Garpnet news vol 2 issue 1 0

GARPNet News Volume 2, Issue 1 January 2016

In this issue: Features: –Phase 2 in Review –Resistance Takes Center Stage –GARP Phase 3

Select CDDEP Publications on Antibiotic Resistance from Phase 2 GARP in the News Contact Information for the GARP Network

GARP Phase 2 in Review Since GARP phase 2 began in 2012, antibiotic resistance has assumed an increasingly prominent place on the global health agenda. Advances in antibiotic resistance policy, awareness and research have been recorded, but most low- and middle-income countries have not yet organized around the issue.

The eight GARP partners are the main exceptions. Phase 1 partners have moved ahead in the policy arena and new GARP working groups in Mozambique, Nepal, Tanzania and Uganda completed situation analyses with recommendations for action, launched at high-level, multi-sectoral events, supported by ministries and other partners. Awareness campaigns, training, workshops and online courses took place across the working groups. In addition to progress toward national polices, GARP partners were among the few low- and middle-income countries to contribute data to the most comprehensive global antibiotic resistance data repository, ResistanceMap. Phase 2 Highlights • GARP-South Africa played a central role in the efforts that culminated in the publication of the Antimicrobial Resistance National Strategy Framework 2014-2024, now being implemented by the South African Antibiotic Stewardship Program and the Ministry of Health.

• In Kenya, the GARP working group coordinator was appointed to the newly created post of antimicrobial resistance (AMR) focal point in the Ministry of

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Health, and many GARP members now sit on the new national antimicrobial stewardship advisory committee, charged with developing a national plan.

• GARP-Vietnam is collaborating on implementing both national AMR policy and surveillance through the National Action Plan to Combat Antimicrobial Resistance and the Vietnam Resistance Project (VINARES).

• GARP-Kenya hosted three annual antibiotic awareness weeks,

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antibiotics by the general public.

• GARP-India hosted a policy forum and training-of-trainers targeting medical students and focusing on hospital antibiotic stewardship in 2014. Increased interest following the forum was successfully leveraged to advocate for revisions to medical school curricula to include antibiotic resistance.

• Several hospitals in India, Nepal and South Africa established (or are establishing) a Drug Resistance Index (DRI) in collaboration with CDDEP to track local resis-

Conference organizers check in medical students at the Kenya Medical Training College during Kenya’s celebration of World Antibiotic Awareness Week.

2013–2015, coinciding with CDCs Get Smart week and the first World Antibiotic Awareness Week. The week’s activities targeted medical and veterinary students and clinical decision makers through lectures and meetings held across the country.

• GARP-Nepal hosted their first awareness week in 2015 featuring rallies, essay competitions, presentations and other activities held in diverse regions. The working group also implemented a media campaign in national newspapers encouraging the appropriate use of

GLOBAL ANTIBIOTIC RESISTANCE PARTNERSHIP

tance rates and inform clinical decision-making.

• GARP-India, Kenya, South Africa and Vietnam contributed data to CDDEP’s ResistanceMap tool, allowing users around the world to interact with and visualize trends in antibiotic resistance and use.

• All eight working groups helped to launch CDDEP’s State of the World’s Antibiotics, 2015, using the occasion to raise awareness and generate interest in policy action at the national level.

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2015: Resistance Takes Center Stage The most visible signal of greater global attention to antibiotic resistance is arguably the Global Action Plan on Antibiotic Resistance, a resolution adopted by the World Health Assembly (WHA) in May 2015. Many GARP partners took part in WHO deliberations on the plan at a meeting in Brazzaville prior to the WHA, and CDDEP director Ramanan Laxminarayan assisted in drafting the document.

“Antimicrobial resistance threatens the very core of modern medicine and the sustainability of an effective, global public health response to the enduring threat from infectious diseases.”

highlight the role of the OIE in developing standards and guidelines and in helping member countries to implement them. The development of standards for data collection and the development of national surveillance systems were included in the recommendations.

The G7 Confront Antimicrobial Resistance Antibiotic resistance and Ebola were the major health topics discussed by the G7 at their meeting in Germany in October 2015. In the Berlin Declaration on Antimicrobial Resistance – Global Union for Antibiotics Research and Develop-

to updating their national plans and supporting other countries to develop their own. Best AMR policy practices from the G7 countries are available here.

