobial resistance will affect every individual, regardless of their health or economic circumstances, lifestyles or behaviours. It will also have an impact on many sectors beyond health including food security, agriculture and animal health, development including economic development. Everyone therefore needs to be engaged in the implementation of this action plan on a personal or professional basis.
Actions need to be based on best available knowledge and evidence. With scarce resources and many competing health and economic priorities, is essential that the actions and investment needed to address antimicrobial resistance are supported wherever possible by clear and compelling evidence or rationale for their benefit and cost-effectiveness. Difficult or costly actions are also too easily avoided or challenged without such evidence. However, the need for action now is clear and must not be delayed because of gaps in scientific evidence or knowledge.
Prevention first. Preventing infection (without use of antimicrobial medicines) has multiple benefits. Every infection prevented is one that does not need treatment whether appropriately or inappropriately, and is also not a source of further infections. Many interventions and practices for the prevention of infection are cost effective and can be implemented in all resource settings and sectors.
Access not excess. The overall goal is to preserve our ability to treat serious infections. In some contexts preserving the effectiveness of antimicrobial medicines means using less. In other settings, poor access to affordable quality assured medicines is currently compromising health outcomes. Actions to address antimicrobial resistance need to take into account the need to maintain equitable access to and appropriate use of existing and new antimicrobial medicines.
Sustainability. Addressing antimicrobial resistance will require long term change and investment, and new practices may need to be maintained indefinitely. Actions are more likely to be sustainable where they are integral to health systems or practices in other sectors, and where there is evidence of continuing health and economic benefit.
Incremental targets for implementation. All countries and other stakeholders need to be able to demonstrate progress towards implementation of the global action plan, whatever their current status. A step-wise approach to targets and performance indicators for implementation of the plan, based on a series of “building-blocks” will allow for different priorities and capacities among Member States and other stakeholders.
The Strategic and Technical Advisory Group (STAG) on antimicrobial resistance has been convened to advise the Director-General on the main areas of concern, priorities for action, and medium- to long-term objectives for inclusion in the draft global action plan. WHO will continue to work with its Strategic and Technical Advisory Group on Antimicrobial Resistance, to engage with a wide range of organizations and experts in order to set out the scientific and policy issues, develop proposals for targets and indicators, and review the draft action plan prior to its submission to the governing bodies in 2015. The next meeting is being planned for 16 to 17 October 2014, and a further meeting prior to the Health Assembly in 2015. http://www.who.int/drugresistance/stag/en/
June 2014: http://www.who.int/drugresistance/netherlands_meeting_june_2014/en/