December 22, 2015
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Table of Contents
  1. Resistance to last-resort antibiotic colistin found in multiple countries among humans, animals, and meat
  2. European Union reports worsening resistance to carbapenems, a last-line antibiotic class
  3. On the global agenda: WHO-DNDi partnership for an antimicrobial research facility, G20 commitment to addressing AMR
  4. UN Secretary General High Level Panel on Access to Medicines Call for Comments
  5. Moving towards implementation of the WHO Global Action Plan in Latin America
  6. UK Review on AMR focuses on antibiotics in agriculture and environmental release
  7. US sales of antimicrobials for food production increases through 2014 despite FDA call for voluntary phase-out of antibiotic growth promoters
  8. CDC calls for government and food industries to increase food safety
  9. FACT Report Finds Most U.S. Turkey Producers Allow Routine Antibiotic Use
  10. Consumers International calls for McDonald's, Subway, and KFC to create global antibiotic policies, while US pork industry pushes back on recent campaigns
  11. MSF leads campaign to reduce pneumococcal vaccine prices
1. Resistance to last-resort antibiotic colistin found in multiple countries among humans, animals, and meat
Yi-Yun Liu et al.Researchers from the South China Agricultural University have discovered a previously unreported plasmid-mediated resistance among food-producing animals in China to colistin, a last-resort antibiotic used for multidrug-resistant infections. Their results, published in the Lancet Infectious Diseases journal, show that unlike earlier incidences of colistin resistance that occurred in chromosomal genes, the resistance mechanism found by Liu in Enterobacteriaceae is plasmid-mediated. This means that the resistance trait can be passed rapidly via horizontal gene transfer, which could allow the gene to spread to bacterial populations around the world. Liu's team has found evidence that resistance has increased in Chinese food animals and retail meat since 2011, and recently, that colistin-resistance is present in human bacterial infections. At the time of publishing, Liu reported that MCR-1 is currently confined to China, but could easily spread globally in the same manner as NDM-1 (a plasmid resistance element that confers broad resistance to beta-lactam antibiotics, which include penicillins, cephalosporins, and carbapenems) or through the trade of animal products produced using antibiotics. In fact, MCR-1 has now been detected in multiple countries. Following submission of the MCR-1 sequence to the open access database ResFinder, several researchers around the world have now matched the genetic information from bacterial isolates from various sources to the MCR-1 sequence published by Liu. ​
During an existing routine surveillance project on food animals, Liu's team detected colistin-resistant E. coli in 2013 in a pig from an industrial farm near Shanghai. They then sampled retail meat from 2011 to 2014, finding that prevalence of MCR-1 resistance in E. coli increased from 4.9% of 206 raw chicken samples and 6.3% of 48 raw pork samples in 2011, to 28% of 75 chicken samples and 22% of 130 pork samples in 2014. They also found that among pig samples taken at slaughter, prevalence of MCR-1 positive isolates increased from 14.4 percent of 216 samples in 2012 to 20.9% of 320 samples in 2014. In 2014, the researchers also found MCR-1 in 16 samples of E. coli and Klebsellia pneumoniae taken from 1,322 hospital inpatients in the Guangdong and Zhejiang provinces. Given the higher proportion of animal resistant isolates, it is likely that the resistance gene originated in animals before being transferred into humans. Using a mouse thigh infection model simulating human colistin doses, the researchers confirmed that MCR-1 can increase colistin resistance in vivo.