CDDEP‘s Contributions Research released by CDDEP in the last several years has provided new data on trends in antibiotic resistance and use in humans across the world (ResistanceMap) and a comprehensive overview of the current state of antibiotic resistance knowledge and national-level action that can be taken, based on the GARP model (State of the World’s Antibiotics, 2015). CDDEP and GARP have

–WHO Director Margaret Chan, Foreword to the Global Action Plan on Antibiotic Resistance

The plan calls on all member states to create national plans within two years of the resolution’s adoption.

Many high-income countries have only recently established such plans, including the United States, which released its first National Action Plan for Combating Antibiotic-Resistant Bacteria in 2015. CDDEP Director Ramanan Laxminarayan now sits on the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (CARB), which is advising on its implementation.

Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria The United States’ national plan began taking shape at the end of 2013, when President Obama requested an assessment and multi-sectoral plan on AMR. Several agencies collaborated to recommend activities to be included in the plan, many of which were launched in 2014. The final action plan was introduced in 2015, and implementation will take place under the guidance of the advisory council (CARB).

The Organization for Animal Health (OIE) Resolution Resolution 26, passed at the 83rd general session of the OIE in May, 2015, aims to combat AMR in animals. Their recommendations

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G7 Health Ministers at a meeting to discuss antibiotic resistance in Germany, October 2015.

ment, the G7 Health Ministers called for a coordinated, one-health approach to curbing AMR, primarily by improving infection prevention and control, conserving antibiotic effectiveness, improving surveillance and through research and development. The G7 members stated their support for the WHO and OIE resolutions and committed

also contributed to new research on antibiotic use and resistance in animals. In November 2015, GARP and CDDEP contributed to the Lancet special series on antibiotic resistance, emphasizing the balance between access and excess. See page three for a list of CDDEP’s selected publications on antibiotic resistance.

The 17th International Congress on Infectious Diseases CDDEP is sponsoring a symposium on national actions on antibiotic resistance and their contribution to a global solution at the 17th International Congress on Infectious Diseases, taking place in Hyderabad, India, March 2-6, 2016. The symposium will highlight the successful national efforts undertaken by the GARP working groups, and speakers will include top policy makers from Ministries of Health and GARP leadership from India, Kenya, Mozambique, Nepal and South Africa. Register to attend the symposium here, or click on the poster to the right.

GLOBAL ANTIBIOTIC RESISTANCE PARTNERSHIP

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Global Antibiotic News GARP in the News Kenya’s antibiotic resistance situation and GARP-Kenya research were discussed in a Daily Nation article (”Growing resistance to antibiotics a ticking time bomb, health experts warn,” Jan 2016).

New on the CDDEP Site Original graphics based on the recent United States Food and Drug Administration 2014 Summary Report on Antimicrobials Sold or Distributed for Use in FoodProducing Animals show increases in US meat production and increases in antibiotic use per kg of animal raised between 2009 and 2014.

Select CDDEP Publications on Antibiotic Resistance from Phase 2 • Abdula N, Macharia J, Motsoaledi A, et al.

National action for global gains in antimicrobial resistance. Lancet, 387(10014):e3-e5 • Center for Disease Dynamics, Economics & Policy. Global ResistanceMap. Washington, D.C.: CDDEP • Laxminarayan R, et al. 2013 Antibiotic resistance -the need for global solutions. Lancet Infectious Diseases, 13(12):1057-1098 • Laxminarayan R, et al. 2015. Access to effective antimicrobials: a worldwide challenge. Lancet, 387(10014):168-175 • Laxminarayan R, Van Boeckel T & Teillant A. 2015.

The economic costs of withdrawing antimicrobial growth promoters from the livestock sector. OECD Food, Agriculture and Fisheries Papers, No. 78, Paris: OECD Publishing • Teillant A & Laxminarayan R. 2015 Economics of antibiotic growth promoters in livestock. Annual Review of Resource Economics, 7(1) • Teillant A & Laxminarayan R. 2015. Economics of antibiotic use in agriculture in the United States.

