April 30, 2016
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Table of Contents
  1. WHO, FAO, and OIE host briefing on AMR at United Nations
  2. ReAct publishes an AMR stakeholder mapping
  3. U.S. Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria releases progress report
  4. Asia Pacific ministers of health make joint declaration on AMR
  5. MSF delivers petition demanding Pfizer and GSK cut price of pneumonia vaccine
  6. MenAfriVac vaccine has nearly eliminated meningitis A in “meningitis belt” in Africa
  7. Antibiotic use may not increase horizontal gene transfer rate as previously believed
A special edition of the ARC newsletter will be coming soon before the World Health Assembly with coverage of the World Health Organization-Nongovernmental Organization (WHO-NGO) Dialogue.

1. WHO, FAO, and OIE host briefing on AMR at United Nations

Watch video coverage of the WHO-OIE-FAO High-Level Dialogue on AMR at the United Nations. →
The World Health Organization (WHO), World Organization for Animal Health (OIE) and Food and Agricultural Organization of the United Nations (FAO) co-organized a High-Level Dialogue on AMR at the United Nations in New York, on April 18th. Setting the stage for the dialogue, the moderator described how AMR poses a barrier to achieving the UN Sustainable Development Goals, since AMR is relevant to several of the goals pertaining to ensuring healthy lives for all, food security, poverty reduction, empowerment of women and girls, clean water and sanitation, and sustainable food production and consumption. The Dialogue panel consisted of representatives of WHO, OIE, FAO, and representatives of Thailand, Mexico, and the U.S. In addition, representatives from several nations took the floor to speak about AMR, framing AMR as both a health and development issue. The speakers emphasized the need for multisectoral commitments and action, especially from the highest levels of government and foreign affairs officials not typically as engaged in health issues. This Dialogue comes in the lead up to the UN General Assembly high level meeting on AMR that will take place in September 2016.

Ambassador Virachai Plasai, Representative of Thailand to the UN, spoke about how AMR is high on Thailand's national agenda. In accordance with the WHO Global Action Plan, Thailand is working on a new multisectoral, One-Health national action plan. Ambassador Plasai recommended four main actions: 1) promoting rational use and reducing misuse of antibiotics through raising awareness, 2) reducing the irrational use of antibiotics in animal feed, especially as growth promoters, 3) incentivizing pharmaceutical and food companies to give back to their communities by taking an active role in surveillance and disseminating health information, 4) creating funding mechanisms to incentivize better the development of new antibiotics, and 5) ensuring access to medicines, vaccines, and diagnostics for those in need.

Dr. Margaret Chan, Director General of the WHO, warned of "a post-antibiotic era." First-line antibiotics are failing, while second- and third-line antibiotics are expensive and often have adverse side effects. In the intensive care units where second-line antibiotics are often administered, the prevalence of multidrug-resistant pathogens is high. Gonorrhea is resistant to many classes of drugs, and multidrug-resistant typhoid fever has swept across parts of Asia and Africa. Only 50% of patients with multidrug-resistant tuberculosis can be cured. If current AMR trends continue, common infections may kill, and AMR will make it dangerous to perform complex medical care for organ transplants, cancer care, care of preterm infants, and urinary tract infections (particularly in women). Resistant pathogens and antibiotic residues travel internationally in people, animals, and food. In some countries, more antibiotics are used for food production than for medicine. Echoing Ambassador Plasai's remarks, Dr. Chan added that those in foreign affairs can play an important advocacy role and that consumers similarly send an important message through the growing demand of antibiotic-free meat. Dr. Chan called on leaders to make political commitments through national action plans, with appropriate monitoring and accountability mechanisms.