As noted by Richard Young of the Sustainable Food Trust, colistin was introduced in the 1950s, but its severe kidney and neurological side effects led to limited use in humans. Drug companies subsequently developed and continue to market colistin for use in livestock production to prevent or treat diarrhea in young pigs, cows, and chickens. According to an industry report cited by Liu, global demand for colistin is expected to increase to 11,942 tonnes per year by the end of 2015, rising to 16,500 tons by 2021. As of now, RUMA (the Responsible Use of Medicines in Agriculture Alliance), a group of 24 farm industry organizations in the UK, has announced voluntary restrictions on colistin use for livestock. Given the risk posed by the potential spread of MCR-1, Liu suggests that countries should adopt AMR risk management frameworks recommended by the Food and Agriculture Organization and Codex Alimentarius Commission.
2. European Union reports worsening resistance to carbapenems, a last-line antibiotic class
The European Center for Disease Prevention and Control published survey results that show the continued spread in Europe of carbapenemease-producing Enterobacteriaceae (also known as carbapenem-resistant enterobacteriaceae (CRE)). 8 countries reported interregional spread, and 3 countries reported that most hospitals repeatedly saw patients who could not be treated with carbapenems. CRE are particularly alarming since the treatment options are limited, such as polymyxin antibiotics (which includes colistin). Consumption of carbapenems and antibiotics overall has continued to increase in Europe. Dr. Andrea Ammon, the acting director of ECDC stated that "CDC is encouraged to see that many EU countries have taken action to combat CPE, with national plans and other measures. However, there is more work to be done at all levels, local, national and European."
3. On the global agenda: WHO-DNDi partnership for an antimicrobial research facility, G20 commitment to addressing AMR
Marc Sprenger, director of the World Health Organization (WHO) secretariat for antimicrobial resistance, wrote in the Guardian about the shared responsibility to address AMR among healthcare and veterinary professionals, people using healthcare, farmers and the agricultural sector, governments, development organizations, and the pharmaceutical industry. In his op-ed, Dr. Sprenger calls attention to the proposal for a global R&D facility on antibiotic resistance, which is taking shape as a joint effort organized by the Drugs for Neglected Diseases Initiative (DNDi) and WHO. The proposal for a global R&D facility on antibiotic resistance received mention in the G7 Health Ministers Declaration in October 2015. This effort to tackle upstream discovery of novel antibiotics as well as ensure affordable access downstream in the healthcare delivery system for patients in need have continued to move forward. DNDi and WHO have shared this proposal at a November 2015 meeting of key stakeholders on incubating a global R&D facility for antibiotic innovation
Lord Jim O'Neill, chair of the UK Review on AMR, has also made a call to action on AMR. He highlights the importance of AMR's mention in the G20 Leaders' communiqué from the Antalya summit in November 2015. In the communiqué, the G20 states agreed about the importance of coordinated response to global health risks including "antimicrobial resistance, infectious disease threats, and weak health systems." According to the communiqué, the G20 will work on AMR this coming year to mitigate its impact on growth and stability. O'Neill suggests that the G20 would be an ideal forum for international action since the countries at risk of facing significant AMR burden include Brazil, Russia, India, and China. Given these developments, O'Neill believes the discussion now needs to focus on how to divide costs among governments, the pharmaceutical industry, health systems, development agencies, and large charitable foundations. The Review on AMR estimates that market-entry rewards for 15 new antimicrobials would cost $16 to $35 billion over 10 years. Based on this, O'Neill argues that "finding about $2 billion a year over ten well within the means of the world's 20 richest countries or 20 of its largest pharmaceutical companies." Such an investment, he says, would be a "small price to pay" relative to the estimated $100 trillion in lost global economic output due to AMR.
4. UN Secretary General High Level Panel on Access to Medicines Call for Comments
United NationsOn December 11, 2015, the United Nations Secretary General's High Level Panel on Access to Medicines held its first meeting New York City, New York. Convening such a panel came following recommendations of the Global Commission on HIV and the Law in  and was also later hinted at in the Secretary General's report on the post-2015 development agenda. The United Nations Development Program will serve as the Secretariat for the High Level Panel. The High Level Panel consists of 16 individuals including former government officials, civil society stakeholders, and academics, where they will be coming together to “recommend solutions for remedying the policy incoherence between the justifiable rights of inventors, international human rights law, trade rules and public health in the context of health technologies.” Co-chairs of the High Level Panel are Ruth Dreifuss, former President of the Swiss Confederation and former Chairperson of the WHO Commission on Intellectual Property Rights, Innovation, and Public Health and Festus Gontebanye Mogae, former President of Botswana and current Chairman of Champions for a HIV Free Generation. The complete list and biosketch of each member of the High Level Panel can be found here.