Washington, D. C.: Choices • Van Boeckel TP et al. 2015. Global trends in antimicrobial use in food animals. Proceedings of the National Academy of Sciences, 112(18):5649-54 • Van Boeckel TP et al. 2014. Global trends in antibiotic consumption, 2000–2010. Lancet Infectious Diseases, Aug; 14(8):742-50

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GARP Phase 3 The Bill & Melinda Gates Foundation have awarded CDDEP a grant to continue GARP through a third phase, thanks to the impressive work of all eight GARP partners. CDDEP was challenged with devising a new plan to expand the GARP franchise to a larger number of countries. What we proposed was to capitalize on the expertise and experience of the current eight partners to extend GARP’s reach by asking working groups to act as mentors to new groups, with CDDEP support. The plan is to form an African network and an Asian network. As the current partners know, getting started, through development of situation analyses, is a labor-intensive and advice-intensive process. Respecting the needs of this process, we intend to draw in a small number of new countries initially and use the experience to further characterize and refine the process.

The process will be launched formally in spring 2016, with regional meetings, including current partners and key individuals from new entrants.

We will be communicating more about this in the next couple of months. In the meantime, we are interested in your ideas of countries that you think we should approach to discuss possible partnership, and within those countries, potential working group members, who may be researchers, academics, veterinarians, policy makers or others. We are available to discuss this by teleconference, or send ideas to us by email (millerpetrie@cddep.org).

CDDEP in Review, 2015 Read a roundup of CDDEP’s major work and research completed in the last year, from on-the-ground successes with GARP to studies published in leading journals, including The Lancet and Proceedings of the National Academy of Sciences.

Send us your feedback!

We welcome your comments on and additions to each newsletter. Please send any content or questions to Molly Miller-Petrie at millerpetrie@cddep.org

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GARP Network Contact Information India

Secretariat CDDEP–New Delhi Working group chair Professor NK Ganguly Acting Coordinator Jordan Levinson, CDDEP Email: levinson@cddep.org

Kenya

Secretariat Working group chair

Kenya Medical Research Institute (KEMRI) Sam Kariuki, Director, Centre for Microbial Research Vice chair Linus Ndegwa, Manager, Infection Control, CDC KEMRI Coordinator Eveline Wesangula, Instructor, Kenya Medical Training College Email: garp.kenya@gmail.com

Mozambique

Washington, DC and New Delhi (CDDEP) Principal investigator Ramanan Laxminarayan Director Project Manager Hellen Gelband Associate Director Email: gelband@cddep.org Project analyst Molly Miller-Petrie Senior Research Analyst Email: millerpetrie@cddep.org Communications Andrea White , Communications Associate Email: white@cddep.org

Secretariat Manhiça Health Research Centre (CISM) Working group chair Betuel Sigauque, Senior clinical researcher Vice chair Esperanca Sevene, Eduardo Mondlane School of Medicine Coordinator Bessi Jacob, CISM Email: bessi.jacob@manhica.net

Nepal

Nepal Public Health Foundation Secretariat Sameer Mani Dixit, Country Director, Center for Molecular Dynamics Principal Investigator Buddha Basnyat, Director, Oxford University Clinical Research Unit, Kathmandu Working group chair Vice chair Paras Pokharel, BP Koirala School of Public Health Coordinator Santoshi Giri Email: san.giri2008@gmail.com

South Africa

Secretariat Working group chair Vice chair

University of the Witwatersrand Professor Adriano Duse, Department of Clinical Microbiology & Infectious Diseases Olga Perovic, Head of Microbiology External Quality Assessment Reference Unit, National Institute for Communicable Diseases Consultant/coordinator Kim Faure, independent consultant : Email kim.faure@mweb.co.za

Tanzania

Secretariat Muhimbili University of Health and Allied Sciences Working group chair Said Aboud, Professor and chair of Microbiology Vice chair Robinson Mdegela, Sokoine University of Agriculture Coordinator Vacant Email: millerpetrie@cddep.org

Uganda

Secretariat Uganda National Academy of Sciences Principal Investigator Christian Acemah, Executive Secretary Working group chair Denis Byarugaba, Professor of veterinary medicine, Makerere University Vice chair Donna Kusemererwa, Independent Consultant Coordinator James Lakony, UNAS Email: jameslakony@unas.or.ug

Vietnam

Secretariat Oxford University Clinical Research Unit (OUCRU), Hanoi Principal investigator Rogier van Doorn, OUCRU, Hanoi Director Working group chair Coordinator Do Thuy Nga, OUCRU, Hanoi Email: ngadtt@oucru.org

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