Next, Maria Semedo, Deputy Director General of the FAO, discussed FAO's One Health efforts while also stressing the need for commitments not just from the actors directly working on AMR. As the FAO has previously stated, AMR poses risks to animal health and welfare, as well as to sustainable and safe food production. Semedo began her talk by noting that "intensifying food production and food systems means additional challenges in disease management and even higher potential for increased antimicrobial resistance." She also stated that there is a need to support countries where legislation, surveillance, and prevention of AMR are lacking. Semedo argued that AMR disproportionately affects the rural poor who live in low-hygiene settings and in close contact with animals. She also noted that most of these smallholder farmers are women. Semedo summarized FAO work on AMR, including collaboration with the Codex Alimentarius Commission to create coherent regulatory frameworks to increase safety in food production, transportation, and trade. In June 2015, the FAO passed a resolution endorsing a One Health approach to AMR. FAO is also in the process of developing an Action Plan on AMR to reinforce the capacity and systems for monitoring and managing antimicrobials in livestock production, fisheries, and crops. The action plan will prioritize raising awareness along the food chain, gathering scientific advice, enabling governance and capacity-building at the national level, ensuring sustainable agricultural systems, and promoting prudent antimicrobial use. Semedo echoed Dr. Chan's call for high-level commitments, particularly from national governments, foreign affairs, interregional bodies, and economic bodies. The private sector, nonprofits, and consumers are also important stakeholders, she said. Semedo declared FAO's commitment to cooperate with the UN to promote sustainable and safe food production practices.

Dr. Monique Eliot, Director General of OIE, gave an address about how AMR threatens animal health and in turn, food security, national economies, and the livelihoods of livestock farmers. Dr. Eliot said that countries have not been consistent in their implementation of the OIE guidelines on responsible and prudent use. Therefore, Dr. Eliot called on national leaders to help countries in controlling AMR. Unfortunately, antimicrobials, many of which are of poor quality, are available without prescriptions. The lack of regulations on antimicrobial registration and dispensing contributes to overuse and misuse. National regulatory mechanisms and veterinary oversight in prescribing antibiotics are therefore vital. Political will is needed for creating appropriate regulations. Resource investments will help ensure compliance. Sustained funding could also support training, infection prevention and control, and research on alternatives to antibiotics such as vaccines, best farming practices, and methods to increase resilience against disease.

Dr. Jessica Petrillo, Senior Health Security Officer in the Office of International Health and Biodefense at the U.S. State Department, underscored the value of the September 2016 UN General Assembly as a way of fostering national-level and local ownership in combating AMR. Dr. Petrillo highlighted infection prevention and awareness-raising as important priorities. She also suggested that SDG number 7, relating to energy, is additionally relevant to AMR due to its connection to water and sanitation.

Ambassador Juan Gómez Camacho, Permanent Representative of Mexico and facilitator of the upcoming high-level meeting on AMR, described AMR as a multisectoral challenge that will threaten more than just developing countries. Camacho urged diplomats to take a far larger role in health issues like AMR and "go outside of the walls of the UN" to translate technical knowledge to action. He also raised a concern about mistrust about health policy efforts, which means that policymakers will need to engage and be transparent with all stakeholders.

Representatives from Japan, UK, Brazil, the European Union, Australia, India, Germany, France, Canada, and Ecuador made interventions. Common themes across these interventions included an emphasis on multisectoral collaboration to develop national action plans and educate all stakeholders, further research and risk analyses about AMR in food production, financing of the Global Action Plan with assistance to low- and middle-income countries, and access to medicines. The representative from India emphasized innovation and access for medicines, without impediment from intellectual property laws and with further proposals for R&D business models that are delinked from the prices of medicines.

2. ReAct publishes an AMR stakeholder mapping

ReAct EuropeReAct has released a stakeholder mapping on antimicrobial resistance (AMR) commissioned by the World Health Organization (WHO). The stakeholder mapping will allow policymakers, civil society organizations, and health professionals to identify and coordinate partners and allies in the fight against AMR. The stakeholder mapping covers 70 organizations and initiatives, classifying them in five categories: 1) Policy, which includes United Nations institutions, intergovernmental and international institutions, policy institutes, and think tanks; 2) Advocacy, which includes civil society groups; 3) Innovation & Research; 4) Surveillance, which includes the the WHO Global AMR Surveillance System (GLASS), WHO Advisory Group on Integrated Surveillance of AMR (AGISAR), and GASP (the Gonococcal Antimicrobial Surveillance Program), and regional surveillance networks; and 5. Funding. Organizations are further categorized into three focus areas: human health, animal health, and environmental effects. The mapping additionally classifies stakeholders according to whether they operate at the global or regional level. Included in the stakeholder mapping are summaries of the relevant AMR work of these organizations, their geographical focuses, and links to their websites.

