November 30, 2016
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Newsletter of the Antibiotic Resistance Coalition (ARC)

Table of Contents (click on links to jump to sections)

ARC Highlights from World Antibiotic Awareness Week (November 14-20)

During World Antibiotic Awareness Week (WAAW), ARC members launched a number of actions and materials to bring awareness around specific issues related to AMR. Some highlights from this week include:

The Alliance to Save Our Antibiotics coordinated a letter alongside Medact from doctors to the UK government calling for a ban on preventative prescription of antibiotics in food animals, which was published in the Telegraph and also covered on the front page of the national newspaper. Signatories of this letter include 12 royal medical colleges, the Faculty of Public Health, the British Medical Association, and two prominent health journals. More information in their accompanying press release. Emma Rose, Campaigns, Lobbying and Communications Specialist for the Alliance to Save Our Antibiotics and Jane Dacre, President of the Royal College of Physicians were also interviewed about this letter on BBC radio programs.
Additionally, the Alliance to Save Our Antibiotics and Compassion in World Farming launched a series of animations and action pages calling for national governments to ban the routine prophylactic mass medication in livestock and curb farm use of critically-important antibiotics. Here are the UK, Czech, French, and Italian pages.
The Alliance also released an investor briefing with Farm Animal Investment Risk and Return and Aviva Investors outlining the “investment risks associated with farm antibiotic use.” The report also puts forward recommendations for investments on how they might be able to engage with companies to lessen this risk and compel changes in the farm, food, and pharmaceutical industries. As the report states, “The global investment community has a key role to play in driving positive change. By engaging with companies on the issue of farm antibiotic use, investors can exert significant positive pressure on these actors, thereby contributing to the long-term health and stability of the food, farm and pharmaceutical markets.”
OIE

Universities Allied for Essential Medicines (UAEM) also positioned their annual Access to Medicines Week around WAAW where students around the world called for reform of the R&D system for antibiotics and others drugs. During this week, UAEM released a position paper on AMR and R&D as well as a series of social media graphics and videos highlighting the lack of novel antibiotic innovation. Over the course of the week, UAEM hosted a series of panel discussions at universities around innovation and access related to AMR, including a global webinar that included Kevin Outterson, Executive Director of CARB-X and Law Professor at Boston University and Reshma Ramachandran, Assistant Scientist at the Johns Hopkins Bloomberg School of Public Health and ReAct Strategic Policy Program. Later in the week, UAEM students at McGill University also staged a wedding proposal to highlight the barriers to accessing medicines worldwide.
OIEOn November 15th, the U.S. Public Interest Research Group (PIRG) put together a panel event at Yale University that included various perspectives on how to combat antibiotic resistance. Speakers on the panel were Matt Wellington - Field Director for U.S. PIRG’s Antibiotics Program, Chris Carroll - Chief Advertising Officer for Subway Restaurants, Dr. Nicholas Bennett - Co-Director of the Antimicrobial Stewardship Program at Connecticut Children’s Medical Center, and Dr. Melinda Pettigrew - Yale School of Public Health. Dr. Pettigrew and Dr. Bennett emphasized that combatting antibiotic resistance requires real action to reduce unnecessary antibiotic use in both healthcare and agriculture. Mr. Carroll also noted that Subway decided to phase out meat raised on antibiotics from its U.S. locations not only because of consumer demand but because it’s the right thing to do for public health.
OIEBesides this, the U.S. PIRG also presented a case study at the American Medical Student Association (AMSA) annual fall conference in New York City on November 19th on the consumer campaigns to convince major restaurants to phase out meat raised on routine antibiotics from their supply chains. Matt Wellington addressed more than one hundred medical and pre-med students around the importance of the medical community voice on this issue, and what U.S. PIRG is doing to amplify it. Major restaurants care deeply about where the medical community stands because such a voice can drastically impact consumer opinion. Many restaurants are also vying for millennials’ business; medical students often fall into both of these important constituencies—young people and medical professionals. Through this workshop, U.S. PIRG demonstrated how the next generation of the medical community, particularly AMSA, can play a critical role in moving major restaurants to help preserve antibiotics and their effectiveness.

