Tripartite Joint Secretariat On Antimicrobial Resistance
The political declaration at the UN High Level Meeting on AMR, committed to by Heads of State at the United Nations General Assembly in New York in September 2016, confirmed a strong focus on a broad, coordinated approach that engages all including the human, animal, plant and environmental health sectors. WHO is working closely with FAO and OIE in a One Health approach to promote best practices to reduce the levels of AMR and slow its development.
The Interagency Coordination Group on AMR was convened by the Secretary-General of the United Nations after the UN High-Level Meeting on Antimicrobial Resistance in 2016. The IACG brought together partners across the UN, international organizations and individuals with expertise across human, animal and plant health, as well as the food, animal feed, trade, development and environment sectors, to formulate a plan for the fight against antimicrobial resistance. The Interagency Coordination Group on AMR submitted its report No time to wait: Securing the future from drug-resistant infections to the UN Secretary-General in April 2019. Its recommendations are now being implemented.
Why Is Antimicrobial Resistance A Global Concern
The emergence and spread of drug-resistant pathogens that have acquired new resistance mechanisms, leading to antimicrobial resistance, continues to threaten our ability to treat common infections. Especially alarming is the rapid global spread of multi- and pan-resistant bacteria that cause infections that are not treatable with existing antimicrobial medicines such as antibiotics.
The clinical pipeline of new antimicrobials is dry. In 2019 WHO identified 32 antibiotics in clinical development that address the WHO list of priority pathogens, of which only six were classified as innovative. Furthermore, a lack of access to quality antimicrobials remains a major issue. Antibiotic shortages are affecting countries of all levels of development and especially in health- care systems.
Antibiotics are becoming increasingly ineffective as drug-resistance spreads globally leading to more difficult to treat infections and death. New antibacterials are urgently needed for example, to treat carbapenem-resistant gram-negative bacterial infections as identified in the WHO priority pathogen list. However, if people do not change the way antibiotics are used now, these new antibiotics will suffer the same fate as the current ones and become ineffective.
The cost of AMR to national economies and their health systems is significant as it affects productivity of patients or their caretakers through prolonged hospital stays and the need for more expensive and intensive care.
The Status Quo Problem And The Role Of Consumers Against Antimicrobial Resistance
- 1Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- 2Umeå School of Business, Economics and Statistics, Umeå University, Umeå, Sweden
- 3Centre for Regional Science, Umeå University, Umeå, Sweden
- 4Department of Business Studies, Uppsala University, Uppsala, Sweden
- 5Uppsala Global Health Research on Implementation and Sustainability, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Drug Resistance In Fungi
The prevalence of drug-resistant fungal infections is increasing and exasperating the already difficult treatment situation. Many fungal infections have existing treatability issues such as toxicity especially for patients with other underlying infections . Drug-resistant Candida auris, one of the most common invasive fungal infections, is already widespread with increasing resistance reported to fluconazole, amphotericin B and voriconazole as well as emerging caspofungin resistance.
This is leading to more difficult to treat fungal infections, treatment failures, longer hospital stays and much more expensive treatment options. WHO is undertaking a comprehensive review of fungal infections globally and will publish a list of fungal pathogens of public health importance, along with an analysis of the antifungal development pipeline.
A Priority Health Issue
Over the last decade the message of the impending crisis has started to reach the attention of world leaders and global health institutions. The World Health Organization has declared antimicrobial resistance, including antibiotic resistance, a priority health issue and has prompted its Member States to take action. Warnings from the former WHO Director General Margaret Chan describe a world near to a post-antibiotic era.
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The Global Antimicrobial Resistance And Use Surveillance System
WHO launched the Global Antimicrobial Resistance and Use Surveillance System in 2015 to continue filling knowledge gaps and to inform strategies at all levels. GLASS has been conceived to progressively incorporate data from surveillance of AMR in humans, surveillance of the use of antimicrobial medicines, AMR in the food chain and in the environment. GLASS provides a standardized approach to the collection, analysis, interpretation and sharing of data by countries, territories and areas, and monitors the status of existing and new national surveillance systems, with emphasis on representativeness and quality of data collection. Some WHO regions have established surveillance networks that provide technical support to countries and facilitate enrollment into GLASS.