The stakeholder mapping has several limitations as a result of the mapping's inclusion and exclusion criteria. First, the division of stakeholders into global and regional actors may have excluded bilateral agreements, which tend not to be widely publicized. National agencies on AMR, such as public health agencies, are currently excluded from the mapping. Stakeholders that work on a single disease or pathogen (such as tuberculosis) were also not included. In addition, only websites available in English were included, which means the mapping excludes actors where English is not widely spoken.

3. US Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria releases progress report

The Presidential Advisory Council met on March 30-31 to discuss and finalize their report. Watch videos of the meeting on Youtube. →
The U.S. Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB) offered praise for National Action Plan implementation efforts by partner U.S. government agencies, but called attention to several areas for attention in a report released in late March. PACCARB convened on March 30-31 to finalize their report, and video coverage of the meeting is available on Youtube. The themes of improvement suggested by PACCARB were the following:
  • Embracing a One Health approach: The report recommends increasing the integration and dialogue among the currently disconnected veterinary and human health institutions as well as exploring further the health effects of environmental contamination by antibiotics. In particular, the report urges the U.S. Congress to enhance and sustain funding for food retail and on-farm animal surveillance, an area that has been underfunded despite previous calls for increased funding from the White House in 2016 and 2017.
  • Creating a lead federal champion: PACCARB suggests that a government champion at the level of a White House Cabinet Secretary or Department Undersecretary would be well-suited to coordinating and aligning agency efforts on AMR.
  • Coordination of federal response: PACCARB found that existing central coordination mechanisms are not sufficient to ensure synergy and coverage while avoiding duplicative work.
  • Resource allocation: Each of the five working groups of PACCARB found that the initiatives for implementing the National Action Plan are underfunded. PACCARB suggested that potential solutions may involve new funding authorized from Congress, re-budgeting within departments and agencies, or reallocation of employees between agencies to reduce redundancy and cost while increasing the level of coordination.
  • Development of partnerships: The report emphasized the need to partner with state and local agencies, tribes, private-sector organizations, commodity groups, philanthropic organizations, and international bodies.
  • Economic incentives for new diagnostic, preventive, and therapeutic tools: PACCARB believes that the existing economic model is inadequate to ensure the availability of antibiotics to treat and prevent the emergence of resistant infections. This indicates the need to develop a business model that takes into account the societal costs of AMR and incentives to drive antibiotic stewardship.
The five working groups of PACCARB, organized along the five goals of the U.S. National Action Plan, made the following recommendations:

Goal 1 - Slow the Emergence of Resistant Bacteria and Prevent the Spread of Infections. PACCARB recommends enhanced and sustained funding to enable antibiotic-stewardship programs and education in human and veterinary health settings and further inter-agency collaboration. The report suggests increasing attention to antibiotic stewardship in outpatient settings, possibly through the Centers for Medicare and Medicaid Services’ Merit-Based Incentive Payment System to incentivize rational use. In terms of animal agriculture, the report points out the limited progress in finalizing a plan to assess the impact of the FDA voluntary phase-out of medically important antibiotic growth promoters. Therefore, PACCARB proposes determining metrics for appropriateness of antibiotic use in animals, especially antibiotics used for preventative purposes.  In the interest of a One Health approach, PACCARB suggests that antibiotic stewardship be made more prominent in medical, veterinary, and agricultural education and outreach.