On November 16th, Consumers International published an open letter to the CEOs of Subway, KFC, and McDonald's
urging them to prohibit suppliers from using antibiotics in their food animals for disease prevention and growth promotion, and only when an illness has been diagnosed. They also called for these companies to globalize their commitments to phasing out such uses of antibiotics and to develop timetables for actions with specific targets. A slightly shorter version of the letter was published on the letters page of The Guardian, while a longer version was posted on Consumers International’s website. Signatories to the letter included a number of ARC members including Food Animal Concerns Trust, ReAct, and US PIRG. In addition to this, Consumers International also launched an AMR Quiz in multiple languages asking people to test their knowledge about antibiotics in the food chain as part of the #AntibioticsOfftheMenu campaign.
Jean Halloran, Director of Food Policy Initiatives at Consumers Union participated in an event on “Advocating for Appropriate Antibiotic Use” in New York hosted by the WHO Office at the UN on November 16th. Participants at this event included UN agencies, country missions, local government officials, industry, and civil society. Jean specifically spoke on the findings of the Chain Reaction II report and scorecard, noting the continued high use of antibiotics in fast food restaurants. She also highlighted the role of consumer campaigns in shifting such policies and the need for policies to be globalized outside of the United States. Other speakers at this event included H.E. Judith Arrieta Munguia of the Permanent Mission of Mexico to the UN, Dr. Theoklis Zaoutis who serves as the Chief of Infectious Diseases at the Children’s Hospital of Philadelphia, Dr. Jay Varma who serves as the Deputy Commissioner for Disease Control at the New York City Department of Health and Mental Hygiene, Carla Mucavi who serves as the Director of the New York Liason Office of the Food and Agricultural Organization, and a representative from Panera Bread. The event was moderated by Dr. Nata Menabde, Executive Director of the WHO Office at the UN. Photos of the event can be found here.
OIEHealth Care Without Harm also launched a series of activities during WAAW: Health Care Without Harm and the Clinician Comprehensive Antibiotic Stewardship Collaborative collected clinician stories about their experience with AMR to motivate transformative policy change. Each day during WAAW, the organizations posted a new story in their Storify stream from health professionals across the United States on AMR and their work preventing the misuse and overuse of these critical lifesaving medicines in clinical care and animal agriculture. Health Care Without Harm also worked with hospitals in calling attention to purchasing food products without the routine use of antibiotics. As part of this, they developed visual materials for hospitals to display in their dining area, a social media guide, and educational materials to educate consumers and peers about antibiotic stewardship.
ReAct-Action on Antibiotic Resistance and the Dag Hammarskjold Foundation (DHF) sent communications during WAAW to Werner Obermeyer, Deputy Director at the WHO Office at the UN and David Nabarro, the Special Adviser on 2030 Agenda for Sustainable Development in the UN Secretary-General's office regarding the process for establishing the UN Inter-Agency Coordination Group on AMR. ReAct and DHF have called for there to be safeguards established to protect against conflict of interest, that the process for establishing the terms of reference be inclusive of civil society, and that there be an independent Scientific Advisory Committee established to support this coordination group.

FEATURE: 7th Meeting of WHO Strategic and Technical Advisory Group on AMR (November 2-3, 2016)
(by Dr. Anthony So, Director of ReAct Strategic Policy Program/North America)

The 7th meeting of the WHO Strategic and Technical Advisory Group (STAG) convened in Geneva on November 2-3, 2016. A broad range of stakeholders attended as observers along with partner organizations, from UNICEF to the World Bank.

Providing an update on the UN General Assembly’s adoption of the Political Declaration on AMR in September, Assistant Director-General Keiji Fukuda recognized how important a milestone this was. Highlights, he described, included the urgency signaled by the Political Declaration, the multisectoral nature of the process, the Global Action Plan and need to “finalize” the development and stewardship framework, and the creation of an ad hoc interagency coordination group. Dr. Fukuda then outlined ingredients for UNGA success, from changing the narrative to the focus on awareness and trust building. He also warned, however, of ongoing challenges:
  1. minimal awareness in the larger world;
  2. ongoing concerns by developing countries, from those that question the relevance of the AMR agenda to them to agricultural use of antibiotics;
  3. ongoing sensitivities related to AMR issues in agriculture and food; and
  4. continuing uncertainty over how to proceed. Important recognition of the need for horizontal communications, coordination and cooperation was highlighted in the process, both across sectors and agencies within and beyond the UN. There is little appetite for new global funds, so the process started by the World Bank is likely to be pursued. Dame Davies argued that having a separate body on AMR would suggest to others that AMR is not their problem but rather being handled by that dedicated entity. Dr. Fukuda concluded by describing the parallel challenges for WHO—the need for matrix management to implement the work and identifying where WHO might be most valued in implementing GAP and other actions within a broad, multisectoral framework.
Dr. Henk Ormel (FAO) took issue with Mark Sprenger’s observation of the power of labeling food animal products as antibiotic-free and noted that Codex regulations mandate products to be so and that animals also require antibiotic treatment. Brazil’s representative noted that more people die of lack of access to antibiotics than excessive use. To restrict trade or travel when not warranted would run counter to the spirit of the UN Political Declaration and of the International Health Regulations.WHO has budgeted USD 53 million for its biennial program on AMR, but has only received so far USD 29 million in contributions and pledges, leaving a shortfall of USD 23 million. Monies from the Fleming Fund are going to regional and country offices as well as WHO, FAO and OIE on condition that they work together.

