D1-Dr. van Weezenbeek-What can the AMR response learn from the COVID-19 response and vice versa (1)

08/10/2021
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What can the AMR response learn from the COVID-19
response and vice versa?
Dr Kitty van Weezenbeek
WHO Director Surveillance, prevention, and control of
Antimicrobial resistance (AMR)
WMA Scientific Session
October 7th , 2021
Outline of the presentation:
1. Introduction to Antimicrobial Resistance (AMR)
― the global situation
― the AMR patient pathway and programmatic AMR response
― WHO initiatives at national and global level
2. COVID-19 and AMR: differences, similarities and lessons learned
Assignment:
“Explore and identify ‘issues’ arising from the COVID-19 epidemic that are relevant to
ensuring a more comprehensive coordinated response to the growing threat of
antimicrobial resistance”
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Antimicrobials: crucial for human & animal health
Antimicrobials
Wound
infections
Urinary tract
infections
Pneumonia Typhoid fever
Neonatal
sepsis
Preterm babies
Complicated
deliveries
Hip
Replacement
Organ
Transplants
Cancer
Treatment
Maternal and
child health
Modern
medicine
Basic
health care
Source: Antimicrobial resistance – a threat to the World’s Sustainable Development. Jasovsky et al. 2016. Dag Hammarskjold Foundation.
Misuse and overuse of antimicrobials,
Poor access to quality, affordable
medicines, vaccines and diagnostics,
Lack of access to clean water,
sanitation and hygiene
Inability to treat
infections
Increased
mortality
Economic
damage
AMR demands a comprehensive multisectoral response
Drivers of Antimicrobial Resistance
Impact of
Antimicrobial
Resistance
Discharge of waste
Misuse and overuse
of antimicrobials
Transmission of
resistant pathogens
Poor infection and disease
prevention and control
Terrestrial and aquatic animals
Food and feed
Plants and crops
Environment
Water, sanitation
and hygiene
Humans
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In 2018, WHO, FAO and OIE signed a Memorandum of
Understanding (MoU) signaling their joint cooperation
and strong focus on AMR in the context of the “One
Health” approach. This was followed by the
establishment of a standing Tripartite Joint
Secretariat (TJS) within WHO to lead and coordinate the
global response to AMR.
Each agency works with constituencies and
addresses AMR issues according to its mandate
and comparative advantage, but these overlap,
and the Tripartite will address these areas
where joint action is necessary and most
impactful.
WHO
OIE
FAO
Tripartite collaboration to address AMR, plus UNEP
 Drug-resistant infections caused by AMR are silently affecting
the lives of thousands worldwide, a threat often referred to as
“the silent pandemic”.
 Every third minute a child dies from sepsis due to antibiotic-
resistant infections.
 AMR is a One Health issue, affecting and being affected by
humans, animals and the environment.
If nothing is done, there will be
10 million AMR-related deaths by 2050, 9
million of which in low- and middle-income
countries*
*Jim O’ Neill (2016), Tackling Drug-Resistant Infections Globally: final report and
recommendations, Review on AntimicrobialResistance
AMR: the humanitarian and economic cost of inaction
Strategic Objectives Global AMR Action Plan (WHA 2015)
But where is
the diagnostic
pathway?
Improve awareness and understanding of antimicrobial resistance through effective
communication, education and training
Strengthen the knowledge and evidence base through surveillance and research
Reduce the incidence of infection through effective sanitation, hygiene and
infection prevention measures
Optimize the use of antimicrobial medicines in human and animal health
Dev
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
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2
3
4
5
Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report
Global AMR data: progress in reporting
Most reporting countries show an increase in the number of surveillance sites!
Reported to GLASS – AMR
2017 2018 2019 2020
(22 countries) (48 countries) (66 countries) (70 countries)
Number of sites
Hospitals 466 3,097 5,557 5,942
Outpatients clinics 139 2,358 56,818 60,239
In-out patients N.A. N.A. 1,998 6,351
Other institutions 124 560 424 1,089
Total 729 6,015 64,797 73,621
Number of patients with suspected infection
Blood stream 81,920 262,265 441,794 502,584
Urinary tract 415,679 1,424,011 1,888,545 2,577,333
Gastro-intestinal 7,477 10,735 17,061 17,003
Sexually transmitted 2,847 9567 18,572 9,682
Total 507,923 1,706,578 2,365,972 3,106,602
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Preliminary information on SDG indicators for AMR in BSI
Low- and middle-income countries (LMICs) need urgent support and analysis of underlying causes
Note: *Countries that reported 70% pre-clinical pipeline driven by small medium
size enterprises
ANTIBIOTICS: PRECIOUS BUT DIMINISHING RESOURCE
?
