the global antibiotic resistance partnership
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The Global Antibiotic Resistance Partnership
Global Health Council ConferenceTuesday 14 June 2011
Hellen GelbandCDDEP
The Global Antibiotic Resistance Partnership--GARP
The Global Antibiotic Resistance Partnership (GARP) aims to address the challenge of antibiotic resistance by developing actionable policy proposals in four low- and middle-income countries: India, Kenya, South Africa and Vietnam
Why GARP?· Antibiotic resistance has been defined by
high-income countries. Why it matters: Access Cost
· Action takes place at the country level Local knowledge Locally-generated research Sustainability
Key Elements· CDDEP organization· International Advisory Group· Working Groups in each country· Affiliations with premier medical and
research organizations· Coordinators +/-· All sectors represented (human/animal,
public/private sectors; urban/rural)
International Advisory Group--IAGKeith Klugman, Emory University, Atlanta, ChairZulfiqar Bhutta, Aga Khan University, KarachiAdriano Duse, University of the Witwatersrand, Chair, GARP-South
Africa NWGNK Ganguly, National Institute of Immunology, New Delhi, Chair,
GARP-India NWGDavid Heymann, Health Protection Agency, LondonDean Jamison, University of WashingtonSamuel Kariuki, Kenya Medical Research Institute, Chair, GARP-Kenya
NWGNguyen Van Kinh, National Institute of Infectious and Tropical Diseases,
Hanoi, Chair, GARP-Vietnam NWGEric Simoes, University of Colorado
International Advisory Group--IAGKeith Klugman, Emory University, Atlanta, ChairZulfiqar Bhutta, Aga Khan University, KarachiAdriano Duse, University of the Witwatersrand, Chair, GARP-South
Africa NWGNK Ganguly, National Institute of Immunology, New Delhi, Chair,
GARP-India NWGDavid Heymann, Health Protection Agency, LondonDean Jamison, University of WashingtonSamuel Kariuki, Kenya Medical Research Institute, Chair, GARP-Kenya
NWGNguyen Van Kinh, National Institute of Infectious and Tropical Diseases,
Hanoi, Chair, GARP-Vietnam NWGEric Simoes, University of Colorado
Country-level Process
Preliminary Work• Establish NWG• Commission research
Situation Analysis ( research projects)• Ab use in humans, animals; resistance; social and
regulatory structures• Existing/contemplated policies
Final Report: Phase 1• SitAn + Stage 1 Analysis of Policy Options
Interesting and Useful Findings· In all GARP countries, sufficient data can
be found to support high levels of antibiotic resistance, at least in some places
· No GARP country has a functioning surveillance system to monitor trends
· Information on antibiotic use in animals is incomplete
· Most studies concentrate on urban areas and hospitals
Policy Ideas
Reducing Antibiotic Demand· Vaccines· Infection control in hospitals· Eliminating some animal use (e.g., growth
promotion)Altering Antibiotic Supply· Restricting sales of advanced drugs (e.g.,
carbapenems in India)
Evidence-Based Change in Policy and Practice: The GARP Strategy· All options identified, a small number
chosen· Thorough and transparent analysis
Feasibility, cost, acceptability, etc.—specific to the country situation
· Presented to the right people and organizations
· Local supporting evidence, when possibleThe Critical Path
Evidence-Based Change in Policy and Practice: The GARP Strategy
[2]· Becoming a trusted source· Seizing opportunities for input
E.g., news stories about infections, antibiotic resistance, drug prices
· Persistence
Opportunist Path
GARP Phase 2: The Next 3 Years· Deepening the relationship in the GARP
founding countries· Expanding the partnership: GARP phase 2
countries· Structuring the partnership itself· Developing tools: PneuMOD, DRI· Developing a sustainable plan for the future
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