garpnet news vol 2 issue 1 0
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GARPNet News
GLOBAL ANTIBIOTIC RESISTANCE PARTNERSHIP WWW.CDDEP.ORG/GARP
Volume 2, Issue 1January 2016
In this issue:Features: –Phase 2 in Review 1
–Resistance Takes Center Stage 2 –GARP Phase 3 3
Select CDDEP Publications on Antibiotic Resistance from Phase 2 3GARP in the News 3Contact Information for the GARP Network 4
1
Since GARP phase 2 began in 2012, antibiotic resistance has assumed an increasingly prominent place on the global health agenda. Advances in antibiotic resistance policy, aware-ness and research have been recorded, but most low- and middle-income countries have not yet organized around the issue. The eight GARP partners are the main exceptions. Phase 1 partners have moved ahead in the policy arena and new GARP working groups in Mozambique, Nepal, Tanzania and Uganda completed situation analyses with recommen-dations for action, launched at high-level, multi-sectoral events, supported by ministries and other partners. Awareness campaigns, training, workshops and online courses took place across the working groups. In addition to progress toward national polices, GARP partners were among the few low- and middle-income coun-tries to contribute data to the most comprehensive global antibiotic resistance data repository, Resis-tanceMap.
Phase 2 Highlights• GARP-South Africa played acentral role in the e�orts thatculminated in the publication ofthe Antimicrobial Resistance National Strategy Framework 2014-2024, now being implement-ed by the South African AntibioticStewardship Program and theMinistry of Health.• In Kenya, the GARP workinggroup coordinator was appointedto the newly created post ofantimicrobial resistance (AMR)focal point in the Ministry of
Health, and many GARP members now sit on the new national antimi-crobial stewardship advisory com-mittee, charged with developing a national plan.• GARP-Vietnam is collaborating onimplementing both national AMRpolicy and surveillance through theNational Action Plan to CombatAntimicrobial Resistance and theVietnam Resistance Project (VIN-ARES).• GARP-Kenya hosted three annualantibiotic awareness weeks,
GARP Phase 2 in Review
2013–2015, coinciding with CDCs Get Smart week and the �rst World Antibiotic Awareness Week. The week’s activities targeted medical and veterinary students and clinical decision makers through lectures and meetings held across the coun-try. • GARP-Nepal hosted their �rstawareness week in 2015 featuringrallies, essay competitions, presen-tations and other activities held indiverse regions. The working groupalso implemented a media cam-paign in national newspapersencouraging the appropriate use of
antibiotics by the general public. • GARP-India hosted a policyforum and training-of-trainerstargeting medical students andfocusing on hospital antibioticstewardship in 2014. Increasedinterest following the forum wassuccessfully leveraged to advo-cate for revisions to medicalschool curricula to include antibi-otic resistance.• Several hospitals in India, Nepal and South Africa established (orare establishing) a Drug Resis-tance Index (DRI) in collaborationwith CDDEP to track local resis-
tance rates and inform clinical decision-making.• GARP-India, Kenya, SouthAfrica and Vietnam contributeddata to CDDEP’s ResistanceMaptool, allowing users around theworld to interact with andvisualize trends in antibioticresistance and use.• All eight working groupshelped to launch CDDEP’s Stateof the World’s Antibiotics, 2015,using the occasion to raiseawareness and generate inter-est in policy action at thenational level.
Conference organizers check in medical students at the Kenya Medical Training College during Kenya’s celebration of World Antibiotic Awareness Week.
2 GLOBAL ANTIBIOTIC RESISTANCE PARTNERSHIP WWW.CDDEP.ORG/GARP
The most visible signal of greater global attention to antibiotic resis-tance is arguably the Global Action Plan on Antibiotic Resistance, a reso-lution adopted by the World Health Assembly (WHA) in May 2015. Many GARP partners took part in WHO deliberations on the plan at a meet-ing in Brazzaville prior to the WHA, and CDDEP director Ramanan Laxm-inarayan assisted in drafting the document.
The plan calls on all member states to create national plans within two years of the resolution’s adoption. Many high-income countries have only recently established such plans, including the United States, which released its �rst National Action Plan for Combating Antibiotic-Resistant Bacteria in 2015. CDDEP Director Ramanan Laxminarayan now sits on the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (CARB), which is advising on its implementation.
Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria
The United States’ national plan began taking shape at the end of 2013, when President Obama requested an assessment and multi-sectoral plan on AMR. Several agencies collaborated to recom-mend activities to be included in the plan, many of which were launched in 2014. The �nal action plan was introduced in 2015, and implemen-tation will take place under the guid-ance of the advisory council (CARB).
