World Health Assembly: Panels Discuss Diagnostics, Surveillance, R&D Models For Antibiotic Resistance

Multiple stakeholders are pushing for a World Health Organization-led global action plan to curb antimicrobial resistance.

Key areas of focus of the collaborative effort should include better surveillance, increased hygiene and a change in the research and development incentive mechanisms to regenerate interest in development of new antibiotics, proponents say. Diagnostics also present an essential tool for surveillance, as well as to control misuse of antibiotics, a major contribution to increased resistance.

Two side events to the 67^th World Health Assembly on antimicrobial resistance (AMR) on 20 May preceded the WHA agenda item 16.5 on antimicrobial resistance scheduled to be addressed by WHO members later this week.

The 67^th World Health Assembly is meeting from 19-24 May.

The events follow a widely publicised WHO report on antimicrobial resistance surveillance. Surveillance is “essential for formulating and monitoring an effective response to AMR,” said the report.

An event on “the fight against antimicrobial resistance: are diagnostics winning?” organised by AdvaMedDx, the European Diagnostics Manufacturers Association (EDMA), and the Global Medical Technology Alliance (GMTA) focussed on the role of diagnostics in fighting AMR.

Diagnostics play a role not only in identifying treatments for patients, but also for surveillance, said moderator Philippe Jacon, executive vice president of emerging markets at Cepheid.

Francis Moussy, a scientist at WHO, said AMR is a “growing global threat to health security…. Some of the most effective drugs are now useless in some parts of the world.”

Moussy called for a WHO-led global action plan on AMR, in which diagnostics would play a crucial role. He also called for surveillance, and to tackle the problem that a “large proportion of antibiotics prescribed ineffectively” as treatment has to be prescribed very fast, often before diagnosis is available.

A draft global action plan has been put forward to member states at the WHA.

Martha Gyansa Lutterodt, from Ghana’s Ministry of Health, said one of the top hospitals in Ghana recently had to be closed down following an outbreak of an outbreak of drug-resistant MRSA (methicillin-resistant staphylococcus aureus).

Ghana has implemented a programme for surveillance “which is unique and any country can buy into” said Lutterodt, but work still needs to be done to educate stakeholders, push for global surveillance initiatives and improve laboratory capacities.

Robert Matiru from UNITAID presented the diagnostic landscape for HIV, TB and Malaria and identified key challenges around which UNITAID decides on its related interventions. Access to diagnostics is a major issue, and the landscape analysis shows that key barriers lie in the lack of availability, affordability and adaptability of diagnostics in key countries.

Jennifer Cohn, medical coordinator for Médecins Sans Frontières, said a major challenge is that the depth of the AMR problem is simply not known. What is known, she said, is that resistance is everywhere, and there is a broadening use of antibiotics.

Some patients are not receiving treatment, whereas others are receiving the wrong treatment, being prescribed a whole range of antibiotics, as diagnosis is not available, she said. Diagnostics are needed to map out where there is such excessive use of antibiotics to restrain use in these areas, and as opposed to where scale-up of use is necessary.

The type of tools required, she added, are affordable, adapted, robust, quality assured tests capable of rapid diagnosis, and innovation based on de-linkage principles is essential for the development of these tools.

Discussion moved on to the fact that the issue of innovation and intellectual property is missing from draft action plan before the WHA. The lack of innovation of new antibiotics is a huge problem. There has been no new drug in over 20 years and large pharmaceutical companies have dropped entire divisions in this area, said Cohn.

Lutterodt said that this discussion “must happen” but is tricky. Innovative R&D mechanisms must be found, highlighting collaboration and partnerships as the way forward. Cohn added that the fact that AMR is affecting high income countries as well now “serves as a wake up call,” and noted that some pharmaceutical manufacturers are considering de-linkage as well.

Matiru added greater transparency and openness from industry about costs is also necessary.

AMR Making Modern Medicine “Useless”, Chan Says

A second event was organised by the delegations of the United Kingdom, Netherlands and Turkey at which WHO Director General Margaret Chan highlighted the urgency of this issue, saying AMR is “making modern medicine useless” and there are no new antibiotics in the pipeline.

Chan urged member states to approve the resolution for a global action plan for AMR and assured that related agencies are working together to tackle all dimensions of the problem.

Netherlands Health Minister Edith Schippers said a post-antibiotic era is a real possibility unless action is taken now in three main areas: stop the abusive use of antibiotics, prevent healthcare infections and develop of new drugs.

Consumption of antibiotics in the Netherlands is subject to “strict national regulations,” she said, and the results are illustrated in the fact that the country has the lowest burden of MRSA at less than one percent compared to the average in Europe of 28 percent.

Regarding the lack of innovation for new antibiotics, Schippers stated that only collaboration, international cooperation and the use of new innovative mechanisms “can break the cycle.”

The Minister of Health of Ghana, Sherry Ayitey, said Ghana launched an AMR platform in 2011 to address key policy gaps and develop a low-cost implementation plan. The plan included dialogue with veterinary sector to reduce antibiotic use in animals, media campaigns to promote hand-washing before food consumption, and the control of substandard and counterfeit drugs, she said.

Sally Davis, the UK chief medical officer, also highlighted the need to develop an effective incentive mechanism to spur industry interest in antibiotic innovation, preserve the antibiotics that are available and promote “excessive” hygiene and sanitation.

Vaccines have proved to be an effective solution to reduce antibiotic use in animals, she said, but better collaboration for surveillance and building laboratory capacity is still required. Both she and Schippers urged member states to support the proposal for a WHO action plan for AMR.

Meanwhile, the Antibiotic Resistance Coalition issued a statement [pdf] urging international leadership to take up measures to control antibiotic use in humans and animals, and “promote new, needs-driven and open research.”

And a Universities Allied for Essential Medicines statement also calls for de-linkage models to be taken up and the recommendations from the 2012 Consultative Expert Working Group (CEWG) on Research and Development report on R&D and financing to be applied to antimicrobial product innovation.

Julia Fraser is an intern at Intellectual Property Watch. She is currently training to be a solicitor and will start work at an international law firm in London in 2015. She has a BSc Honours in Biology from Edinburgh University where she developed an interest in public health related intellectual property issues.