At the first meeting, the panel reaffirmed its mandate to finding solutions to ensure access to medicines, while also promoting increased development for new treatments for patients worldwide. They also noted that while progress had been made in many areas, millions of patients worldwide continue to suffer from lack of access to life-saving drugs and die. Former President Mogae noted that, "It is a basic fundamental right that everyone should be able to access medicines, vaccines and diagnostics they need in order to ensure healthy lives and promote the well-being of people of all ages, as set out in Sustainable Development Goal 3." The panel also noted that they are not focused solely on low-income countries, but on all countries including high-income countries, as former President Dreifuss stated, "“Even in middle and high-income countries, the cost of lifesaving treatments for hepatitis C and cancer are increasingly out of reach of those who need them."

In addition, a separate Expert Advisory Group was formed, which will provide technical and analytic support to the High Level Panel. Members of the Expert Advisory Group include staff from UN agencies including the World Health Organization, World Trade Organization, World Intellectual Property Organization, United Nations Conference on Trade and Development, United Nations Children's Fund, and others as well as representatives from civil society and academics from institutions around the globe. Within ARC’s circle, Dr. Anthony So from Duke University’s Program on Global Health and Technology Access was among those named to the Expert Advisory Group.

The High Level Panel will be seeking further input for their final recommendations to the Secretary General by calling for and assessing proposals from outside organizations as well as staging a process to further examine shortlisted proposals through two public hearings. The call for proposals will continue until mid-February regarding how "misalignment between the right to health and trade rules can be best addressed." Further details on the call for proposals will be posted on the High Level Panel's website, which is also where proposals can be submitted.
5. Moving towards implementation of the WHO Global Action Plan in Latin America
ReActThe El Salvador Ministry of Health together with Pan American Health Organization (PAHO), ReAct Latin America, and People’s Health Movement of Latin America organized the “First National Encounter for the Formation of a National Platform on Antibiotic Resistance” in San Salvador, El Salvador from December 1-5, 2015. The purpose of this meeting was to promote a multisectoral approach for developing a national action plan for antibiotic resistance in El Salvador aligned with the WHO Global Action Plan. Participants at this conference included officials and technical officers from various departments of the Ministries of Health, Agriculture, Defense, and Education as well as civil society including El Salvador’s National Health Forum. ​
In addition, representatives from ReAct nodes in North America, Europe, Africa, and Southeast Asia were also present to give presentations on various topics including giving an overview of the Antibiotic Resistance Coalition and Declaration as well as a summary of the interventions detailed in the April 2015 WHO-NGO Dialogue; the growing evidence linking the use of antibiotics in food animals and human resistance as well as policy proposals to curb overuse; and best practices from ReAct’s work across the different regional nodes to help frame the process for developing a comprehensive a national action plan to tackle antibiotic resistance. ReAct Latin America also hosted workshops with local civil society organizations on communications tools and community engagement. As a result of this conference, ReAct Latin America was able to build a strong partnership with the El Salvador Ministry of Health to advise them further on this process and also help position their efforts as a model for other countries in the region. Over the next months, the Ministries of El Salvador will come together to draft their national strategy on AMR and host an international meeting for other countries and other stakeholders in the region during the Spring of 2016.
6. UK Review on AMR focuses on antibiotics in agriculture and environmental release

