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AMR Global Overview
and Action Plan
Dr Khanchit Limpakarnjanarat
WHO Representative to Indonesia
Seminar on AMR, Balai Kartini, 5 August 2015
World Health Organization | 05-Aug-20152 |
Presentation Outline
1. Global and Regional Overview
2. The Global Action Plan on AMR
3. Framework for Action on AMR
4. Summary
World Health Organization | 05-Aug-20153 |
AMR …..(1)
 Irrational use is main driver of selection pressure that
contributes to Antibiotic resistance:
– 50% antibiotics are prescribed inappropriately;
– 50% patients have poor compliance;
– 50% of populations do not have access to essential
antibiotics;
– 50% of antibiotics in some countries are used for
animal growth promotion;
World Health Organization | 05-Aug-20154 |
AMR…..(2)
 Alexander Fleming, inventor of Penicillin (1881–1955)
* http://www.nobelprize.org/nobel_prizes/medicine/laureates/1945/fleming-lecture.pdf
“ The time may come when penicillin
can be bought by anyone in the shops.
Then there is a danger that the
ignorant man may easily under dose
himself and by exposing his microbes
to non lethal quantities of the drug
make them resistant..” (Alexander
Fleming, Nobel Lecture, Dec 11,
1945)*
World Health Organization | 05-Aug-20155 |
Global and Regional Overview…(1)
“This (AMR) is the single greatest
challenge in infectious diseases
today….This is happening in all parts
of the world, so all countries must do
their part to tackle this global threat.”
“While there is a lot to be
encouraged by, much more work
needs to be done to combat one
of the most serious global health
threats of our time…” Dr Keiji Fukuda,
WHO’s ADG for Health Security
World Health Organization | 05-Aug-20156 |
Global and Regional Overview…(2)
 In 2013, there were estimated 480,000
new cases of MDR-TB globally with
210,000 deaths. 3.5% of new and
20.5% of previously treated TB cases
are estimated to have MDR-TB. On
average, an estimated 9% of people
with MDR-TB have XDR-TB.
 As of 2010, pre-treatment resistance to
HIV among adults were about 5%. Since
then, reports suggesting that pre-
treatment resistance is increasing,
peaking at 22% in some areas;
World Health Organization | 05-Aug-20157 |
Global and Regional Overview…(3)
 High proportions of antibiotic resistance in bacteria that
cause common infections (e.g. urinary tract infections,
pneumonia, bloodstream infections);
 A high percentage of hospital-acquired infections are
caused by highly resistant bacteria such as methicillin-
resistant Staphylococcus aureus (MRSA) or multidrug-
resistant Gram-negative bacteria.
World Health Organization | 05-Aug-20158 |
Global and Regional Overview…(4)
World Health Organization | 05-Aug-20159 |
Invention of New Antibiotics
Will it be the End of the Road?
Golden Era of
Antibiotics Invention
Only few new ABs
were invented
World Health Organization | 05-Aug-201510 |
Global and Regional Overview…(6)
WHO report on Worldwide country
situation analysis (April ‘15) focusing to
country progress on:
 Comprehensive, financed national plan with
accountability and civil society engagement.
 Surveillance and laboratory capacity;
 Access to essential medicines of assured
quality;
 Regulation and promotion of rational use of
medicines, and ensure proper patient care;
 Infection prevention and control;
 Innovation, research and new tools.