WHO’s global activities in antimicrobial R&D
R&D
Priority
setting and
pipeline
Fostering
R&D
Fostering
access
Elimination
Control
Prevention
19
GAP
Objective 5:
R&D
GARDP
AMR Action Fund
Prevention
Priority Pathogens List
Fungal Priority Pathogens List
Clinical and Pre-Clinical Pipeline Analysis
SECURE
One-health research agenda
Identification of Priorities (2017)
Global Priority Pathogens List: 13 pathogens prioritized to guide R&D
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*2
*4
CRITICAL
PRIORITY
HIGH
PRIORITY
MDEIUM
PRIORITY
Tacconelli E et al. Lancet Infect Dis. 2018; 18(3):318-
327
Source http://www.who.int/entity/medicines/areas/rational_use/PPLreport_2017_09_19.pdf?ua=1
2022
update
08/10/2021
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21
• SECURE will establish a quality assured
portfolio driven by public health and
clinical needs and
• be open to all interested countries
and other eligible entities
SECURE will provide countries with
sustainable access to:
(1) new antibiotics to address drug-
resistant infections
(2) existing antibiotics that are not
widely available or that suffer from
frequent supply chain interruptions
and/or shortages
SECURE: The antibiotic facility Infection, prevention and control
Stronger hygiene and infection prevention measures, including
vaccination, strong hand hygiene, appropriate aseptic technique,
consistent maintenance of clean, hygienic medical facilities,
equipment and practices along with thoughtful and thorough
surveillance, monitoring and evaluation measures can limit the
spread of resistant microorganisms and reduce antimicrobial
misuse and overuse.
Vaccination
Hand hygiene
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Curricula for health facility cleaning staff to improve IPC
and environmental cleaning (finalization phase)
 Poor basic cleanliness is a major cause of perinatal morbidity
and mortality
 Cleaners are a neglected HCW group with limited access to
sufficient cleaning supplies and adequate training on IPC
 WHO updated a training curriculum for cleaning staff in
collaboration with WHO IPC hub, WHO Health Workforce and
WASH, and London School of Hygiene and Tropical Medicine
Next steps
 develop a facilitators guide to standardize training approach
 implementation pilot in 4 countries
 Global dissemination
Slide | 24
Global AMR research agenda – Concept note 2021
Problem: limited AMR evidence base, especially in LMICs
• Knowledge gaps related to the burden and factors associated with AMR?
• New /improved interventions for AMR prevention, diagnosis, care and treatment?
• Best way to deliver these interventions?
1. Identify and prioritize research questions
2. Catalyse investment and scientific interest among
researchers, donors, health professionals and private sector
3. Guide the translation of research into action
Objectives
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Shared issues
• Governance / coordination/ regulations
• Both poor and rich communities affected
• Diagnostic capacity and IPC
• Rational use of medicines
• Human resource capacity
• Supply chain management
• National surveillance and evidence generation
Differences
• Awareness, visibility and advocacy
• Immediate vs longer term economic threat
• R&D funding, capacity and pace
• Market dynamics
• Use of digital health solutions
• Prioritization of HR capacity
• Trust in social media and science
COVID-19 and AMR: similarities and differences
Literature
AMR and COVID-19
7-8% hospitalized COVID-19 patients had secondary co-infections:
• higher proportion of ICU patients
• most common: Mycoplasma pneumonia, Pseudomonas aeruginosa,
Haemophilus influenzae
72% received antibiotic therapy – broad-spectrum antibiotics
AMS and COVID-19
WHO clinical management of COVID-19 interim guidance
10/8/2021 27
 For suspected or confirmed mild COVID-19 – recommend
against antibiotic therapy or prophylaxis
 For suspected or confirmed moderate COVID-19 – recommend
that antibiotics should not be prescribed unless there is
clinical suspicion of a bacterial infection
 For suspected or confirmed severe COVID-19 – recommend the
use of empiric antimicrobials to treat all likely pathogens, based
on clinical judgement, patient host factors and local
epidemiology and this be done as soon as possible, ideally with
blood cultures obtained first. Antimicrobial therapy should be
assessed daily for de-escalation
Source:
https://www.who.int/publications/i/ite
m/clinical-management-of-covid-19
New(er) lessons
• Impressive global R&D and FDA response,
both pace and quality, is possible
• Weak pandemic response everywhere
• Societal mistrust (science & governance)
• Role of social media
• Potential of digital health
• Preaching equity / practicing ‘nation first’
Very old lessons
• No equitable global distribution
• Most public health systems are weak
‒ Governance, operations and $$
‒ human resource capacity
‒ supply chain management
‒ laboratory capacity, IPC
‒ vulnerable groups suffer
‒ market dynamics prevail
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COVID-19 lessons relevant to the AMR response
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Antimicrobials, vaccines and IPC were game changers …..
Penicillin increased survival from
10% to 90% among patients with
pneumonia & BSI
The cost of inaction is too high!
Join us in the World Antimicrobial
Awareness Week 2021
18-24 November!