Review on AMRThe United Kingdom Review on Antimicrobial Resistance has released a report on antimicrobials in agriculture and the environment, with recommendations to reduce antibiotic use in animals, increase standards on environmental discharge from antibiotic manufacture, and improve surveillance of AMR. The Review on AMR conducted a literature review on agricultural use, finding that 100 out of the 139 studies reviewed suggest a link between antibiotic consumption in animals and AMR in humans. Recent studies have also shown that antibiotic growth promoters may not impart as much economic benefit as previously thought, especially in countries with higher standards for animal husbandry. 
The report recommends creating a global target to reduce antibiotic use in the production of livestock and fish. Due to the differing political, economic, and cultural conditions around the world, the Review on AMR proposes that individual countries should decide how to meet international targets through a combination of regulations on antibiotic use, taxes on antibiotics, and subsidies to mitigate the transition costs towards better infection control or alternatives to antibiotics. Development of vaccines and rapid diagnostics could also reduce unnecessary use of antibiotics in animals. The report acknowledges that low and middle-income countries may need more time to meet a global target. In addition to measures to reduce antibiotic use in animals, the report calls for restrictions on the use of antibiotics important for human medicine, as well as further research on antimicrobials dedicated to animal use. The current overlap between human and animal antimicrobials is significant, especially since 31 of 41 antimicrobials sold in the US for animal use are classified by the FDA as important for human medicine.

Further, the report calls for rapid development of minimum standards to reduce pollutants released into the environment as a result of antimicrobial manufacturing. Most manufacture of active pharmaceutical ingredients takes place in China and India, where production costs and environmental standards are low. However, antibiotic manufacturing waste can create reservoirs of resistance, putting significant burdens on local communities. Harmonized regulation on antimicrobial waste could be created using existing frameworks such as Good Manufacturing Practice guidelines on medicinal products or hazardous waste guidelines. The report suggests that major buyers could factor in environmental impact into their purchasing decisions.

Lastly, the report stresses the need for improved surveillance to monitor antimicrobial use in agriculture and release from manufacturing. Improved surveillance would help demonstrate the links between these sources of AMR and human health, while also measuring progress against global targets.

7. US sales of antimicrobials for food production increases through 2014 despite FDA call for voluntary phase-out of antibiotic growth promoters
FDAThe US Food and Drug Administration has just published its 2014 report on sales and distribution of antimicrobials approved for use in food-producing animals. The report found that the sales of antimicrobials has continued to increase despite the introduction of the FDA's Guidance for Industry #213 in 2013, which called for a voluntary industry phase-out of the use of medically important antimicrobials for growth promotion. According to the report, US sales and distribution of antimicrobials for animal use increased to 15,358,210 kilograms in 2014. This represents a 22% from 2009 through 2014, with a 4% increase from 2013 to 2014. Sales of medically important antimicrobials increased by 23% from 2009 to 2014, with a 3% increase from 2013 to 2014. Medically important antimicrobials accounted for 62% of these sales in 2014, with tetracyclines comprising 70% of these. The majority of medically important antimicrobials in the US continue to be sold for "Production or Production/Therapeutic Indications", composing 72% of medically important antimicrobial sales both in 2009 and 2014 (increasing from 5.6 to 6.8 million kilograms over this time period).​
The FDA defines "production indications" as use for increased weight gain or improved feed efficiency, and "therapeutic indications" as use for "treatment, control, or prevention of a specific disease." Writing about the new FDA report, Maryn McKenna points out that the distinctions between growth promotion and preventive use remain unclear. As noted in a Pew Charitable Trusts report, 66 of 287 antimicrobials can be used in at least one species of livestock (chickens, turkeys, pigs, or cattle) for disease prevention at doses within the range of growth promotion use. The FDA report also found that the majority of antimicrobials for animal use continued to be sold over-the-counter, only decreasing from 98% in 2009 to 97% in 2014. Susan Vaughn Grooters of Keep Antibiotics Working was quoted, "This troubling trend reaffirms that an approach based largely on voluntary industry reductions, is inadequate faced with the public health crisis of antibiotic resistance. There is no indication that FDA’s change in policy has yet resulted in any meaningful reductions on antibiotic sales and usage in food animal production. Over the counter sales clearly indicate that veterinary oversight couldn’t come soon enough.”

