Strategy and Policy Cohesion:Strategy and Policy Cohesion:

““The One Health Agenda: will it deliverThe One Health Agenda: will it deliver””

Elizabeth J. Phillips, MD, FRCPC,FRACP, FACTMElizabeth J. Phillips, MD, FRCPC,FRACP, FACTM

Professor & Director, Centre for Clinical Pharmacology & Infectious DiseasesProfessor & Director, Centre for Clinical Pharmacology & Infectious DiseasesInstitute for Immunology & Infectious Diseases, Murdoch UniversityInstitute for Immunology & Infectious Diseases, Murdoch University

John A. Oates Chair in Clinical ResearchJohn A. Oates Chair in Clinical ResearchProfessor of Medicine & PharmacologyProfessor of Medicine & PharmacologyDirector of Personalized ImmunologyDirector of Personalized Immunology

Oates Institute for Experimental TherapeuticsOates Institute for Experimental TherapeuticsVanderbilt University School of MedicineVanderbilt University School of Medicine

““Drugs Don’t Work”Drugs Don’t Work”

Allan Roses, December 2003Allan Roses, December 2003

VP of Genetics (GSK)VP of Genetics (GSK)

>90% of drugs have efficacy in 30-50% of >90% of drugs have efficacy in 30-50% of peoplepeople

Overview of Global and National ResponseOverview of Global and National Response

• Social, financial and environmental depthSocial, financial and environmental depth

• Education and communicationEducation and communication

• National antimicrobial resistance response National antimicrobial resistance response documents supporting commitmentdocuments supporting commitment

• Global antimicrobial responseGlobal antimicrobial response

• Implementation – what are the measurable Implementation – what are the measurable outcomesoutcomes

The AMR One Health Policy Toolkit: The AMR One Health Policy Toolkit: Animal-Human InterfaceAnimal-Human Interface

• Awareness Awareness

• Surveillance (obstacles to data collection) and Surveillance (obstacles to data collection) and antimicrobial stewardship in agricultureantimicrobial stewardship in agriculture

• Education and CommunicationEducation and Communication

• Evidence base (decreased AMR after voluntary Evidence base (decreased AMR after voluntary withdrawal) and ongoing effectiveness monitoringwithdrawal) and ongoing effectiveness monitoring

• Broad agricultural implications and complexity of Broad agricultural implications and complexity of the “AMR web” (aquaculture, the plant connection)the “AMR web” (aquaculture, the plant connection)

• Alternatives to antimicrobials in agricultureAlternatives to antimicrobials in agriculture

• Industry and regulatory issuesIndustry and regulatory issues

Globalisation & Governance of AMRGlobalisation & Governance of AMR

• Challenges in developing world parallel those in Challenges in developing world parallel those in developed world – political & cultural developed world – political & cultural considerationsconsiderations

• Defining extent of problem, educational compaignsDefining extent of problem, educational compaigns

• Conservation of antibiotics and promote Conservation of antibiotics and promote stewardship and infection control stewardship and infection control

• Challenges of global demand for animal protein Challenges of global demand for animal protein (antimicrobial consumption in agriculture) – need (antimicrobial consumption in agriculture) – need incentives to change practice, non-antibiotic incentives to change practice, non-antibiotic approaches, infection controlapproaches, infection control

• AMR shows no boundariesAMR shows no boundaries

One Health ApproachOne Health Approach

• Broadly engageBroadly engage– Doctors, veterinarians, farmers, industry and communityDoctors, veterinarians, farmers, industry and community

• Consistent approachesConsistent approaches– Infection prevention, optimize antibiotic utilization in human Infection prevention, optimize antibiotic utilization in human

and animal sectors, new treatments and diagnostic methodsand animal sectors, new treatments and diagnostic methods

• Simple messagesSimple messages– What can be done now?What can be done now?

