October 31, 2016
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Addressing AMR in the Global and National
Policy Agenda

OIEIn an expert comment published by Chatham House, Professor David Heymann and Abbas Omaar of the Centre for Global Health Security call for further vaccine development to reduce antimicrobial consumption and address AMR. The authors note that the last three vaccines targeting bacteria developed since the 1980s have led to the prevention of “infection, illness, and death and contributed significantly to reducing the need to prescribe antibiotics.” They recommend that there be dedicated efforts to conducting cost-benefit analyses of vaccine development, ascertaining their value compared with investments for new drug development and stewardship of antimicrobials.
From October 18-19, the World Bank hosted a meeting on “Financing Preparedness: Aligning around a comprehensive framework” that brought together stakeholders “to discuss and articulate practical approaches to mobilize domestic and international resources to support countries strengthen their preparedness and response capacities for major disease outbreaks and health emergencies”, including AMR. The second day of the meeting focused on AMR, with sessions on:
  • Prioritizing investments in AMR prevention
  • Challenges and solutions for effective AMR containment
  • Financing and coordinating AMR interventions at the country level
  • Financing R&D in the context of pandemic threats and AMR
Further information on this meeting and the panelists for each session can be found in the agenda here.
OIEAt the annual World Health Summit held in Berlin from October 9-11, the M8 Alliance called for the endorsement of the political declaration on AMR adopted by the UN General Assembly. The M8 Alliance is a collaboration among 23 academic institutions across 16 countries committed to improving global health. The Alliance further called for a One Health approach to addressing this issue, while also reinforcing the need to “ensure access and affordability.” The 2016 M8 Alliance Declaration can be found here.
The U.S. President’s Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB) held their fourth public meeting on September 19 focused on prevention and stewardship. Here, speakers from various U.S. governmental agencies including the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, U.S. Department of Agriculture, and the Food and Drug Administration spoke on current approaches and policies towards infection prevention and control as well as stewardship across both medical and veterinary settings. The meeting concluded with public comments from stakeholders including from the Natural Resources Defense Council and Consumers Union. Dr. Martin Blaser, Chair of PACCARB closed the meeting stating that while PACCARB had established working groups on incentives for development of therapeutics, diagnostics, and vaccines, “other efforts on prevention and stewardship [would] follow.” A detailed summary of this public meeting can be found here.
OIEOn September 22, Elanco, the veterinary products arm of Eli Lilly and Co., hosted a One Health Summit with over 250 participants across the private and public sector in Washington, D.C. The focus of this meeting was on addressing AMR “as part of efforts to produce a sustainable food supply. The meeting covered three core areas where participants developed next steps towards addressing AMR, including the formation of working groups across these areas. The three core areas address increasing veterinary oversight, improving AMR monitoring and reporting, and accelerating innovation. A press release detailing these three core areas and outcomes as well as response to adoption of the Political Declaration on AMR at the UN General Assembly can be found here
School Food Focus in the United States has recently updated their Certified Responsible Antibiotic Use (CRAU) Standard to certify poultry raised without the use of antibiotics for disease prevention as well as growth promotion. The standard still allows for the use of antibiotics for treatment and control, but as prescribed by a licensed veterinarian with documentation that the animals are diseased or have been exposed to a disease. Companies wishing to meet the CRAU standard in providing poultry to schools, hospitals, or other institutions are regularly audited by the U.S. Department of Agriculture to ensure compliance. According to School Food Focus founder Kathy Lawrence, schools purchase $1 billion worth of chicken every year and leveraging such purchasing power can encourage poultry producers to shift towards responsible production practices.
FEATURE: ARC Members participate in the 7th Meeting of WHO AGISAR (by Steven Roach, Food Safety Program Director at
Food Animal Concerns Trust)
OIEThe 7th Meeting of the WHO Advisory Group on Integrated Surveillance of Antimicrobial Resistance (AGISAR) met in Raleigh, North Carolina in the United States from October 17 to 20.  AGISAR, first convened in December 2008, is a group of 30 internationally renowned experts that provide advice to the WHO on steps to minimize AMR resulting from the use of antimicrobials in food animals. AGISAR has developed and maintained the WHO List of Critically Important Antimicrobials, which ranks drugs by their importance in human medicine to help manage the use of such drugs in food animals.