World Health Organization | 05-Aug-201511 |
WHO Report 2015
Countries Involved in the Analysis
http://apps.who.int/iris/bitstream/10665/163468/1/9789241564946_eng.pdf?ua=1&ua=1
World Health Organization | 05-Aug-201512 |
WHO Report 2015
(i) Countries with Financed National Plan
45%
World Health Organization | 05-Aug-201513 |
WHO Report 2015
(ii) Countries with Surveillance and Lab Capacity….(1)
 No and % of Member States that had conducted AMR surveillance
World Health Organization | 05-Aug-201514 |
WHO Report 2015
(ii) Countries with Surveillance and Lab Capacity….(2)
Member States
which developed
reports on
surveillance for
antimicrobial
resistance (in the
past 5 years)
36%
World Health Organization | 05-Aug-201515 |
WHO Report 2015
(iii) Access to Quality-assured Antimicrobial Medicines…(1)
 Countries with National Regulatory Authority
81.8%
54.5%
63.6%
World Health Organization | 05-Aug-201516 |
WHO Report 2015
(iii) Access to Quality-assured Antimicrobial Medicines…(2)
 No and % of Member States that had a list of essential medicines
World Health Organization | 05-Aug-201517 |
WHO Report 2015
(iv) Use of Antimicrobial Medicines
%
%
%
%
World Health Organization | 05-Aug-201518 |
WHO Report 2015
(v) Promotion of Public Awaraness on AMR
No. and % of Member States that had conducted a campaign about
use of antimicrobial medicines in the previous 2 years
45.4%
World Health Organization | 05-Aug-201519 |
WHO Report 2015
(vi) Infection Prevention and Control Programme
63.6%
81.8%
World Health Organization | 05-Aug-201520 |
The Global Action Plan on AMR…(1)
 Rationale: AMR (including antibiotic resistance, the most
urgent drug resistance trend) is occurring everywhere in
the world, compromising the ability to treat infectious
diseases.
 Goal: to ensure, for as long as possible, continuity of
successful treatment and prevention of infectious diseases
with effective and safe medicines that are quality-assured,
used in a responsible way, and accessible to all who need
them.
 Has been endorsed at 68th WHA (2015)
World Health Organization | 05-Aug-201521 |
The Global Action Plan on AMR…(4)
The five strategic objectives :
1. Improve awareness and understanding of AMR
(OneHealth);
2. Strengthen the knowledge and evidence base through
surveillance and research (human and animal);
3. Reduce the incidence of infection (IPC);
4. Optimize the use of antimicrobial agents (action plan);
and
5. Develop the economic case for sustainable investment
in new medicines, diagnostic tools, vaccines and other
interventions (med, diagnosis, vaccine).
World Health Organization | 05-Aug-201522 |
INDONESIA: Way Forward
1. Advocate to all stakeholders – AMR is a global issue;
2. Adapt the Global AMR Action Plan into a comprehensive
National AMR Action Plan;
3. Develop necessary policies and regulations to support the
implementation of National AMR Action Plan;
4. Resource mobilization to adequately finance the National
AMR Action Plan;
5. Actively engage all relevant ministries and bodies within the
government, private institutions, International agencies,
Professional Organizations, NGOs, CSOs and wider-
community to implement the National Action Plan.
World Health Organization | 05-Aug-201523 |
Summary
 AMR is a serious threat to global public health;
 AMR is caused natural phenomenon that is propagated by
several factors that can be prevented;
 AMR threatens the prevention and treatment of infections that
may lead to higher morbidity, mortality and economic loss;
 AMR - The Global Action Plan is reference to develop
‘Country Action Plans’ involving all relevant government
sectors and society;
 AMR Program M&E to measure effectiveness;
 AMR can be effectively tackle by International collaboration.
