ICARS International Centre for Antimicrobial Resistance Solutions Based on slides prepared by professor kåre mølbak Vice-president and director of Division of infectious diseases preparedness Statens Serum Institut, denmark Heading ICARS interim steering committee

This presentation What Why When, how & where JPIAMR ↔ ICARS

What is ICARS A Danish inter-ministerial initiative, suggested in 2017 by World Bank and CGIAR, on solutions for AMR mainly in LMIC. ICARS is under development in 2019 ICARS conduct, commission and participate in research to support the development of interventions to contain and mitigate AMR in LMICs Translational research transforms national action plans and policies into practice Bottom-up participatory research and complex intervention studies Top-down risk assessments and economic analyses to aid risk management, and setting of governmental priorities and intervention research Combination of top-down and bottom-up: ICARS as a policy interface Independent open resource to public and private bodies

Mode of operation Focus on solutions and interventions Intervention and implementation science - social science, development experts and related disciplines Complex interventions aiming at implementation in ”real life” – not only clinical trials - the devil is in the context One Health, including human public health Long-term commitments and partnerships Knowledge node – assist on technical matters with relevant partners

Direct + indirect focus AMR specific and AMR sensitive interventions Too much emphasis on antimicrobial use ? Indirect drivers to be addressed: Environment – domestic and the public domain WASH (water, sanitation, hygiene) Better use of existing vaccines (a.o. flu for pregnant, childhood vaccines) Management practices in health care and in agriculture Infection control The ”AMR lens” on such interventions

Why ICARS: AMR is a ”wicked problem” Difficult to clearly define – cannot first understand and then solve Multi-causal with many interdependencies Unforeseen consequences of addressing them Solutions are not right or wrong – they are better-worse; good enough-not good enough Are socially complex, context matters making each one unique Responsibility of multiple organizations Solutions involve changes in behavior Often characterized by chronic policy failure

Re-focus Bias in research towards presenting challenges rather than working on solutions and interventions When solutions are addressed, it is often addressed with a single or few disciplines Although there is a concensus on One Health, there is a lot of silo thinking and focus on antimicrobial use Focus on publishing rather than making a change

Why LMIC MIC are home to 5 of the world’s 7 billion people and 73% of the world’s poor people. MICs also represent about one-third of global GDP and are major engines of global growth Need to be working with NGO’s, private partners and local governments

When, how & where Workshop, Interim SC, MoU DK↔CGIAR 2018 Workshop, Interim SC, MoU DK↔CGIAR DK financial commitment (€6M annually) 2019 Secretariat (DK) Organizational fabric: Legal status – MB - AB-Policy - AB-Science - Partner network First projects with LMIC (Kenya, Ghana, Vietnam) Fundraising - foundations 2020 Role of ICARS is defined in relation to international agencies and organizations DK financial commitment geared x 3-4 Implementing legal structure and organization 2025-2030 Further financial gearing. CGIAR centre? 300-400 scientists working at ICARS new-built centre in CPH 300-400 affiliated scientists working locally mainly at LMICs hubs

JPIAMR ↔ ICARS Meeting JPIAMR – ICARS 27 March: JM update JPIAMR MB Once the roadmap and secretariat of ICARS becomes ready, ICARS will visit JPIAMR’s secretariat for mutual information and coordination ICARS will include JPIAMR in ICARS’ scientific advisory board ICARS will sign up as member of the JPIAMR VRI