Strategy and Policy Cohesion:

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Strategy and Policy CohesionThe 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

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Drugs Dont WorkAllan Roses, December 2003VP
of Genetics (GSK)

• gt90 of drugs have efficacy in 30-50 of people

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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

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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

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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

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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
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Drivers and Consequences of Antimicrobial
Resistance
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Multidisciplinary Toolkit

• System change
• Training and education
• Evaluation
• Reminders (eg workplace)
• Safety climate
• Adapt to culture

Dr. Didier Pittet
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Allegranzi, Lancet ID Oct 2013
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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
2013-2018
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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

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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 RD.

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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
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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)

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Lancet ID 2013
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US National Goals (A partnership between
healthcare, public health, vetinary medicine,
agriculture, food safety and federal, academic
and industrial research)