World Health Organization | 05-Aug-201524 |
THANK YOU

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WHO - AMR Global Overview and Action Plan

  • 1. AMR Global Overview and Action Plan Dr Khanchit Limpakarnjanarat WHO Representative to Indonesia Seminar on AMR, Balai Kartini, 5 August 2015
  • 2. World Health Organization | 05-Aug-20152 | Presentation Outline 1. Global and Regional Overview 2. The Global Action Plan on AMR 3. Framework for Action on AMR 4. Summary
  • 3. World Health Organization | 05-Aug-20153 | AMR …..(1)  Irrational use is main driver of selection pressure that contributes to Antibiotic resistance: – 50% antibiotics are prescribed inappropriately; – 50% patients have poor compliance; – 50% of populations do not have access to essential antibiotics; – 50% of antibiotics in some countries are used for animal growth promotion;
  • 4. World Health Organization | 05-Aug-20154 | AMR…..(2)  Alexander Fleming, inventor of Penicillin (1881–1955) * http://www.nobelprize.org/nobel_prizes/medicine/laureates/1945/fleming-lecture.pdf “ The time may come when penicillin can be bought by anyone in the shops. Then there is a danger that the ignorant man may easily under dose himself and by exposing his microbes to non lethal quantities of the drug make them resistant..” (Alexander Fleming, Nobel Lecture, Dec 11, 1945)*
  • 5. World Health Organization | 05-Aug-20155 | Global and Regional Overview…(1) “This (AMR) is the single greatest challenge in infectious diseases today….This is happening in all parts of the world, so all countries must do their part to tackle this global threat.” “While there is a lot to be encouraged by, much more work needs to be done to combat one of the most serious global health threats of our time…” Dr Keiji Fukuda, WHO’s ADG for Health Security
  • 6. World Health Organization | 05-Aug-20156 | Global and Regional Overview…(2)  In 2013, there were estimated 480,000 new cases of MDR-TB globally with 210,000 deaths. 3.5% of new and 20.5% of previously treated TB cases are estimated to have MDR-TB. On average, an estimated 9% of people with MDR-TB have XDR-TB.  As of 2010, pre-treatment resistance to HIV among adults were about 5%. Since then, reports suggesting that pre- treatment resistance is increasing, peaking at 22% in some areas;
  • 7. World Health Organization | 05-Aug-20157 | Global and Regional Overview…(3)  High proportions of antibiotic resistance in bacteria that cause common infections (e.g. urinary tract infections, pneumonia, bloodstream infections);  A high percentage of hospital-acquired infections are caused by highly resistant bacteria such as methicillin- resistant Staphylococcus aureus (MRSA) or multidrug- resistant Gram-negative bacteria.
  • 8. World Health Organization | 05-Aug-20158 | Global and Regional Overview…(4)
  • 9. World Health Organization | 05-Aug-20159 | Invention of New Antibiotics Will it be the End of the Road? Golden Era of Antibiotics Invention Only few new ABs were invented
  • 10. World Health Organization | 05-Aug-201510 | Global and Regional Overview…(6) WHO report on Worldwide country situation analysis (April ‘15) focusing to country progress on:  Comprehensive, financed national plan with accountability and civil society engagement.  Surveillance and laboratory capacity;  Access to essential medicines of assured quality;  Regulation and promotion of rational use of medicines, and ensure proper patient care;  Infection prevention and control;  Innovation, research and new tools.
  • 11. World Health Organization | 05-Aug-201511 | WHO Report 2015 Countries Involved in the Analysis http://apps.who.int/iris/bitstream/10665/163468/1/9789241564946_eng.pdf?ua=1&ua=1
  • 12. World Health Organization | 05-Aug-201512 | WHO Report 2015 (i) Countries with Financed National Plan 45%
  • 13. World Health Organization | 05-Aug-201513 | WHO Report 2015 (ii) Countries with Surveillance and Lab Capacity….(1)  No and % of Member States that had conducted AMR surveillance
  • 14. World Health Organization | 05-Aug-201514 | WHO Report 2015 (ii) Countries with Surveillance and Lab Capacity….(2) Member States which developed reports on surveillance for antimicrobial resistance (in the past 5 years) 36%
  • 15. World Health Organization | 05-Aug-201515 | WHO Report 2015 (iii) Access to Quality-assured Antimicrobial Medicines…(1)  Countries with National Regulatory Authority 81.8% 54.5% 63.6%
  • 16. World Health Organization | 05-Aug-201516 | WHO Report 2015 (iii) Access to Quality-assured Antimicrobial Medicines…(2)  No and % of Member States that had a list of essential medicines
  • 17. World Health Organization | 05-Aug-201517 | WHO Report 2015 (iv) Use of Antimicrobial Medicines % % % %
  • 18. World Health Organization | 05-Aug-201518 | WHO Report 2015 (v) Promotion of Public Awaraness on AMR No. and % of Member States that had conducted a campaign about use of antimicrobial medicines in the previous 2 years 45.4%
  • 19. World Health Organization | 05-Aug-201519 | WHO Report 2015 (vi) Infection Prevention and Control Programme 63.6% 81.8%
  • 20. World Health Organization | 05-Aug-201520 | The Global Action Plan on AMR…(1)  Rationale: AMR (including antibiotic resistance, the most urgent drug resistance trend) is occurring everywhere in the world, compromising the ability to treat infectious diseases.  Goal: to ensure, for as long as possible, continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way, and accessible to all who need them.  Has been endorsed at 68th WHA (2015)
  • 21. World Health Organization | 05-Aug-201521 | The Global Action Plan on AMR…(4) The five strategic objectives : 1. Improve awareness and understanding of AMR (OneHealth); 2. Strengthen the knowledge and evidence base through surveillance and research (human and animal); 3. Reduce the incidence of infection (IPC); 4. Optimize the use of antimicrobial agents (action plan); and 5. Develop the economic case for sustainable investment in new medicines, diagnostic tools, vaccines and other interventions (med, diagnosis, vaccine).