The Organization for Animal Health (OIE) Resolution
Resolution 26, passed at the 83rd general session of the OIE in May, 2015, aims to combat AMR in animals. Their recommendations
2015: Resistance Takes Center Stage
“Antimicrobial resistance threatens the very core of modern medicine and the sustainability of
an effective, global publichealth response to the enduring threat from infectious diseases.”
–WHO Director Margaret Chan,Foreword to the Global Action Plan
on Antibiotic Resistance
highlight the role of the OIE in developing standards and guide-lines and in helping member coun-tries to implement them. The devel-opment of standards for data collec-tion and the development of national surveillance systems were included in the recommendations.
The G7 Confront Antimicrobial Resistance
Antibiotic resistance and Ebola were the major health topics discussed by the G7 at their meet-ing in Germany in October 2015. In the Berlin Declaration on Antimicro-bial Resistance – Global Union for Antibiotics Research and Develop-
ment, the G7 Health Ministers called for a coordinated, one-health approach to curbing AMR, primarily by improving infection prevention and control, conserving antibiotic e�ectiveness, improving surveil-lance and through research and development. The G7 members stated their support for the WHO and OIE resolutions and committed
to updating their national plans and supporting other countries to devel-op their own. Best AMR policy prac-tices from the G7 countries are avail-able here.
CDDEP‘s Contributions
Research released by CDDEP in the last several years has provided new data on trends in antibiotic resis-tance and use in humans across the world (ResistanceMap) and a com-prehensive overview of the current state of antibiotic resistance knowl-edge and national-level action that can be taken, based on the GARP model (State of the World’s Antibiot-ics, 2015). CDDEP and GARP have
also contributed to new research on antibiotic use and resistance in animals. In November 2015, GARP and CDDEP contributed to the Lancet special series on antibiotic resistance, emphasizing the balance between access and excess. See page three for a list of CDDEP’s selected publica-tions on antibiotic resistance.
The 17th International Congress on Infectious Diseases
CDDEP is sponsoring a symposium on national actions on antibiotic resis-tance and their contribution to a global solution at the 17th International Congress on Infectious Diseases, taking place in Hyderabad, India, March 2-6, 2016. The symposium will highlight the successful national e�orts undertaken by the GARP working groups, and speakers will include top policy makers from Ministries of Health and GARP leadership from India, Kenya, Mozam-bique, Nepal and South Africa. Register to attend the symposium here, or click on the poster to the right.
G7 Health Ministers at a meeting to discuss antibiotic resistance in Germany, October 2015.
GLOBAL ANTIBIOTIC RESISTANCE PARTNERSHIP
Send us your feedback!
We welcome your comments on and additions to each newsletter. Please
send any content or questions to Molly Miller-Petrie at
Global Antibiotic NewsGARP in the NewsKenya’s antibiotic resistance situation and GARP-Kenya research were discussed in a Daily Nation article (”Growing resistance to antibiotics a ticking time bomb, health experts warn,” Jan 2016).
New on the CDDEP Site
Original graphics based on the recent United States Food and Drug Administration 2014 Summary Report on Antimicrobials Sold or Distributed for Use in Food-Producing Animals show increases in US meat production and increases in antibiotic use per kg of animal raised between 2009 and 2014.
WWW.CDDEP.ORG/GARP3
Select CDDEP Publications on Antibiotic Resistance from Phase 2• Abdula N, Macharia J, Motsoaledi A, et al. National action for global gains in antimicrobial resistance. Lancet, 387(10014):e3-e5
• Center for Disease Dynamics, Economics & Policy. Global ResistanceMap. Washington, D.C.: CDDEP
• Laxminarayan R, et al. 2013 Antibiotic resistance -the need for global solutions. Lancet InfectiousDiseases, 13(12):1057-1098
• Laxminarayan R, et al. 2015. Access to effective antimicrobials: a worldwide challenge. Lancet, 387(10014):168-175
• Laxminarayan R, Van Boeckel T & Teillant A. 2015. The economic costs of withdrawing antimicrobial growth promoters from the livestock sector. OECD Food, Agriculture and Fisheries Papers, No. 78, Paris: OECD Publishing
• Teillant A & Laxminarayan R. 2015 Economics of antibiotic growth promoters in livestock. Annual Review of Resource Economics, 7(1)
• Teillant A & Laxminarayan R. 2015. Economics of antibiotic use in agriculture in the United States. Washington, D. C.: Choices
• Van Boeckel TP et al. 2015. Global trends in antimicrobial use in food animals. Proceedings of the National Academy of Sciences, 112(18):5649-54
• Van Boeckel TP et al. 2014. Global trends in antibiotic consumption, 2000–2010. Lancet Infec-tious Diseases, Aug; 14(8):742-50
GARP Phase 3The Bill & Melinda Gates Foundation have awarded CDDEP a grant to continue GARP through a third phase, thanks to the impressive work of all eight GARP partners. CDDEP was challenged with devising a new plan to expand the GARP franchise to a larger number of coun-tries. What we proposed was to capitalize on the expertise and experience of the current eight partners to extend GARP’s reach by asking work-ing groups to act as mentors to new groups, with CDDEP support. The plan is to form an African network and an Asian network. As the current partners know, getting started, through development of situation analyses, is a labor-in-tensive and advice-intensive process. Respect-ing the needs of this process, we intend to draw in a small number of new countries initially and use the experience to further characterize and re�ne the process.
