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The Global Antibiotic Resistance Partnership
Global Health Council ConferenceTuesday 14 June 2011
Hellen GelbandCDDEP
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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
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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
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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)
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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
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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
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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
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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
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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)
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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
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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
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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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