Antimicrobial Resistance In The Western Pacific
Antimicrobial resistance happens when microorganisms change when they are exposed to antimicrobial drugs . Microorganisms that develop AMR are sometimes referred to as superbugs. As a result, the medicines become ineffective and infections persist in the body, increasing the risk of spread to others. AMR occurs naturally over time, usually through genetic changes. However, the misuse and overuse of antimicrobials is accelerating this process.
Antimicrobial resistance is a complex problem that affects all of society and is driven by many interconnected factors. Single, isolated interventions have limited impact. Coordinated action is required to minimize the emergence and spread of AMR. All countries need national action plans on AMR, and greater innovation and investment are required in research and development of new antimicrobial medicines, vaccines and diagnostic tools.
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Drug Resistance In Malaria Parasites
The emergence of drug-resistant parasites poses one of the greatest threats to malaria control and results in increased malaria morbidity and mortality. Artemisinin-based combination therapies are the recommended first-line treatment for uncomplicated P. falciparum malaria and are used by most malaria endemic countries. ACTs are a combination of an artemisinin component and a partner drug. In the WHO Western Pacific Region and in the WHO South-East Asia Region, partial resistance to artemisinin and resistance to a number of the ACT partner drugs has been confirmed in Cambodia, Lao Peoples Democratic Republic, Myanmar, Thailand, and Viet Nam through studies conducted between 2001 and 2019. This makes selecting the right treatment more challenging and requires close monitoring.
In the WHO Eastern Mediterranean Region, P. falciparum resistance to sulfadoxine-pyrimethamine led to artesunate-sulfadoxine-pyrimethamine failures in some countries, necessitating a change to another ACT.
In Africa, evidence has recently been published showing emergence of mutations linked to partial artemisinin resistance in Rwanda. So far, ACTs that have been tested remain highly efficacious. However, further spread of resistance to artemisinin and ACT partner drugs could pose a major public health challenge and jeopardize important gains in malaria control.
More Than Half Of Antibiotics Used Inappropriately
The importance of using the tool is underscored by WHOs estimate that over half of antibiotics in many countries are administered inappropriately. Examples include the use of the drugs to treat viruses , or patients being prescribed the wrong antibiotic.
Both practices can contribute to the spread of resistance and, in hospitals, patients run the risk of being infected with antimicrobial resistant bacteria that can cause blood and wound infections, pneumonia and meningitis.
Antimicrobial resistance is one of the most urgent health risks of our time. Tedros Adhanom Ghebreyesus, Director-General, WHO
At the same time, around one million children die every year from pneumonia because of a lack of access to appropriate antibiotics, a tragedy that disproportionately affects low and middle-income countries.
Antimicrobial resistance is one of the most urgent health risks of our time and threatens to undo a century of medical progress, said WHO chief Tedros Adhanom Ghebreyesus in a statement calling on governments to adopt AWaRe.
All countries must strike a balance between ensuring access to life-saving antibiotics and slowing drug resistance by reserving the use of some antibiotics for the hardest-to-treat infections.
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Protecting The Efficacy Of Antimicrobial Agents
Antimicrobial resistance poses a worldwide health threat: its consequences, direct and indirect, can damage both human and animal health.
For those in the animal health sector, the use of veterinary medicinal products, including antimicrobial agents, is essential for the following reasons
- To protect animal health and welfare, in the knowledge that animal diseases can cause production losses of up to 20%
- To contribute to food safety, as world population growth leads to an increase in the demand for high-quality animal protein, for example, that found in eggs, meat and milk
- To protect public health, because more than 60% of infectious animal diseases are transmissible to humans.
For all these reasons, antimicrobial agents constitute a global public good, and protecting their efficacy remains crucial.
World Health Organization Global Report On Antibiotic Resistance
In April 2014, WHO released its first global report on antimicrobial resistance including data and surveillance from 114 countries.
The report reveals that this serious threat is no longer a prediction for the future it is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country. Antibiotic resistancewhen bacteria change so antibiotics are no longer effective in people who need them to treat infectionsis now a major threat to public health.