PACCARB also recommends reconciling concerns about confidentiality of producers and farms. The report does not specify exactly what balance will be struck on food producer privacy. However, the proceedings of a USDA-CDC-FDA meeting regarding the expansion of on-farm data collection held in September 2015 may provide some indication. Representatives of industry groups including the National Cattlemen's Beef Association, the Animal Health Institute (which presents the veterinary pharmaceutical industry), and the American Feed Industry Association, expressed concerns about the misuse of data. However, it is already the case that data reported to the USDA National Animal Health Monitoring System and to the FDA under the Animal Drug User Fee Act (ADUFA) are confidential. According to the CARB 180-day progress report, on-farm sampling by the USDA will be voluntary for producers.

Goal 2 - Strengthen National One Health Surveillance Efforts to Combat Resistance. In addition to calling for funding and coordination of efforts, PACCARB recommends increasing data sharing in human surveillance, partnerships among industry and other stakeholders to improve animal surveillance, and developing a strategy to conduct environmental surveillance in soil, sewage, and surface water. The report supports increasing the number of hospitals reporting antibiotic use and resistance data to the National Healthcare Safety Network, which is currently a voluntary program. The report also recommends ensuring CDC funding to develop regional laboratories. This laboratory network would enable greater isolate and data sharing among CDC, FDA, and the Department of Defense.

To expand animal surveillance, PACCARB suggests making AMR surveillance an explicit purpose of the U.S. government National Animal Health Laboratory Network and the Veterinary Laboratory Investigation and Response Network. To strengthen animal surveillance, the report also recommended identifying pathogens to focus on, the needs and scope of a surveillance network, and procedural obstacles such as data confidentiality and information technology for data aggregation. Lastly, PACCARB called for enhanced monitoring on resistance patterns, and antibiotic sales, use, and management practices at multiple points in the food chain - to be achieved through sustained funding to FDA for the retail meat NARMS program and to USDA for on-farm surveillance. The report notes that collection of farm-level surveillance data has not yet been implemented, and collection of resistance data is limited, in part as a result of Congress denying the funding requests to implement these efforts for 2016.

Goal 3 - Advance Development and Use of Rapid and Innovative Diagnostic Tests for Identification and Characterization of Resistant Bacteria. PACCARB recommends collaboration among laboratories and antibiotic stewardship programs to create user demand for diagnostics. To reduce barriers for commercial diagnostic development, the report calls for mechanisms to reduce the cost of clinical studies, and a comprehensive strategy to fund outcome studies that in turn influence clinical practice. PACCARB recommends creating economic incentives to encourage and train healthcare providers to use diagnostic tests to guide therapy, instead of resorting to the empiric use of antibiotics (made in the absence of knowledge of the nature of the infection). PACCARB also encourages funding and support for the development of animal diagnostics, and education on appropriate use by healthcare providers, companion animal practitioners, crop agriculturalists, and dentists.

Goal 4 - Accelerate Basic and Applied R&D for New Antibiotics, Other Therapeutics, and Vaccines. The report calls for evaluating what R&D incentives would best serve the U.S. market. These may include tax credits, competitions, prizes, and delinkage of return on investment from sales volume. PACCARB also emphasizes accelerating R&D for narrow-spectrum antibiotics, which may disrupt the normal protective microbiota to a lesser extent and thereby be less likely to increase AMR. PACCARB suggests that the Limited Population Antibacterial Drug pathway, as proposed in the Promise for Antibiotics and Therapeutics for Health Act (PATH Act), would be a meaningful step towards creating a reliable clinical, regulatory, and financial model for narrow-spectrum antibiotics. PACCARB calls for collaboration across government agencies using a standardized sharing process for data, specimens, and knowledge. Similarly, the report also calls on the U.S. government to address barriers to public-private partnerships due to coordination challenges in specimen sharing and database development. Regarding animal use, the report recommends increasing collaborative basic research to understand the development of AMR with an emphasis on the connection among humans, animals, and the environment. One potential area for research includes developing animal drugs using candidates that are no longer being pursued for human use.