During this meeting, AGISAR members along with invited international experts updated the WHO List of Critically Important Antimicrobials, updated guidance on integrated surveillance of AMR, and initiated work on a new project aimed at providing technical assistance to low- and middle-income countries in monitoring resistance in people, food animals, and the environment. An important area of discussion was how to take into account recent information on the global spread of transferable resistance from food animal production to humans to the drug of last resort in clinical medicine, colistin. At this same meeting, select members of AGISAR along with other invited experts participated in developing a WHO guideline on the use of antimicrobials in food-producing animals based on the WHO List of Critically Important Antimicrobials. ARC member, Steven Roach attended as a member of AGISAR as well as another ARC member, Dr. David Wallinga as an invited expert on the WHO guideline development. Official reports of the meeting are not yet available but will be shared upon release.
FULL VIDEO: ARC Members participate in the WHO-WTO-WIPO Technical Symposium on AMR
On October 25, WHO-WTO-WIPO co-hosted a sixth technical symposium focused on AMR and how to foster innovation, access, and appropriate stewardship of antibiotics. A full agenda of the event can be found here, which included:
  • An opening session led by the Directors-General of WIPO and WTO as well as outgoing WHO Special Representative for AMR and Assistant Director-General Keiji Fukuda. Following these remarks, Hala Audi, head of the UK Review on AMR team spoke on their work. A full video of this session can be seen here.
  • Panel 1 on "Fostering access and appropriate use" moderated by Suzanne Hill, Director of the WHO Essential Medicines and Health Products. Speakers included Evalina Tacconelli (Professor of Medicine at Universitätsklinikum Tübingen, Tübingen, Germany), Eveline Wesangula (Coordinator of the Global Antibiotic Resistance Partnership - Kenya), and Rob Ahern (Principal Officer of Agricultural Health and Food Safety, Inter-American Institute for Cooperation in Agriculture). A full video of this session can be seen here.
  • Panel 2 on "Business models for antibiotic innovation" moderated by Edward Kwakwa, Senior Director of WIPO Department for Traditional Knowledge and Global Challenges. Speakers included Jean-Pierre Paccaud (Business Development and Legal, Drugs for Neglected Diseases Initiative and WHO/DNDi Global Antibiotic Research and Development Partnership), Viviana Muñoz Tellez (ARC Member and Coordinator of the South Centre Development, Innovation and Intellectual Property Programme), and Brian Woolhouse (Head of Merck Sharp & Dohme Hospital and Acute Care Business). A full video of this session can be seen here.
  • Panel 3 on "Trade policy in support of antimicrobial access and stewardship" moderated by Hoe Lim, Director of the WTO Trade and Environment Division. Speakers included Monique Eloit (Director General of the World Organisation for Animal Health), Lucas Vinícius Sversut (Second Secretary of the Permanent Mission of Brazil to the United Nations Office and other international organizations in Geneva), and Jørgen Schlundt (Professor of Food Science and Technology at Nanyang Technological University, Singapore). A full video of this session can be seen here.

From the Research Bench on AMR

A modeling study published in PLoS Medicine estimates that the total disease burden of six healthcare-associated infections based on point-prevalence data from 2011-2012 is more than that of all other communicable diseases cumulatively in the European Union. Among the six infections examined were pneumonia, urinary tract infections, surgical site infections, neonatal sepsis, primary bloodstream infections, and Clostridium difficile infections. The authors conclude that such modeling could be used to approximate the potential benefit of prevention and control measures on healthcare-associated affections across the region.
Data from the sixth report of the European Surveillance of Veterinary Medicine of the European Medicines Agency showed that between 2011 and 2014, total sales of veterinary antimicrobials decreased by 2.4 percent, while the total sales of medically-important antibiotics rose during this same time period, across 25 countries. In a press release from ARC member organization Alliance to Save Our Antibiotics, Coilin Nunan noted that “[t]he increased use of last-resort and critically important antibiotics is particularly alarming and confirms that reliance on voluntary and softly-softly approaches is not working.”
Researchers at the University of Sydney published a study in Scientific Reports, identifying a potential source of new antibiotics in Tasmanian devil milk. The found that antimicrobial peptides in the milk called cathelicidins were effective against multiple bacterial pathogens, including methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecalis. The researchers speculate that these antimicrobial compounds evolved from the need to protect underdeveloped newborns from bacteria in the mother’s pouch through passive immune transfer in the milk.
Shu Lam, a 25-year old PhD student and her team have reported discovery of a new “structurally nanoengineered antimicrobial peptide polymers (SNAPPs)” in Nature Microbiology. In in vitro studies, compounds were found to be effective against various Gram-negative bacterial strains including the ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter, Pseudomonas aeruginosa and Enterobacter), colistin-resistant, and other multi-drug resistant pathogens. The study found that the antimicrobial activity of SNAPPs is due to these polymers interfering with the bacterial survival process, placing stress on the bacteria causing the pathogens to self-destruct. Further research is needed to develop SNAPPS into antimicrobial agents.
At the 2016 European Respiratory Society International Congress, results from an analysis of 32 observational studies suggest that early antibiotic use in children increases allergy use in adulthood. Researchers examined observational studies published between 1966 and 2015 looking for possible links between antibiotic use in children under 2 years of age and the development of eczema or hay fever over time. This association may be due to the suggested immunomodulatory properties of antibiotics as well as the disruption of the gut microbiome. 

Mobilizing Resources to Address AMR

Elanco, the veterinary products division of Eli Lilly and Co., has announced a partnership with InnoCentive to launch a series of Grand Challenges on alternatives to antibiotics in food animal production. As a requirement for the proposals, the solutions must be either an antibiotic alternative or animal-only antibiotic to prevent, treat, or control specific diseases afflicting cattle, poultry, or swine. Three of the first Challenges focus on prevention or treatment of mastitis in dairy cattle to reduce antibiotic use in the industry, prevention or treatment of Streptococcus suis infections in swine as well as transmission to humans, and prevention, treatment, and control of necrotic enteritis in poultry. Further information about these and upcoming challenges can be found on the Elanco Pavilion here.
On October 7th, the U.S. Centers for Disease Control and Prevention (CDC) announced that it has granted over $14 million for examining “new approaches to combat antibiotic resistance, including research on how the microbiome can be used to predict and prevent infections caused by drug-resistant organisms.” These particular research projects will examine how antibiotic drugs disrupt healthy microbiomes, how such microbiomes put people at risk, and how antibiotic stewardship protects the microbiome.

To subscribe to the monthly ARC Newsletter, please sign up here. Visit the ARC website at abrdeclaration.org to view the Newsletter and get other updates on ARC.

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/Strategic Policy Program at Johns Hopkins Bloomberg School of Public Health. 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 rramach9@jhu.edu.

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