WHO sought input from the STAG and invited observers, from country missions, industry and civil society, on next steps for their work on AMR,  their draft Monitoring & Evaluation framework, and their global development and stewardship framework. As part of this framework, Dr. Suzanne Hill, WHO Director of Essential Medicines and Health Products Department, described their work on a priority pathogens list, with the UN Commission on LIfe-saving Commodities, in monitoring antimicrobial consumption, and on the Essential Medicine List’s comprehensive review of antibiotics. She floated a proposed, new, three-level listing classification for antibiotics:unrestricted (empiric); targeted (specific) and restricted (preserved). Timed with the WHO STAG meeting, WHO has also launched global guidelines for the prevention of surgical site infections. 

FEATURE: The Centre for Science and the Environment hosts International Workshop on National Action Plan on AMR for Developing Countries (November 10-11, 2016)

(by Satya Sivaraman, Communications Coordinator of ReAct’s Empowerment, Engagement and Network Extension)
The bulk of the world’s antibiotics is used in the food animal and agricultural sector, often for non-therapeutic purposes, from where antimicrobial resistance finds its way into the human health sector. Antibiotic production in some parts of the world results in the release of effluents into the environment that further results in increased resistance.

To highlight the need to include these concerns in National Action Plans on AMR in developing countries, a global meet of doctors, veterinarians, pharmacists, medical researchers, health bureaucrats and civil society activists was organized in New Delhi on November 10-11 by the Food Safety and Toxins team at the Centre for Science and Environment. Participants from 18 developed and developing countries, and including three delegates from ReAct Asia-Pacific and North America, attended the workshop. The first day of the workshop saw expert presentations from participants around various aspects of antimicrobial resistance from food animals. There was sharing of best practices, challenges, and suggestions to move forward, largely based on country-level experiences. The critical areas of discussion involved responsible antibiotic use in food animal production, surveillance of antibiotic use and antibiotic resistance and addressing the environmental aspect of the AMR problem.

Day two of the workshop entailed intense discussions among working groups, across the three themes, followed by a presentation of relevant inputs that could be considered for incorporation in the National Action Plan, being drafted by many countries. Participating experts and also representatives of the WHO, FAO, and OIE discussed and agreed on the importance of containing the environmental spread of AMR during the workshop.

In his presentation, Dr. Anthony So, Director of ReAct North America and Strategic Policy Program, said that projections showed rapidly increasing consumption of animal protein in several parts of the developing world. Unless sufficient investments are made to eliminate the non-therapeutic use of antibiotics in this sector now the cost of tackling the problem of AMR at a later stage would be prohibitively high. Dr. So also emphasized the need for shifting consumer demand, improving animal husbandry practices and innovation to find new vaccines and diagnostics for disease.

Quick Policy Hits on AMR

On November 17-18, the South African and United Kingdom Departments of Health co-hosted a regional conference on “Surveillance of AMR” in Johannesburg, South Africa. The two-day meeting included government representatives, researchers, and civil society from the Southern African Development Community countries and focused on the challenges to AMR surveillance in resource-limited settings. In her remarks, the British High Commissioner Dame Judith Macgregor noted that the UK had made a £265 million commitment to the Fleming Fund to support capacity building for surveillance across sectors. She also stated that this support would be available to specific countries in sub-Saharan Africa, South Asia, and Southeast Asia. Mirfin Mpundu, Coordinator of ReAct Africa and Executive Director of the Ecumenical Pharmaceutical Network also gave remarks at this convening on “Exploring regional themes in capacity gaps for AMR surveillance.”
On November 30, the U.S. House of Representatives passed the 21st Century Cures Act in a 392-26 vote despite concerns from Congresswoman Rose DeLauro (D-CT) as well as Senators Elizabeth Warren (D-MA) and Bernie Sanders (D-VT) around the bill's deregulatory provisions impacting the Food and Drug Administration (FDA). Sections 3041-3044 under Subtitle E, "Antimicrobial Innovation and Stewardship", put forward proposals to expedite review of new antimicrobial drugs including through a "limited population" approval pathway. This pathway would allow for new antimicrobials to be approved and labeled for use in patients with "unmet medical needs" despite the drug having not been tested in such populations. Researchers from Harvard argue that labeling with "disclaimers flagging this pathway" would not be enough to protect against inappropriate use, citing studies that patients and prescribers rarely read or follow such labels. Public Citizen has also outlined other areas of concern in the legislation in this fact sheet. The bill will now go to the Senate for a vote, likely early next week.

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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