Last month, the US Department of Agriculture Economic Research Service published a study that found the productivity increases associated with the use growth promotion or disease prevention were not statistically significant. The study predicts that restrictions on the use of animal antibiotics would change prices and quantities by less than 1 percent over time. The study also reported on-farm antibiotic information drawn from the USDA-administered Agricultural Resource Management Survey:
  • While the proportion of pigs given antibiotic growth promoters decreased (52 to 40% in finishing hogs, 29 to 23% in nursery hogs), the share of operations stating that they did not know or report antibiotic use increased from 7 to 22% for finishing hog producers and 5 to 20% for nursery hog producers.
  • Between 2006 and 2011, the proportion of broiler chickens producers who did not use antibiotics except for disease treatment or rose from 42 to 48% with a "don't know" response rate increasing from 29 to 32%.
  • 15.8% of beef/cow-calf operations (which raise calves for sale into feedlots) use antibiotics for growth promotion. However, 49% of cattle at large-scale feedlots (1,000 head or more) were given antibiotics for "production purposes" in 2011 compared to 38% for operations smaller than 1,000 head in 2011. In both 1994 and 2011 surveys of beef feedlots, nearly three quarters of large-scale feedlots gave antibiotics in feed or water, including for growth promotion and disease prevention, though the exact distribution for purpose of administration was not reported.
  • In 2007, 90.1% of dairy operations provided antibiotics for disease prevention.
The USDA study drew upon controlled experiments, observational studies, and examinations of the outcomes following European bans of antibiotic growth promoters.
8. CDC calls for government and food industries to increase food safety
CDC Vital SignsThe CDC released a set of recommendations for improving food safety in its most recent Vital Signs report, which highlights the unique danger of multi-state outbreaks. In October, the U.S. Centers for Disease Control and Prevention (CDC) reported new multi-state outbreaks of Shigellosis, a multidrug resistant bacteria that causes severe intestinal illness. Now, the CDC is calling for more concerted action from government and food industries to stem the rising tide of multi-state foodborne pathogen outbreaks. On average, these outbreaks occur 24 times annually and cause 56% of deaths associated with foodborne illness, and have affected up to 37 states at one time. Furthermore, the Vital Signs report found that the pathogens associated with multi-state outbreaks - Salmonella, E. coli, and Listeria - are more dangerous than those associated with single-state outbreaks. These three pathogens cause 91% of multi-state outbreaks and can contaminate a wide variety of foods, including unexpected products such as caramel apples and chia powder. ​
The CDC report recommends more government-led investigations of multi-state outbreaks, claiming that these investigations can reveal problems at the food production stage, processing stage, or distribution stage that lead to contamination. The report commends recent efforts by the USDA Food Safety and Inspection Service to monitor foodborne pathogens through DNA sequencing technology that traces contaminated foods back to their source, as well as improved food inspection regulations. The CDC calls for a more collaborative effort among federal agencies like the USDA and FDA, state and local health agencies, food industries, and healthcare providers to prevent future multi-state outbreaks. Recommendations for food industries include keeping detailed records to trace foods from source to destination, sourcing food from suppliers that use best food safety practices, and publicly recalling products that may be linked to an illness outbreak. Health agencies, providers, and individuals can work together to promptly report any food-associated sickness and submit germs from sick people to public health labs for testing.
9. FACT Report Finds Most U.S. Turkey Producers Allow Routine Antibiotic Use
Food Animal Concerns TrustJust in time for this past U.S. Thanksgiving holiday, the Food Animal Concerns Trust (FACT) released a report revealing the use of antibiotics for turkey growth promotion by the top 20 turkey producers in the United States. FACT, which is a part of the Keep Antibiotics Working Coalition, elected to survey drug use in turkey production because the meat is often claimed to be “healthier” than other meats, but the chemicals used in its production may negate this claim. FACT contacted the 20 largest U.S. turkey producers and inquired about their use of antibiotics for both growth promotion and disease prevention. The organization also asked about use of the veterinary drug nitarsone and the artificial growth promoter ractopamine, which can both be harmful to human and animal health.​
The report found that only two of the top 20 companies, Hain Pure Protein and Tyson Foods, prohibit routine use of antibiotics for disease prevention and growth promotion. The companies Cargill, Jennie-O, Foster Farms, and Norbest reported that they prohibit antibiotic use for growth promotion, but not for disease prevention. The remaining 14 turkey companies did not report any policies limiting use of antibiotics for either growth promotion or disease prevention.  Ractopamine is an artificial growth promoter that has been linked to increased mortality in turkeys, and has been banned in several countries due to its human health risks including heart problems and reproductive deficiencies. Nine of the surveyed companies reported no use of ractopamine in turkeys, but the remaining 11 refused to respond to the question about ractopamine use.  The veterinary drug nitarsone is an arsenical feed additive that was used in turkey feed at the time that FACT started collecting information for their report. In April 2015, the FDA announced that nitarsone will be withdrawn from the feed market by the end of the year. For this reason, FACT did not report any findings on nitarsone use in turkey producers.