– Reinforce positive achievements, raise awareness of risk, Reinforce positive achievements, raise awareness of risk, attention to health science, social, environmental and attention to health science, social, environmental and economic issues and uncertainties surrounding alleconomic issues and uncertainties surrounding all

Australian Colloquium 2013

Driver’s and Consequences of Driver’s and Consequences of Antimicrobial ResistanceAntimicrobial Resistance

Multidisciplinary ToolkitMultidisciplinary Toolkit

• System changeSystem change

• Training and educationTraining and education

• EvaluationEvaluation

• Reminders (eg workplace)Reminders (eg workplace)

• Safety climateSafety climate

• Adapt to cultureAdapt to culture

Dr. Didier Pittet

Partnership, Leadership & InnovationPartnership, Leadership & Innovation

• The Human health and social care sectorThe Human health and social care sector

• Livestock, food retail and veterinary sectorsLivestock, food retail and veterinary sectors

• Research councils, other research funders and Research councils, other research funders and academicsacademics

• Pharmaceutical industryPharmaceutical industry

• Local governments, professional boards, scentific Local governments, professional boards, scentific and other advisory committeesand other advisory committees

UK 5 year antimicrobial resistance strategy 2013-2018

WHO Global Action PlanWHO Global Action Plan

• Building Block 1: Building Block 1: AWARENESSAWARENESS

• Building Block 2: Building Block 2: IDENTIFYING and IDENTIFYING and OPERATIONALIZING INFECTION PREVENTION OPERATIONALIZING INFECTION PREVENTION APPROACHESAPPROACHES

• Building Block 3:Building Block 3: OPTIMIZING ANTIMICROBIAL OPTIMIZING ANTIMICROBIAL USE IN HUMAN & ANIMAL HEALTH & USE IN HUMAN & ANIMAL HEALTH & AGRICULTUREAGRICULTURE

• Building Block 4:Building Block 4: CLOSING KNOWLEDGE GAPS CLOSING KNOWLEDGE GAPS

• Building Block 5:Building Block 5: INNOVATION INNOVATION

• Building Block 6:Building Block 6: COSTS AND INVESTMENTCOSTS AND INVESTMENT

US National Goals, Sept 2014US National Goals, Sept 2014

• 1. Slow Emergence of AMR1. Slow Emergence of AMR

• 2. Strengthen National One-Health 2. Strengthen National One-Health Surveillance EffortsSurveillance Efforts

• 3. Advance development of rapid diagnostic 3. Advance development of rapid diagnostic tests to identify and characterize AMR.tests to identify and characterize AMR.

• 4. New Antibiotics, therapeutics and 4. New Antibiotics, therapeutics and vaccinesvaccines

• 5. Global effort on AMR prevention, 5. Global effort on AMR prevention, surveillance, control and antibiotic R&D.surveillance, control and antibiotic R&D.

Canadian AMR ResponseCanadian AMR Response

• ACTION 1:ACTION 1: establish and increase surveillance in establish and increase surveillance in both animal and human settingsboth animal and human settings

• ACTION 2: ACTION 2: promote appropriate antibiotic use in promote appropriate antibiotic use in animal and human settingsanimal and human settings

• ACTION 3:ACTION 3: work with animal agriculture sector work with animal agriculture sector (antibiotic stewardship in veterinary medicine)(antibiotic stewardship in veterinary medicine)

• ACTION 4: ACTION 4: promote innovationpromote innovation

October 2014

Where to go from here?Where to go from here?

• Definition and measurement of problem, Definition and measurement of problem, awareness and broad and global engagementawareness and broad and global engagement

• Build on existing success and models that have a Build on existing success and models that have a proven track recordproven track record

• What can we do now and defining prioritiesWhat can we do now and defining priorities

• What are the short and long-term measurable What are the short and long-term measurable outcomesoutcomes

• Diagnostic test development Diagnostic test development

• Antibiotic pipeline (a lengthy process that will not Antibiotic pipeline (a lengthy process that will not modify behavior or attack root of the problem)modify behavior or attack root of the problem)

• Other approaches (vaccine, non-antimicrobial)Other approaches (vaccine, non-antimicrobial)