Goal 5 - Improve International Collaboration and Capacities for Antibiotic-resistance Prevention, Surveillance, Control, and Antibiotic R&D. PACCARB recommends choosing several indicators and a qualitative narrative of expected impact to measure the effectiveness of the U.S. National Action Plan’s international strategy. PACCARB criticized the existing milestones for Goal 5 as encouraging a "checkbox approach" too focused on technical assistance and lacking in the integration of health into foreign policy as a whole. PACCARB also criticized the U.S. National Action Plan for giving a narrow definition of surveillance while simultaneously lacking specificity about infection prevention. The report advises promotion of international laboratory capacity-building to identify at least three of the seven WHO priority AMR pathogens using standardized detection assays. For this goal, the CDC has been providing technical assistance to build laboratory-based surveillance systems, with the goal of entering the WHO Global Antimicrobial Resistance Surveillance System (GLASS). CDC has worked with countries through the Global Health Security Agenda and other bilateral partner countries. However, these efforts are limited by funding and barriers to information-sharing due to international and bilateral agreements. PACCARB recommends improving surveillance and global data-sharing, with harmonization of data resistance definitions. The report suggests expanding surveillance to include molecular typing and transmission tracing. For urgent threats, the report recommends creating a mechanism for international communication that might build on the communication between the U.S. and EU through the Transatlantic Task Force on Antimicrobial Resistance (TATFAR). The report calls for expanding the involvement of additional states, especially among developing countries where the intensive animal agricultural sector is growing and healthcare utilization is as well. PACCARB advises increasing engagement with professional societies, academia, non-profits, pharmaceutical and diagnostic industries, and other governments around the world. This would include promoting public-private partnerships to develop alternatives to antibiotics, vaccines, and rapid diagnostics. PACCARB also calls for collaboration with international organizations such as FAO and OIE to harmonize international data submission, risk assessments, and regulatory pathways for animal health products.

In addition to their recommendations for action, PACCARB praised several accomplishments by the U.S. government. The Centers for Medicare and Medicaid Services created a rule in 2015 that requires participating inpatient and long-term care clinical facilities to implement antibiotic stewardship programs. The CARB Biopharmaceutical Accelerator public-private partnership was established by the Biomedical Advanced Research and Development Authority and the National Institute for Allergy and Infectious Diseases. The CARB Biopharmaceutical Accelerator has total funding of 250 million dollars and expects to award two 30 million dollar grants this year for research on drugs, vaccines, and diagnostics. Founded in 2009, the Department of Defense Multidrug-Resistant Organism Repository and Surveillance Network (MRSN) conducts surveillance in military health facilities and disseminates reports to clinicians, infection control teams, and policymakers to guide clinical practices. PACCARB also pointed out the FDA Veterinary Feed Directive as a positive step towards by requiring veterinary supervision over the administration medically-important antibiotics in animal feed and water. In the coming months, PACCARB will continue to evaluate U.S. government efforts and solicit public feedback using the comments interface within the Federal Register.

4. Asia Pacific ministers of health make joint declaration on AMR

Yasuhisa Shiozaki, Minister of Health, Labour and Welfare, Japan and ReAct’s founder and senior advisor, Otto Cars, at the high-level meetings in Tokyo, Japan.Countries in the WHO Asia Pacific region pledged to collaborate on AMR at the Tokyo Meeting of Health Ministers on April 16, 2016. At the meeting, Ministers of Health and representatives from the Asia Pacific region adopted a Communiqué on combating AMR. The Communiqué marks the launch of an Asia-Pacific One Health Initiative on AMR, which will prioritize working on 1) a surveillance system and laboratory network, 2) healthcare management, 3) antimicrobial access and regulation, and 4) research and development. These nations reaffirmed their commitment to develop national action plans based on the WHO Global Action Plan with a multisectoral One Health approach. The countries will identify underlying drivers of AMR and implement sustainable system changes to benefit human and animal health, agriculture, food security, and environment. Countries will promote prevention and containment measures for AMR in line with national strategies for achieving the UN Sustainable Development Goals. World Antibiotic Awareness Week will be used as an avenue for increasing awareness about responsible antibiotic use in all sectors. Countries will also monitor progress of national action plans and report to the appropriate bodies. The Communiqué commits the nations to build resilient health systems with the goal of universal health coverage. Under such systems, AMR containment will be a core element of quality and safe healthcare services. This will include infection prevention and control measures in healthcare institutions and communities, and improving access to clean water and sanitation. Likewise, the countries will work towards providing safe, effective, quality, and affordable antimicrobials, diagnostics, and vaccines. The Communiqué includes a commitment to support the AMR initiatives of UN Member States and UN agencies, and calling on Member States and UN agencies to highlight areas for priority action and political commitment at the UN General Assembly. In addition, countries will work with regional and global initiatives such as the G7 on AMR issues. The Communiqúe emphasizes collaboration with ministers from the animal, agriculture, and environment sectors to ensure a One Health approach.