The report also indicates that the key tools needed to tackle antibiotic resistancesuch as basic systems to track and monitor the problemshow gaps or do not exist in many countries. While some countries have taken important steps to address the problem, every country and individual needs to increase their efforts.
Other important actions include preventing infections from happening in the first place to reduce the need for antibiotics. This can be accomplished through better hygiene, access to clean water, infection control in health-care facilities, and vaccination. WHO is also calling attention to the need for new diagnostics, antibiotics and other tools, which will allow healthcare professionals to stay ahead of emerging resistance.
To view the report please visit
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Global Shortage Of Innovative Antibiotics Fuels Emergence And Spread Of Drug
The world is still failing to develop desperately needed antibacterial treatments, despite growing awareness of the urgent threat of antibiotic resistance, according to report by the World Health Organization. WHO reveals that none of the 43 antibiotics that are currently in clinical development sufficiently address the problem of drug resistance in the worlds most dangerous bacteria.
The persistent failure to develop, manufacture, and distribute effective new antibiotics is further fueling the impact of antimicrobial resistance and threatens our ability to successfully treat bacterial infections, says Dr. HananBalkhy, WHO Assistant Director General on AMR.
Almost all the new antibiotics that have been brought to market in recent decades are variations of antibiotic drugs classes that had been discovered by the 1980s.
The impact of AMR is most severe in resource-constrained settings and among vulnerable groups such as new-borns and young children. Bacterial pneumonia and bloodstream infections are among the major causes of childhood mortality under the age of 5. Approximately30% of neonates with sepsis die due to bacterial infections resistant to multiple first-line antibiotics.
The review concludes that overall, the clinical pipeline and recently approved antibiotics are insufficient to tackle the challenge of increasing emergence and spread of antimicrobial resistance.
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Estimating Antimicrobial Resistance Burden
The study authors assessed the role of antimicrobial resistance in mortality and disability in 204 countries and territories in 2019.
They gathered data from multiple sources, including evidence from published studies, clinical trial data, surveillance systems, diagnostic laboratories, and hospital systems.
They used these data to create a model and subsequently estimate mortality and disability due to antimicrobial resistance for 23 bacterial species and 88 combinations of antimicrobial drugs and bacterial species.
The researchers note that limited data were available from low income nations. They also stress the need for microbiological testing infrastructure and surveillance systems to help track antimicrobial resistance.
To estimate the burden of antimicrobial resistance, the study authors calculated deaths attributable to antimicrobial resistance and deaths associated with antimicrobial resistance.
Deaths attributable to antimicrobial resistance refer to the additional deaths due to drug-resistant bacterial species compared with lives lost if the bacterial species was replaced with a drug-sensitive one.
In contrast, deaths associated with antimicrobial resistance refer to the additional deaths due to drug-resistant species compared with a scenario where vaccination or other measures prevented the infection.
Western sub-Saharan Africa had the highest rate of deaths attributable to and associated with antimicrobial resistance.
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World Health Organization: Antibiotic Resistance Grave Global Problem
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The World Health Organization has released a significant report marking what I think must be the first attempt to quantify antibiotic resistance globally. It’s a very sobering read — not just for what the data says about the advance of resistance worldwide, but also because of what the organization could not say, because the data doesn’t exist.
The numbers themselves are unsettling. Dr. Keiji Fukuda, the WHO’s assistant director general, told the press: “Its clear that rates are very high of resistance among bacteria causing many of the most common serious infections the ones that we see both occurring in the community as well as in hospitals … In all regions of the world, we now see that hospitals are reporting untreatable, or nearly untreatable, infections.”
But the gaps in the numbers are too: There are 194 member countries in the WHO, but only 114 had the data-gathering resources to contribute something to the report, and only 22 were able to send in data on the most important occurrences of resistance in very common bacteria. Thus it’s possible that the report could be an under-estimate, or an over-estimate. But I can’t think of a scenario in which it could be considered substantially inaccurate. Its portrait of a world in which antibiotic resistance is advancing to grave proportions ought to be taken seriously.
Drug Resistance In Viruses
Antiviral drug resistance is an increasing concern in immunocompromised patient populations, where ongoing viral replication and prolonged drug exposure lead to the selection of resistant strains. Resistance has developed to most antivirals including antiretroviral drugs.