FACT Food Safety Program Director Steve Roach commented, “this report shows that most turkey companies have not committed to ending routine antibiotic use on their farms.” Roach urged consumers to seek out more information about the drugs used in the turkey and other meat products that they consume. The FACT report concluded with recommendations for consumers, including avoiding turkey companies that allow antibiotics and ractopamine use, and seeking out companies that are transparent about turkey production practices and produce under a third-party-verified humane certification. Humane certifications require that animals are raised according to species-specific welfare standards, including restricted or prohibited use of all antibiotics and growth hormones. FACT’s Guide to Common Food Labels provides a breakdown of which certifications and food labels are backed up by independent verification and which are misleading and unverified. 
10. Consumers International calls for McDonald's, Subway, and KFC to create global antibiotic policies, while US pork industry pushes back on recent campaigns
Consumers InternationalConsumers International (CI) launched a campaign to coincide with World Antibiotic Awareness Week (November 16-22, 2015) demanding that restaurant chains McDonald's, Subway, and KFC stop sourcing meat and poultry raised with the routine use of antibiotics used in human medicine. CI sent letters to Steve Easterbrook, CEO of McDonald's; Suzanne Greco, president of Subway; and Greg Creed, CEO of Yum! Brands (owner of KFC). In March 2015, McDonald's announced that their US and Canadian restaurants will no longer serve chicken raised with antimicrobials defined by the WHO as critically important to human medicine or antibiotic growth promoters or by March 2017. However, the policy allows for the use of antimicrobials used in human medicine for treatment or prevention when used under a "veterinary-developed animal health care program." In October, Subway announced a policy to eliminate the use of antibiotics for meat served in its US locations - chicken by the end of 2016, turkey between 2018 and 2019, and pork and beef by 2025. As of now, KFC does not have a publicly available antibiotic policy, leading to their failing grade in the Chain Reaction scorecard in September.​
In the three letters, CI asks each company to go further in their policies by making a "meaningful global commitment" that includes all worldwide restaurant locations and all meat products served. Specifically, the letters call for:
  1. A time-bound action plan to phase out the routine use of antibiotics used in human medicine and,
  2. Third-party auditing to measure progress in meeting such an antibiotic use policy.
In addition to these letters, CI led an effort among 31 consumers organizations in 29 countries (including in Africa, Asia, Europe, the Middle East, and Latin America) to send letters to local company headquarters to create consumer pressure on antibiotic resistance. CI's letters to the CEOs of McDonald's, Subway, and KFC have asked for a response by December 23.

In the wake of Subway committed to removing antibiotics from its US supply chain, the National Pork Producers Council and the National Pork Board ran a full-page advertisement in the Wall Street Journal asking Subway to take "a more balanced approach" to antibiotics rather than banning them entirely. Commenting on behalf of Keep Antibiotics Working, Steve Roach stated, “Our policy has always been that it has been appropriate to use antibiotics to treat sick animals. We’ve never asked them to not use antibiotics to treat sick animals.” Roach stated that there may be overlap in the goals of public health groups and the concerns of producers - to restrict antibiotic use to treatment of sick animals, and to stop routine subtherapeutic antibiotic administration for disease prevention or growth promotion.