  • 22. World Health Organization | 05-Aug-201522 | INDONESIA: Way Forward 1. Advocate to all stakeholders – AMR is a global issue; 2. Adapt the Global AMR Action Plan into a comprehensive National AMR Action Plan; 3. Develop necessary policies and regulations to support the implementation of National AMR Action Plan; 4. Resource mobilization to adequately finance the National AMR Action Plan; 5. Actively engage all relevant ministries and bodies within the government, private institutions, International agencies, Professional Organizations, NGOs, CSOs and wider- community to implement the National Action Plan.
  • 23. World Health Organization | 05-Aug-201523 | Summary  AMR is a serious threat to global public health;  AMR is caused natural phenomenon that is propagated by several factors that can be prevented;  AMR threatens the prevention and treatment of infections that may lead to higher morbidity, mortality and economic loss;  AMR - The Global Action Plan is reference to develop ‘Country Action Plans’ involving all relevant government sectors and society;  AMR Program M&E to measure effectiveness;  AMR can be effectively tackle by International collaboration.
  • 24. World Health Organization | 05-Aug-201524 | THANK YOU

Editor's Notes

  1. Slide 21: GAP on AMR SO1: Increase public communication programs that target different audiences in human health, animal health and agricultural sectors; Ensure AMR is a core component of professional education, training, certification and development for the health, veterinary, and agricultural practices; Include AMR in school curricula and ensure that public media are provided with accurate and relevant information; Ensure that AMR is recognized as a priority across all government ministries. Measure of Effectiveness: Reduction of global consumption of antibiotics in Humans and use in Animals SO2 Evidence based: Develop a national surveillance system for AMR and as part of IHR 2005; Implement global research agenda on AMR (responsible use of antimicrobials, infection prevention in human and animal, and development of novel diagnostics and antimicrobial medicines. Measure of Effectiveness: reduction in the prevalence of AMR SO3 reduce incidence of infection: Strengthen hygiene and infection prevention and control (IPC) in health care facilities; Include training and education in hygiene and IPC as core (mandatory) for health care and veterinary professional education and trainings; Ensure AMR national surveillance includes data on antimicrobial susceptibility of pathogens causing health care-associated infections; Promote vaccination as a method of reducing infections in food animals. Measure of Effectiveness: reduction in the prevalence of preventable infections, and in particular the incidence of drug-resistant infections in health care settings SO4 optimal use: Develop and implement comprehensive action plans on antimicrobial resistance that incorporate the following elements: data on use of antimicrobial agents in human and animal health;+prescription, distribution and dispensing of antimicrobials is carried out by accredited health or veterinary professionals; +marketing authorization is given only to antimicrobial agents that are quality assured, safe and efficacious; +development and use of WHO Model Lists of Essential Medicines, reimbursement lists and standard treatment guidelines; Measure of Effectiveness: extent of reduction in global consumption of antibiotics in human and animals (for food production and other purposes) SO5 sustainable investment: assess investment needs for implementation of national action plan on AMR and develop plans to secure the financing; participate in international collaborative research on the development of new medicines, diagnostic tools and vaccines Measure of Effectiveness: sustainable investment in capacity to counter AMR including in development of new medicines, diagnostics and other interventions
  2. World Health Day 2011 was dedicated for Anti Microbial Resistance issue with the tag line “No action today, No cure tomorrow’