The Communiqué notes that the Asia Pacific region faces rapid economic development, sociodemographic and cultural changes, and weak health system capacities. These factors contribute to poor regulation of medicines and appropriate trade controls, which in turn lead to unregulated consumption of antimicrobials and the emergence of AMR. This is evidenced by the spread of multidrug-resistant strains of malaria and tuberculosis. To address AMR, the Communiqué sets out several goals. The Communiqué called for increased education about AMR and responsible use for all stakeholders. It also pointed out the need for more progress towards universal health coverage with access to healthcare services and medicines. The Communiqué stresses a One Health approach that involves human and veterinary medicine, agriculture, aquaculture, and the environment. Recognizing antimicrobials as a global public good, the Communiqué recommends global, regional, and national cooperation. It also recommends the implementation and monitoring of regulations over production, distribution, and use of vaccines, diagnostics, and antimicrobials for humans and animals. Lastly, the Communiqué acknowledges the need for research and development of new antimicrobials, diagnostics, and vaccines.

Representatives from Australia, Bangladesh, China, India, Indonesia, Japan, Malaysia, Myanmar, Philippines, Republic of Korea, Thailand and Vietnam, and representatives of WHO and partner organizations attended the meeting. The meeting was organized by the Government of Japan and WHO, with collaboration from FAO and OIE.

5. MSF delivers petition demanding Pfizer and GSK cut price of pneumonia vaccine

MSFMédecins Sans Frontières (Doctors Without Borders, MSF) delivered a petition demanding that Pfizer and GlaxoSmithKline (GSK) reduce the price of pneumonia vaccines outside the headquarters of Pfizer in New York City the night before their annual shareholder meeting. The petition, signed by 400,000 people in 170 countries, asks Pfizer and GSK to decrease the price to $5 per child in all developing countries and for humanitarian organizations. MSF held a demonstration at the Pfizer headquarters where they placed 2500 flowers at the door to represent the number of children who die each day from pneumonia. In addition, papers with signatures were placed in an empty baby crib. Despite the existence of a vaccine that prevents pneumonia, it remains the leading global cause of childhood death in many countries, killing nearly 1 million children per year (and only one third of children with bacterial pneumonia receive the antibiotics they need). Dr. Greg Elder, Medical Coordinator at MSF’s Access Campaign pointed out, “After combined sales of more than $30 billion for the pneumonia vaccine alone, we think it’s pretty safe to say that Pfizer and GSK can afford to lower the price so all developing countries can protect their children from this childhood killer.”

In 2015, the World Health Assembly passed a resolution calling for more affordable vaccines and vaccine price transparency. The governments of more than 50 countries described the inequity due to the financial burden of new vaccines. Several countries expressed that they have not been able to introduce the pneumonia vaccine because of its high price. In 2015, MSF launched their "A Fair Shot" campaign to push companies to reduce the price of pneumonia vaccines. As part of that campaign, MSF released a report entitled "The Right Shot: Bringing Down Barriers to Affordable and Adapted Vaccines", which detailed how many countries are unable to afford new high-priced vaccines like the pneumonia vaccine. In fact, in the poorest countries, it is now 68 times more expensive to vaccinate a child than in 2001.

