1. | Antimicrobial Resistance Global Report on Surveillance 2014 Global Action Plan to combat antimicrobial resistance

2. | Antimicrobial Resistance Global Report on Surveillance 2014 % survivors Penicillin Untreated Days Penicillin increased the chance of survi val from 10% to 90 % Patients with pneumonia and bacteria in the blood Adapted from Austrian et al. Ann. Int. Med 1964; 60, 759

3. | Antimicrobial Resistance Global Report on Surveillance 2014 The more we use them, the more we lose them From Albrich et al EID 2004

4. | Antimicrobial Resistance Global Report on Surveillance 2014 Diseases that should be treatable now more likely to kill

5. | Antimicrobial Resistance Global Report on Surveillance 2014 Impact on mutliple sectors of health care Infectious disease Pneumonia Gonorrhea Enteric infections Blood infections etc. Medical Procedures Neonatal care Transplantation Cancer treatment Surgery etc.

6. | Antimicrobial Resistance Global Report on Surveillance 2014 Why now? Increasingly serious global public health threat –New evidence and information –Desperation over "dry pipeline" Economic impact –World Economic Forum 2013 Global Risk Report Growing awareness and commitment –Political, professional, public

7. | Antimicrobial Resistance Global Report on Surveillance 2014

8. | Antimicrobial Resistance Global Report on Surveillance 2014 Focuses on antibacterial resistance (ABR) Information gathered include: Surveillance of ABR according to WHO regions National and published data on 7 bacteria Systematic reviews of evidence of health and economic burden in 5 bacteria/ resistance combinations Identification of gaps Antimicrobial Resistance Global Report on Surveillance 2014 (I)

9. | Antimicrobial Resistance Global Report on Surveillance 2014 BacteriumResistance/ decreased susceptibility to: Escherichia coli3 rd generation cephalosporins, fluoroquinolones Klebsiella pneumoniae3 rd generation cephalosporins, carbapenems Staphylococcus aureusMethicillin (beta-lactam antibiotics) i.e. MRSA Streptococcus pneumoniaePenicillin Nontyphoidal Salmonella (NTS)Fluoroquinolones Shigella speciesFluoroquinolones Neisseria gonorrhoeae3 rd generation cephalosporins Selected Bacteria/Resistance Combinations

10. *National data means data obtained from official sources, but not that data necessarily are representative for the population or country as a whole Available National Data* on Resistance for Nine Selected Bacteria/Antibacterial Drug Combinations, 2013

11. | Antimicrobial Resistance Global Report on Surveillance 2014 Name of bacterium/ resistance Examples of typical diseases No. of 194 MS providing national data No. of WHO regions with national reports of 50 % resistance or more Range of reported proportion of resistance Escherichia coli Urinary tract infections, blood stream infections -vs 3 rd gen. cephalosporins845/60-82 -vs fluoroquinolones905/63-96 Klebsiella pneumoniae Pneumonia, blood stream infections, urinary tract infections -vs 3 rd gen. cephalosporins856/62-82 -vs carbapenems692/60-68 Staphylococcus aureus Wound infections, blood stream infections -vs methicillin “MRSA”835/60.3-90 Bacteria Commonly Causing Infections in Hospitals and Communities

12. | Antimicrobial Resistance Global Report on Surveillance 2014 Name of bacterium/ resistance Examples of typical diseases No. of 194 MS providing national data No. of WHO regions with national reports of 25 % resistance or more Range of reported proportion of resistance Streptococcus pneumoniae Pneumonia, meningitis, otitis -non-susceptible to penicillin 666/60-73 Nontyphoidal Salmonella Foodborne diarrhoea, blood stream infections -vs fluoroquinolones 663/60-96 Shigella species Diarrhoea (“bacillary dysenteria”) - vs fluoroquinolones 342/60-47 Neisseria gonorrhoeae Gonorrhoea -vs 3 rd gen. cephalosporins 423/60-36 Bacteria Mainly Causing Infections in the Community

13. | Antimicrobial Resistance Global Report on Surveillance 2014 Is there any difference in outcome from infections caused by resistant vs sensitive bacteria? Systemic Reviews: Evidence of the Burden of Antibacterial Resistance

14. | Antimicrobial Resistance Global Report on Surveillance 2014 Deaths (%) Outcome (number of studies included)ResistantNot resistantRR (95% CI) Escherichia coli resistant to: 3 rd gen. cephalosporinsBacterium attributable mortality (n=4)23.612.62.02 (1.41 to 2.90) FluoroquinolonesBacterium attributable mortality (n=1)00 Klebsiella pneumoniae resistant to: 3 rd gen. cephalosporinsBacterium attributable mortality (n=4)2010.11.93 (1.13 to 3.31) CarbapenemsBacterium attributable mortality (n=1)2713.61.98 (0.61 to 6.43) Staphylococcus aureus resistant to: Methicillin (MRSA)Bacterium attributable mortality (n=46)26.316.91.64 (1.43 to 1.87) Risk of Death is Higher in Patients Infected with Resistant Strains

