Update SRA to SRIA 24 October 2018 Jean Yves Madec Linda van Gaalen

SRA Update Milestone 17: Editorial board – December 2017 Linda van Gaalen (WG leader) Antoine Andremont (France) Jessica Boname (United Kingdom) Martijntje Bakker (Netherlands) Virginie Mouchel (France) Patriq Fagerstedt (Sweden) Maria Josefina Ruiz Alvarez (Italy) Gian Maria Rossolini (Italy) Kay Duggan-Walls (Ireland) Laura Plant (JPIAMR Secretariat) Martine Batoux (France) Marita van de Laar (Support) Monthly teleconferences Meetings – work sessions (3)

SRA update; what has been done so far Actions Dates SAB meeting on process of SRA update - Amsterdam 13/14 December 2017 SAB feedback and suggestions on SRA pillars January 2018 General outline for updating SRA - CSA meeting - Brussels 1 February 2018 Editorial Board meeting - Brussels 2 February 2018 MB meeting update on SRA update - Stockholm 26 March 2018 SAB input on pillars Diagnostics and Therapeutics 13 May 2018 SAB input on rest of the pillars 27 May 2028 Presentation of pillars Diagnostics and Therapeutics the IMI scientific at the advisory group meeting 4-5 June 2018 EB Meeting to work session on revision of SRA with SAB and IMI comments - Utrecht 26-27 June 2018 Consultation JPIAMR member countries - via MB From 9 July to 15 September 2018 Open consultation via open questionnaire

SRA update; Future plans Actions Dates Editorial Board meeting - To process MB and science input 22 October 2018 MB discussion research priorities/enabling activities and other issues raised in consultations 24 October 2018 Collate 2nd draft version SRIA October 2018 Survey MB on research priorities & enabling activities Deadline 9 November 2018 Prioritisation & Roadmap Workshop Participants: SAB (old and new), SC and EB 6-7 December 2018 Preparing SRIA, priority list and Roadmap for MB last review December 2018 to 20 January 2019 MB review SRIA, priority list and Roadmap 20 January 2019 to MB meeting Q1 2019 MB approval SRIA & roadmap MB meeting Q1 - 2019 Edit, publish and promote SRIA From MB Q1 2019 onwards

MB consultation: Germany, France, Netherlands, Sweden, Japan, Korea, Estonia, Norway and Ireland 215 comments 191 content / edit comments 5 extra references 29 unlisted comments

Open consultation: Responses from 48 individuals 40 (83%) from Europe 8 (17%) from other parts of the world No response from animal health or agricultural sector Hospitals 26%; research institutes 32% (mostly human health & microbiologists)

Area of expertise and feedback per pillar Number of responses

Comments Therapeutics (N=28) Appropriateness: Yes 20 No 7 DK 1 Anything missing: Yes 20 No 3 DK 4 Reasonable but not inclusive; Different scope between objectives 1-4 vs 5-8 Fungal resistance is missing (mentioned 14 times + one person provided details regarding objectives & rationale). To better understand how local practices and beliefs affect treatment regimes in LMIC. Number of references (specified, i.e. Lancet ID). Barriers: access to industry; to policymakers; to data. Lack of connectivity, and funding was mentioned as well.

Comments Diagnostics (N=20) Appropriateness: Yes 13 No 7 DK 1 Anything missing: Yes 15 No 2 DK 3 Fungal resistance is missing (mentioned 10 times + details provided re objectives & rationale); viral infections (2 times) Address more specifically LMIC and settings. Merge 3rd and 4th objective. Number of references (specified). Barriers: access to samples; to policymakers; to data. Lack of expertise, funding, interest in full spectrum was mentioned.

Comments Surveillance (N=17) Appropriateness: Yes 13 No 4 Anything missing: Yes 9 No 1 DK 4 Fungal resistance is missing (mentioned 9 times) Global surveillance builds on national systems; setting up infrastructures in LMIC; lack of cohesive reporting across countries. Address more specifically WHO global systems and avoid setting up parallel systems. Merge 2nd & 3rd objective, add for policy and intervention development. Number of references (specified, ie. Lancet ID). Barriers: access to data; to samples; data integration. Missing networks: ESCMID Fungal Infection Study Group surveillance projects, ECMM Fungiscope; Antifungal surveillance; surveillance on antifungal resistance in yeasts and moulds

Comments Transmission (N=11) Appropriateness: Yes 8 No 3 Anything missing: Yes 6 No 3 DK 2 Fungal resistance is missing (mentioned 3 times) Lacking: more on methods and risk assessment; research infrastructure missing in most LMIC Include broad microbial community research; Focus on effective intervention of pathogens; scope is too narrow. Not well separated for this topic and Environment. Number of references (specified, i.e. Murray). Barriers: data integration; access to data. Lack of funding is mentioned

Comments Environment (N=14) Appropriateness: Yes 14 No 0 Anything missing: Yes 10 No 2 DK 1 Objectives are very appropriate Not well separated for this topic and Transmission. Lacking: sources and reservoirs fungal infections See specific suggestions made for improving the text Number of references (specified, i.e. Murray). Barriers: data integration; access to data; to samples. Lack of funding is mentioned; lack of expertise “same people”; access to policymakers.

Comments Interventions (N=12) Appropriateness: Yes 9 No 2 DK 1 Anything missing: Yes 7 No 3 DK 2 Intervention objectives for fungal infections (mentioned 4 times) Stewardship is part of training – no need to single out – focus on prevention of infections is OK (not just on AMR)! Merge objectives 4 & 5 Lacking: need for health economic research; behavioural research as well as social norms and beliefs Long comment given on education and awareness, limited positive changes; why not address other means for behaviour change? Number of references (specified, i.e. Murray). Barriers: access to data; lack of appropriate skills; of expertise; access to industry partners.

Scientific Advisory Board

Scientific Advisory Board activities 2018 Input for SRA update Input for call topics Review of SRA pillars Feedback on the updated SRA text Providing candidates for new SAB Participation of SAB nomination committee; Bruno Gonzalez Zorn, Gunnar Skov Simonsen, Mark Sobsey “Old” and new SAB members are invited for the Prioritisation Workshop, 6 and 7 December 2018

Scientific Advisory Board - Election 2018 SAB Nomination Committee; consisting of 2 MB members and 3 former SAB members Nominations for new SAB members and second term members SAB Nomination Committee proposed 15 SAB candidates to MB Online vote on new SAB membership. (October 6-7) MB appoints new SAB members (October 23) Election new SAB Chair (November - December) 2019 Jan 1st New SAB membership term starts

SAB views on Fungi and antifungal resistance Emerging problem (Candida and Aspergillus fumigatus) Immune compromised individuals, health care facilities etc. Relation between antibiotic use and fungal infections and resistance Agricultural use and antifungal resistance pose a risk to human health Relatively low prevalence, but high morbidity and mortality rates Increasing discussions in several countries, CDC, ECDC, WHO At this point the SRIA does not address antifungal resistance or other emerging resistance issues.

SAB views on Emerging resistance issues Will JPIAMR address emerging topics in future, such as antifungal resistance, if the urgency increases? Should the JPIAMR SRIA leave the option open to address antifungal resistance in any way? YES / NO Capacity building ICARe (International Course on Antibiotics and Resistance) Network calls followed by research calls Interaction SAB – SC Contribution of the SAB to assessment of monitored projects JPIAMR-VRI Task Force

Thank you! @: jpiamr@zonmw.nl