Antimicrobial resistance: report by the Secretariat

EXECUTIVE BOARD EB140/11 140th session 12 December 2016 Provisional agenda item 7.2 Antimicrobial resistance Report by the Secretariat 1. This report provides an update on the United Nations General Assembly High-level Meeting on Antimicrobial Resistance (New York, 21 September 2016), held pursuant to its resolution 70/183 on global health and foreign policy and resolution 70/297 on scope, modalities, format and organization of the high-level meeting on antimicrobial resistance. It also summarizes progress in implementing resolution WHA68.7 (2015), in which the Sixty-eighth World Health Assembly adopted the global action plan on antimicrobial resistance and requested the Director-General to develop options for establishing a global development and stewardship framework. 2. The high-level meeting on antimicrobial resistance was addressed by the Secretary-General and the Directors-General of WHO, FAO and OIE. Besides a plenary session for Member States, the meeting included two interactive panels, with participation that included representatives of government, nongovernmental organizations and the private sector. The General Assembly subsequently adopted resolution 71/3, “Political declaration of the high-level meeting of the General Assembly on antimicrobial resistance”.1 3. The political declaration included commitments by Heads of State and Government and representatives of States and Governments to develop their multisectoral national action plans in line with a “One Health” approach; to mobilize funding for, inter alia, the implementation of these plans and for research and development; to ensure that national plans cover the development of surveillance, monitoring and regulatory frameworks on the preservation, use and sale of antimicrobial medicines; and to increase and sustain awareness of and knowledge about antimicrobial resistance among the public and health professionals. 4. The political declaration also includes three major requests to WHO and its partners. First, it advances the Health Assembly’s request by calling for the finalization by WHO, together with FAO and OIE, of a global development and stewardship framework on antimicrobial medicines and resistance. Secondly, it calls on WHO in collaboration with FAO, OIE, regional and multilateral development banks, including the World Bank, other United Nations agencies and intergovernmental organizations, civil society and multisectoral stakeholders to support national action plans and other activities to counter antimicrobial resistance at national, regional and global levels. Thirdly, it requests the Secretary-General to establish, in consultation with WHO, FAO and OIE, an ad hoc interagency coordination group to provide practical advice on approaches to ensure effective action to address antimicrobial resistance. The political declaration also requested the Secretary-General to submit a 1 Available at: http://www.un.org/en/ga/search/view_doc.asp?symbol=A/RES/71/3 (accessed 25 November 2016). EB140/11 2 report to the General Assembly at its seventy-third session. In accordance with these requests, WHO is working with the Secretary-General, FAO and OIE on proposals for the interagency coordination group, and with FAO and OIE on the processes needed to establish a global development and stewardship framework. 5. In resolution WHA68.7 (2015) the Health Assembly urges Member States to adapt the global action plan to their national priorities and specific contexts, and to have national action plans on antimicrobial resistance in place by the Seventieth World Health Assembly. WHO, FAO and OIE have published a manual for developing national action plans with a set of accompanying tools. 1 In addition to high-level meetings to generate political interest and support, workshops have been conducted with the active involvement of FAO and OIE in all WHO regions to share these tools and to support countries in elaborating their national action plans. To date, a total of 227 participants from 51 countries have attended these workshops, of which more are planned for late 2016. The Secretariat has also supported antimicrobial resistance situation analyses, the results of which underpin national action plans, and facilitates coordination and planning meetings. It is drawing up a roster of consultants to support this process. Completed national action plans are now available in 32 countries and at least 59 countries (as at 14 October 2016) are in the process of drafting them. The findings from the use of a survey tool developed by the tripartite collaboration between FAO, OIE and WHO to determine the status of development of a national action plan will form the basis of an extensive report to the Seventieth World Health Assembly and the governing bodies of FAO and OIE. 6. Progress in establishing national action plans has not been uniform. Obtaining political engagement and support has been difficult in some countries where understanding of antimicrobial resistance is still limited. However, awareness is growing and will be boosted by the political declaration on antimicrobial resistance. Provision of support for the development of national action plans and their implementation, monitoring and evaluation is a high priority for WHO. The Secretariat’s support includes sharing expertise and developing communities of practice. Intersectoral action, particularly the complexity of coordinating within and across sectors, continues to be a challenge. 7. Since the adoption of the global action plan on antimicrobial resistance, the Secretariat has expanded efforts to prevent and control drug resistance in HIV, tuberculosis and malaria. Multidrug- resistant tuberculosis has already reached the level of a public health crisis in many countries, causing an estimated 250 000 deaths in 2015. WHO has issued new guidelines on programmatic management of multidrug-resistant tuberculosis, recommending a shorter treatment regimen for multidrug-resistant tuberculosis. 2 It has also approved a rapid test that enables the triage of patients with multidrug- resistant tuberculosis, and revised the composition of antibiotic combinations for patients who need longer treatment regimens. Recognizing the need for a coordinated global effort to prevent HIV drug resistance and ensure effective first-line antiretroviral treatment, the Secretariat is leading the development of a global action plan on HIV drug resistance (2017–2021). Guidance on global and national responses to increasing HIV drug resistance is being prepared and is due to be disseminated in the second quarter of 2017. Antimalarial resistance is being monitored globally and resistance management strategies are being implemented. The biggest threat is in the Greater Mekong subregion where multidrug resistance, including resistance to artemisinin-based combination therapy, has 1 Available at: http://apps.who.int/iris/bitstream/10665/204470/1/9789241549530_eng.pdf?ua=1 (accessed 25 November 2016). 2 WHO treatment guidelines for drug-resistant tuberculosis – 2016 update. Geneva: World Health Organization; 2016 document WHO/HTM//TB/2016.04 (http://www.who.int/tb/MDRTBguidelines2016.pdf, accessed 30 November 2016). EB140/11 3 emerged. Intensive monitoring and management strategies are now part of the subregional malaria elimination effort launched by WHO in May 2015. 8. In resolution WHA68.7 (2015) the Health Assembly also requested the Director-General “to develop, in consultation with Member States 1 and relevant partners, options for establishing a global development and stewardship framework to support the development, control, distribution and appropriate use of new antimicrobial medicines, diagnostic tools, vaccines and other interventions, while preserving existing antimicrobial medicines, and promoting affordable access to existing and new antimicrobial medicines and diagnostic tools, taking into account the needs of all countries, and in line with the global action plan on antimicrobial resistance, …”. The Sixty-ninth World Health Assembly noted the progress being made at that time in implementing the resolution. 2 The Secretariat continues working to meet this and the similar request of the United Nations General Assembly in its political declaration on antimicrobial resistance (adopted in resolution 71/3), by consulting with FAO and OIE and providing options for establishing a global development and stewardship framework that are supported by the three Organizations. 9. Some preparatory discussions have taken place on options for such a framework, but further expert consultation is required followed by discussion with Member States and all relevant stakeholders. The Secretariat plans to meet this request, as well as the similar request in the political declaration on antimicrobial resistance, by the time of the Seventieth World Health Assembly. ACTION BY THE EXECUTIVE BOARD 10. The Board is invited to note the report. = = = 1 And, where applicable, regional economic integration organizations. 2 See document WHA69/2016/REC/3, summary record of Committee A, sixth meeting and seventh meeting, section 3.