The process will be launched formally in spring 2016, with regional meetings, including current partners and key individuals from new entrants. We will be communicating more about this in the next couple of months. In the meantime, we are interested in your ideas of countries that you think we should approach to discuss possible partnership, and within those countries, poten-tial working group members, who may be researchers, academics, veterinarians, policy makers or others. We are available to discuss this by teleconference, or send ideas to us by email ([email protected]).
CDDEP in Review, 2015
Read a roundup of CDDEP’s major work and research completed in the last year, from on-the-ground successes with GARP to studies published in leading journals, including The Lancet and Proceedings of the National Academy of Sciences.
GLOBAL ANTIBIOTIC RESISTANCE PARTNERSHIP WWW.CDDEP.ORG/GARP4
GARP Network Contact InformationIndia
Secretariat
CDDEP–New DelhiWorking group chair Professor NK GangulyActing Coordinator
Jordan Levinson, CDDEP
Email: [email protected]
KenyaSecretariat
Kenya Medical Research Institute (KEMRI)
Working group chair Sam Kariuki, Director, Centre for Microbial Research
Vice chair Linus Ndegwa, Manager, Infection Control, CDC KEMRI
Coordinator Eveline Wesangula, Instructor, Kenya Medical Training College
Email: [email protected]
MozambiqueSecretariat
Manhiça Health Research Centre (CISM)
Working group chair Betuel Sigauque, Senior clinical researcherVice chair
Esperanca Sevene, Eduardo Mondlane School of Medicine
Coordinator Bessi Jacob, CISM Email: [email protected]
NepalNepal Public Health Foundation
Buddha Basnyat, Director, Oxford University Clinical Research Unit, Kathmandu Paras Pokharel, BP Koirala School of Public HealthSantoshi Giri
South AfricaSecretariat
University of the Witwatersrand
Working group chair Professor Adriano Duse, Department of Clinical Microbiology & Infectious DiseasesVice chair
Olga Perovic, Head of Microbiology External Quality Assessment Reference Unit,
National Institute for Communicable DiseasesConsultant/coordinator Kim Faure, independent consultant Email
Tanzania Secretariat Muhimbili University of Health and Allied SciencesWorking group chair Said Aboud, Professor and chair of MicrobiologyVice chair Robinson Mdegela, Sokoine University of AgricultureCoordinator VacantEmail: [email protected]
UgandaSecretariat Uganda National Academy of SciencesPrincipal Investigator Christian Acemah, Executive SecretaryWorking group chair Denis Byarugaba, Professor of veterinary medicine, Makerere UniversityVice chair Donna Kusemererwa, Independent ConsultantCoordinator James Lakony, UNAS Email: [email protected]
VietnamSecretariat Oxford University Clinical Research Unit (OUCRU), HanoiPrincipal investigator Rogier van Doorn, OUCRU, Hanoi DirectorWorking group chairCoordinator Do Thuy Nga, OUCRU, Hanoi Email: [email protected]
Washington, DC and New Delhi (CDDEP)
Hellen Gelband Associate DirectorEmail: [email protected]
Project analyst
Communications Andrea White
, Communications Associate Email: [email protected]
Ramanan LaxminarayanDirector
Project Manager
Principal investigator
Sameer Mani Dixit, Country Director, Center for Molecular DynamicsSecretariatPrincipal InvestigatorWorking group chairVice chairCoordinator Email:
Molly Miller-Petrie Senior Research Analyst Email: [email protected]