Meanwhile,the US National Pork Board recently announced a seven-member panel on antibiotic research and education. Three members are currently professors at veterinary schools in the US, three are sourcing or sustainability managers with McDonald's, Subway, and Walmart; and one is the former director of the CDC office of antimicrobial resistance. The panel is intended to be a third-party expert body to review the use of antibiotics in the pork industry and advise the National Pork Board in prioritizing research and producer education programs. The National Pork Board released a Three-Point Stewardship Plan in June 2015, which sets the goals of educating producers on compliance with new FDA rules, conducting epidemiological and risk assessment research, and communicating within and outside of the pork supply chain on industry progress about responsible antibiotic use. 
11. MSF leads campaign to reduce pneumococcal vaccine prices
This Absurd Way of Doing Business is Actually a Reality...
Watch MSF's campaign video: "This Absurd Way of Doing Business is Actually a Reality..."
On World Pneumonia Day on November 12, 2015, Médecins Sans Frontières (MSF) launched a global campaign targeting Pfizer and GlaxoSmithKline, asking the companies to reduce the price of the pneumococcal vaccine to $5 per course per child in all developing countries and for use by humanitarian aid organizations. For the launch, MSF organized a rally outside of Pfizer’s headquarters in New York, NY where they delivered $17 million in fake cash, representing the more than $17 million in sales per day the company earns from the pneumonia vaccine, to CEO Ian Reed. The organization placed an advertisement at a bus stop in front of the Pfizer headquarters, which reads, “Hey Pfizer, why are your vaccines priced out of reach of children in need?” According to the Centers for Disease Control and Prevention (CDC), the pediatric pneumococcal vaccine or Prevnar 13 costs over $450 per child for the full three-dose course of treatment. Pneumonia continues to be the leading cause of death in children, killing over 1 million children per year.​
According to a report released by MSF in January 2015 entitled “The Right Shot: Bringing Down Barriers to Affordable and Adapted Vaccines”, the organization found that it is 68 times more expensive to vaccinate a child in 2001 compared to 2015, with the addition newer, high-priced vaccines like Prevnar 13. Later this year, Member States also adopted a resolution at the World Health Assembly in May 2015 calling for more affordable vaccines as well as transparency around vaccine prices, with many governments stated that the high prices of such new vaccines was threatening the sustainability of their immunization programs and even restricting some from introducing such programs. A study released in The Lancet special series on antimicrobial resistance during World Antibiotic Awareness Week also found that universal coverage with a pneumococcal vaccine could avert over 11 million days of antibiotics for pneumonia in children younger than 5 years per year and almost 50 percent reduction in incidence in 75 countries.

A Pfizer spokesperson responded to the demonstration saying that the company works with charities to offer the vaccine at a discounted rate and that it currently sells the vaccine to the poorest countries for a tenth of the price as it offers to developed countries. Al Jazeera America, which wrote a piece on the MSF rally in November, noted that the spokesperson did not provide the global average price of the vaccine, instead stating that, “Prices vary by market depending on the healthcare system and health needs of local populations.” In its press release accompanying the rally and action, MSF also states that it had engaged in “years of fruitless negotiations” with Pfizer and GlaxoSmithKline to lower the price of vaccine for use by MSF in its projects developing countries and during humanitarian crises. Here, MSF urges the public to put pressure on these companies by signing a global petition asking the companies to lower the price, which you can sign here. MSF also released an accompanying video, highlighting the secrecy behind vaccine prices, further restricting fair and affordable prices for vaccines in developing countries and to humanitarian organizations.

Note: The ARC Newsletter will periodically capture key meetings and developments, as well as news and resources, on antibiotic resistance for Coalition members and partners. This newsletter is prepared and published through ReAct North America and the Program on Global Health and Technology Access at the Sanford School of Public Policy at Duke University. The ARC Declaration on Antibiotic Resistance can be found here. Please share items for consideration for inclusion in future newsletters by writing to Reshma Ramachandran at