15. | Antimicrobial Resistance Global Report on Surveillance 2014 Estimates of Burden of Antibacterial Resistance European Union population 500m 25,000 deaths per year 2.5m extra hospital days Overall societal costs (€ 900 million, hosp. days) Approx. €1.5 billion per year European Union population 500m 25,000 deaths per year 2.5m extra hospital days Overall societal costs (€ 900 million, hosp. days) Approx. €1.5 billion per year United States population 300m >23,000 deaths >2.0m illnesses Overall societal costs Up to $20 billion direct Up to $35 billion indirect United States population 300m >23,000 deaths >2.0m illnesses Overall societal costs Up to $20 billion direct Up to $35 billion indirect Source: ECDC 2007Source: US CDC 2013 Thailand population 70m >38,000 deaths >3.2m hospital days Overall societal costs US$ 84.6–202.8 mill. direct >US$1.3 billion indirect Thailand population 70m >38,000 deaths >3.2m hospital days Overall societal costs US$ 84.6–202.8 mill. direct >US$1.3 billion indirect Source: Pumart et al 2012 Global information is insufficient to show complete disease burden impact and costs

16. | Antimicrobial Resistance Global Report on Surveillance 2014 1.High proportions of resistance were reported in all regions to common treatments for bacteria causing infections in both healthcare settings and in the community 2.Antibacterial resistance has a negative effect on patient outcomes and health expenditures 3.Treatment options for common infections are running out 4.Despite limitations, the report demonstrates worldwide magnitude of ABR and surveillance gaps Summary: Antibacterial Resistance

17. | Antimicrobial Resistance Global Report on Surveillance 2014 Resolution on AMR World health Assembly May 2014... To develop a draft global action plan to combat AMR... to ensure that all countries... have the capacity to combat AMR. –Takes into account existing action plans and all available evidence and best practice –To apply a multisectoral approach by consulting..... Submit to 2015 Health Assembly through the Executive Board January 2015 –November 2014

18. | Antimicrobial Resistance Global Report on Surveillance 2014 Consultation on draft GAP (1) Online consultation held between 4 July and 1 September 2014 –Open to Member States, organizations –130 contributions received from all relevant sectors Member States, Government agencies and organizations: 54 NGOs and civil society: 40 Private sector: 16 Academia: 16 Other (International organizations): 4

19. | Antimicrobial Resistance Global Report on Surveillance 2014 Consultation on draft GAP (2) Strengthen tripartite collaboration –FAO, OIE, WHO –Worked together on development of global action plan Shared actions for the collaboration 16 October consultation with Member States –http://www.who.int/drugresistance/memberstatemeeting/en/http://www.who.int/drugresistance/memberstatemeeting/en/ 17 October 3 rd meeting of WHO Advisory Group Additional Member State consultations scheduled –Optimizing use of medicines (Oslo, November) –Global surveillance (Stockholm, December)

20. | Antimicrobial Resistance Global Report on Surveillance 2014 Draft global action plan will be based on… 5 Guiding principles –Whole of society engagement –Prevention first –Access, not excess –Sustainability –Incremental targets for implementation

21. | Antimicrobial Resistance Global Report on Surveillance 2014 Five strategic objectives: Improve awareness and understanding Strengthen the knowledge and evidence base Reduce the incidence of infection Optimize the use of antimicrobial medicines Develop the economic case for sustainable investment Commitments to report progress

22. | Antimicrobial Resistance Global Report on Surveillance 2014 Communication, Awareness, Training  Public communication programmes  Professional education, training, certification  Schools curricula  Public information and media  Role for all stakeholders in promoting public understanding of infection prevention and use of antimicrobial medicines

23. | Antimicrobial Resistance Global Report on Surveillance 2014 Strengthen the knowledge and evidence base  Capacity to collect, analyse and report data  Global surveillance based on national capacity  Integration of data between human and animal sectors  Develop global public health research agenda  Implement (research funders to support)  Repository of information  Global health R&D observatory

24. | Antimicrobial Resistance Global Report on Surveillance 2014 Reduce the incidence of infection  Hygiene, infection prevention and control  Healthcare settings (hospitals)  Sanitation, water and food safety  Control of STI, vector borne diseases  HIV, gonorrhoea, malaria  Role of vaccines and immunization  Expand use of existing vaccines (e.g. pneumococcal)  Reduce prevalence of infection inappropriately treated with antibiotics (e.g. influenza, rotavirus)  New priority vaccines to prevent difficult-to-treat or untreatable infections  Animal husbandry  High density livestock (terrestrial and aquatic)

25. | Antimicrobial Resistance Global Report on Surveillance 2014 Optimize use  Regulatory mechanisms for new antibiotics  Effective low-cost tools for diagnosis and susceptibility testing  Access to medicines accompanied by measures to protect continued efficacy  Code of practice

26. | Antimicrobial Resistance Global Report on Surveillance 2014 Sustainable investment  Economic case for investment  Realizing the global investment needs  Developing countries  Coordinating initiatives aimed at renewing investment in new antibiotics, diagnostics & other tools

27. | Antimicrobial Resistance Global Report on Surveillance 2014 Implementing, monitoring and evaluation  Countries should develop and implement national action plans  “building blocks”  National priorities, circumstances  WHO will develop a framework for monitoring and evaluation  WHO to report every 2 years  Others to develop own action plans and report within normal reporting cycle

28. | Antimicrobial Resistance Global Report on Surveillance 2014 Thank you