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