1. Antimicrobial resistance “One health fits all”
Anja Schreijer, MD, PhD, MPH
Senior policy advisor AMR Centre for Infectious Disease Control
RIVM

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3. EU
deaths annualy
Costs: 1,5 billion euro/year 3 3

4. WHO draft global action plan Five strategic objectives:
1. to improve awareness and understanding of antimicrobial resistance;
2. to strengthen knowledge through surveillance and research;
3. to reduce the incidence of infection;
4. to optimize the use of antimicrobial agents;
5. to develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.
(to be presented at WHA May 2015)

5. Identifies 7 areas in which actions are most necessary:
- making sure antimicrobials are used appropriately in both humans and animals
- preventing microbial infections and their spread
- developing new effective antimicrobials or alternatives for treatment
- cooperating with international partners to contain the risks of AMR
- improving monitoring and surveillance in human and animal medicine
- promoting research and innovation
- improving communication, education and training.

7. Transmission of resistant microorganisms7

8. One health approach: intersectoral surveillance

9. Specific objectives of AMR surveillance & AB use
Monitor
Antibiotic-susceptibility patterns common pathogens
Magnitude and trends of AMR
Emergence of new AMR
Use/overuse/misuse of antibiotics
In order to
Improve quality, safety and costs of health care
Guidance adequate antibiotic therapy – appropriate use
Support infection prevention & control
Awareness & advocacy
Benchmarking
Improve laboratory capacity, expertise & quality

10. No surveillance no control..

11. Use of antibiotics in Europe (humans)

12. Use of antibiotics in Europe (animals)

13. Intersectoral Coordination:
Ministry of Health, Welfare and Sports & Ministry of Economic Affairs (Agriculture and Livestock)
Health Council of the Netherlands report (2011): Antibiotics in food animal production and resistant bacteria in humans.
Preventive use was prohibited
Restricted use of all critically important antibiotics (3rd choice)
Last resort antibiotics excluded from veterinary use
Mandatory sensibility testing 3rd choice antibiotics
Independent Veterinary Drug Authority (2011): Monitor trends + bench- marking + transparency
Amendment to the law (2013): Antibiotics only with prescription from veterinarian
Guidelines

14. SDA Top down and buttom up

16. Appropriate use of antibiotics
AMR control
Infection control
Appropriate use of antibiotics

17. Control of AMR: infection control
Infection prevention & hygiene
Professional guidelines for each setting
Search and destroy or control/contain
Awareness and sense of urgency
Outbreakmanagement
Enforcement by the national health inspectorate
Problem ownership/responsibilities

18. Control of AMR -> Appropriate use of antibiotics
Right indication, right dose, adequate period, at the lowest cost, good quality
Treatment is correctly followed by the patient.
Bacteria causing the infection need to be susceptible.
Inappropriate use includes over-prescription, under prescription, and prescription and dispensing of unnecessary antibiotic combination
(From: The evolving threat of antimicrobial resistance - Options for action, WHO 2012)
Control: surveillance, awareness, problem ownership, responsibilities, professional guidelines, antibiotic stewardship, enforcement

19. Control of AMR: raising awareness

21. TAP: when knowledge is not enough
Guide to Tailoring AMR Programmes
Design tailored interventions instead of “spray campaigns”
Describes an step by step approach and provides tools to assist national AMR programmes to increase prudent antibiotic use
Based on TIP (Guide to Tailoring Immunization programmes)
TAP is a conceptual model that combines several behavioural change theories, social marketing concepts with previous experience.
TAP brings together several stakeholders from the start to gain ownership and to recognize the work that has to be done together in order to work towards the intervention together
Current state: in development/pilot fase → Sweden, England, Netherlands

22. AMR Dutch EU presidency
NL involvement in WHO GAP and GHSA (one of the leading countries)
Minister of Health announced at the 3rd International One Health Congress in Amsterdam (March 2015): AMR will be one of my priorities during the Dutch EU presidency first half 2016
Focus on One Health approach to AMR; measures needed in human health sector, animals, food and environment
Further recommendations for the next EU AMR Action plan
NL is actively involved in fighting AMR, both nationally and internationally. Internationally we actively promote and are involved in the WHO Global Action Plan, we organised conference to develop GAP in June 2014, with a focus on human –veterinary cooperation. The draft GAP is on the agenda of the next World Health Assembly in May. We are one of the leading countries of the Global Health Security Agenda ‘AMR working package’. In March, we organised a high level meeting with the other leading countries to take this working package further.
AMR is one of my priorities during the Dutch EU-presidency in I intend to focus on the need for a One Health approach to AMR in the EU.
We want to use the evaluation of the current EU action plan as a starting point for our discussions.
We will organise a One Health Ministerial conference on AMR with both ministers of Health and Agriculture, feb 2016.
Aim is to develop strong recommendations that can be included in the next EU Action Plan for AMR
We will ask member states to present best practices from their country, on surveillance, infection prevention or prudent use of antibiotics in the human and veterinary sector.

23. Conclusions:
No action today no cure tomorrow
No surveillance no control of AMR and use of antibiotics
AMR control consists of infection prevention and appropriate us of antibiotics
Knowledge is not enough for behavior change
One health fits all (better safe then sorry)

24. Questions? 24 24 24