All antiretroviral drugs, including newer classes, are at risk of becoming partly or fully inactive because of the emergence of drug-resistant HIV . People receiving antiretroviral therapy can acquire HIVDR, and people can also be infected with HIV that is already drug resistant. Levels of pretreatment HIVDR to non-nucleoside reverse-transcriptase inhibitors among adults initiating first-line therapy exceeded 10% in the majority of the monitored countries in Africa, Asia and Latin America. The prevalence of PDR among infants is alarmingly high. In sub-Saharan Africa, over 50% of the infants newly diagnosed with HIV carry a virus that is resistant to NNRTI. Informed by these findings, latest WHO ARV guidelines now recommend the adoption of a new drug, dolutegravir, as the preferred first-line treatment for adults and children. The use of this drug is particularly urgent in averting the negative effects of resistance to NNRTIs.
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Who Report On Resistant Bacteria
On February 27, 2017, using a multicriteria decision analysis technique, WHO experts together with researchers from the Division of Infectious Diseases at the University of Tübingen, Germany, published a list of microorganisms with relatively high rate of antibiotic resistances that need to be better managed. They classified these microorganisms into three groups according to the urgency of a need to develop new antibiotic treatment and the levels of reported antibiotic resistances. Only microorganisms with critical priority are described on the basis of recent update of their antibiotic resistance profiles. Furthermore, this text aims to propose novel approaches to resolve the current crisis caused by the drug-resistant pathogenic bacteria.
Interagency Coordination Group On Antimicrobial Resistance
The United Nations Secretary-General has established IACG to improve coordination between international organizations and to ensure effective global action against this threat to health security. The IACG is co-chaired by the UN Deputy Secretary-General and the Director General of WHO and comprises high level representatives of relevant UN agencies, other international organizations, and individual experts across different sectors.
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How Does Antibiotic Resistance Develop
Antibiotic resistance is a complex process that occurs as bacteria adapt to the continuous presence of antibiotics.8 Once bacteria become resistant against antibiotics, it becomes much more difficult to get an infection under control. Patients experiencing infection with resistant bacteria often face prolonged hospital stays and higher mortality risks. These patients more extensive care also leads to increased costs.
The defensive strategies bacteria use against antibiotics are called resistance mechanisms.7 Bacteria develop these mechanisms using instructions carried in their DNA. Often, resistance genes are found within plasmids, small pieces of DNA that carry genetic instructions from one germ to another. This means that some bacteria can share their DNA and make other bacteria resistant.7
The overuse and misuse of antibiotics accelerates the natural process of antibiotic resistance.7 Resistant bacteria are then spread via healthcare-acquired infections, which hospitals and clinics struggle to prevent and control. Its a treacherous cycle that has led to increased resistance to life-saving antibiotics around the world, greatly reducing treatment options. Some bacterial strains have even become resistant to both first- and second-line antibiotics. These multidrug-resistant strains can only be treated with last-resort antibiotics, if they can be treated at all.
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U Of T Grad Recognized By World Health Organization For Highlighting Antibiotic Resistance
A University of Toronto graduate has won an international award from the World Health Organization for a video animation showing the dangers of antibiotic resistance.Nitai Steinberg, a graduate of the Institute of Medical Sciences Biomedical Communications program, is the winner of the student prize in the World Health Organizations inaugural Health for All Film Festival.
Dr. Tedros Ghebreyesus, Director-General of the WHO, announced the winners Tuesday at a virtual awards ceremony broadcast from Geneva, Switzerland.
Steinberg beat out applicants from around the world to win the award, which comes with a prize of $5,000 U.S.Antimicrobial resistance is the ability of bacteria to break down antibiotics and render them ineffective. This is a major threat to human health, says Steinberg, who graduated with a masters from the biomedical communications program in 2019.
Modern medicine depends on antibiotics. Without them, many diseases could no longer be treated. Invasive surgeries and organ transplants would not be possible.
Steinberg created the film under the supervision of Jodie Jenkinson, director of U of Ts Biomedical Communications program, which is based at University of Torontos Mississauga campus.To create the video animation, Steinberg received financial support from Jenkinsons Social Sciences and Humanities Research Council of Canada Insight Grant.
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