6. MenAfriVac vaccine has nearly eliminated meningitis A in “meningitis belt” in Africa

Meningitis vaccine launch in Burkina Faso, 2010 - Amy MacIver/PATHIn late February, WHO and PATH announced that their vaccination coverage efforts have nearly eliminated meningitis A in the 26 African "meningitis belt" countries following introduction of the MenAfriVac vaccine in 2010. Since the vaccine's introduction, 16 of the 26 countries in the African meningitis belt have conducted initial mass vaccination campaigns. The remaining 10 countries are expected to conduct campaigns in 2016 and 2017. These efforts have led to immunizations of more than 235 million children and young adults. As many as 250,000 had the disease during an outbreak in 1996. In 2015, this number was down to 80 confirmed cases in countries that had not yet conducted mass immunization campaigns. WHO and PATH partnered to form the Meningitis Vaccine Project in 2001 to work on creating a new vaccine against meningitis A. The result, MenAfriVac, was designed for use in Africa through a public private partnership with a manufacturing company, the Serum Institute of India Private Ltd, and others. Several characteristics help to explain the vaccine’s success: the vaccine costs below $0.50 per dose, does not require constant refrigeration, and can be used at temperatures of up to 40°C (104°F). This success in vaccination coverage represents one of the goals highlighted by the UK Review on AMR and others - increased vaccine coverage would help prevent the 14.5 million episodes of pneumococcal disease (pneumonia, meningitis, sepsis) and 800,000 resulting deaths among children under 5 years of age.

In 2008, the GAVI Alliance committed to financially support immunization of young people in the 26 meningitis belt countries. GAVI provided 367 million dollars for meningitis A campaigns and emergency stockpiles. GAVI also offers financial support to countries to add the vaccine to their routine immunization schedules. UNICEF has been working with national authorities, health workers, and traditional and religious leaders to ensure that vaccines are accepted and that all communities are reached. MenAfriVac is an improvement on older polysaccharide vaccines, which were only provided short-term protection after the start of epidemics and did not protect the youngest children. MenAfriVac also increases the protective immune response to the bacterial disease tetanus. Countries with Meningitis A campaigns have seen a 25% decrease in neonatal tetanus cases.

Moving forward, public health experts plan to target other strains of meningitis. PATH and the Serum Institute of India are partnering on a meningitis vaccine that will target 5 meningitis strains, with clinical trials to begin this year. In March, PATH announced the creation of a Center for Vaccine Innovation and Access to accelerate vaccine development for vulnerable populations. The new center will integrate within a single team work on vaccine research, development, and introduction. The WHO has also created a Vaccine Pipeline Tracker for seven pathogen areas: HIV, malaria, tuberculosis, respiratory syncytial virus (RSV), enterotoxigenic E. Coli (ETEC), shigella, and norovirus. The pipeline tracker, which documents vaccine candidates and their current research stage, will be updated every six months.

7. Antibiotic use may not increase horizontal gene transfer rate as previously believed

A Duke University-led team of researchers has found that the use of antibiotics does not increase the rate of horizontal gene transfer through conjugation. This surprising discovery may influence the design of antibiotic stewardship protocols, since there may be a need for future studies to focus on quantifying the risk of spreading resistance when using antibiotics. Horizontal gene transfer refers to the transfer of genes among bacteria, most commonly through conjugation or bacterial mating. Antibiotic resistance genes are spread among bacteria this way, such as MCR-1 colistin resistance gene, which can be spread easily by horizontal gene transfer since the gene resides on a plasmid. The use of antibiotics contributes to resistance in general. As a result, it was hypothesized that the use of antibiotics would also accelerate the rate of horizontal gene transfer. Instead, this study found that antibiotics can both promote or suppress conjugation dynamics. Watch a video demonstrating their result here.

This study avoided confounding factors encountered in previous studies by separating out the effect of antibiotics on conjugation efficiency (the rate of conjugation) and on the growth of transconjugants (bacteria with transferred genes). They achieved this by using an engineered conjugation system and experimental conditions where the presence or absence of antibiotics was confirmed to not have significantly changed the growth or death of bacteria. Therefore, the researchers were able to isolate the effect of antibiotics on conjugation efficiency using 10 antibiotics and 9 pathogens.

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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.