The Meeting on Combating Antimicrobial Resistance: Public Health Challenges and Priority

by Dr Poonam Khetrapal Singh, Regional Director, WHO South-East Asia
23-25 February, 2016, New Delhi

Excellencies, Distinguished Participants, Ladies and Gentlemen,

When in 1928 a Scottish scientist, Alexander Fleming, chanced upon the discovery of penicillin, public health changed dramatically. The once-fatal bacterial infections became curable, and infection-risks associated with surgical procedures too diminished greatly. Health systems became, not only more effective but also more equitable, as rich and poor alike accessed the medication needed to treat many infections and stay healthy and productive.

As is often the case, too much of a good thing is proving to be harmful.

We are now in a world where the efficacy of antibiotics is under threat. Inappropriate use, widespread abuse for commercial gains, and a host of other misuse of antibiotics have led to resistance, resulting in approximately 700 000 people dying each year from conditions that were once easily curable. Already resistance to HIV drugs is rising; more than 100 countries report extensively drug-resistant tuberculosis, resistance against artemisinin-based combination therapies for falciparum malaria is reported. Hospital acquired infections with highly resistant ineffective organisms are now becoming daily realities. If the present trends continue, by 2050, rising AMR will contribute to more than 10 million deaths worldwide. In the looming post antibiotic era, skin sores and diarrhea could be untreatable; life-saving surgeries more risky.

Though the discovery of antibiotics may have been accidental, their demise will be of our own making.

Therefore, urgent action is needed.

Countries in the South-East Asia Region have been proactive in addressing antimicrobial resistance. Since 2010, several Regional Committee Resolutions on prevention and containment of AMR have been adopted, the last being adopted by the RC last year in Timor-Leste. That resolution emphasized that “combating antimicrobial resistance shall require political commitment, multi-sectoral coordination, sustained investment and technical assistance,” and it called on Member States to put AMR as one of the top priorities on their national agendas. Further, as early as 2011, the Honorable Health Ministers of this Region recognized the seriousness of AMR and adopted the Jaipur Declaration on Antimicrobial Resistance. It was an important and foresighted step to promote, at the highest level, awareness about the problem of AMR and to stimulate concerted efforts to tackle it. The Jaipur Declaration on Antimicrobial Resistance recognized the irrational use of antibiotics as the key driver of the emergence of resistance and advocated for a holistic and multidisciplinary approach to the control and prevention of resistance to antimicrobials.

When I assumed my responsibilities as the new Regional Director for WHO’s South-East Asia in 2014, to highlight the urgency needed to deal with this issue, I made AMR one of my flagship priorities for the Region. Identifying flagship priorities allows us to focus our resources to achieve clear deliverables, and to support countries to develop and implement realistic work plans.

At the international level too, strong and sustained actions have been taken, and the momentum continues.

In May 2015, the 68th World Health Assembly endorsed a resolution making it mandatory for member countries to align national action plans with the global standard by May 2017. WHO published the Global Action Plan on Antimicrobial Resistance to guide Member States in the development of their national action plans. At the UN General Assembly later this year a resolution on AMR is expected to be adopted. Concurrently, the commitment by G7 countries in Berlin in 2015, to promote the AMR agenda will likely be cemented at the G7 summit later this year in Tokyo.

Ladies and gentlemen, we know the problem. We have committed ourselves to deal with it. International attention in AMR has crystallized and global commitment is at its highest. And now, more than ever, is the time to start taking concrete actions on the ground; to walk the talk.

In this context, I applaud India’s leadership in combating AMR. This meeting on AMR-related public health challenges and priorities will contribute to the development and implementation of national action plans in the Region – plans that will assess risks associated with AMR, as well as our response capacities. Since we cannot anticipate what pathogens may evolve, and on what scale they could harm, this planning will be vital. The meeting also provides an opportunity to renew commitments to the global agenda outlined in the World Health Assembly Resolution. Vigilance, risk assessment and risk management is the key.

The key strategy is to have a holistic and multi-sectoral “one health” strategy. AMR cannot be dealt with by the health sector alone. In addition to easy access to medicines and over prescription, antibiotics use is on the rise in the animal and agriculture sectors. Therefore one of the key strategies in the Global Action Plan is to “optimize the use of antimicrobial medicines in human and animal health.” To do this, strong coordination is needed among all sectors, including veterinary medicine, agriculture, and human. Given the multi-sectoral nature of AMR, the presence of the Ministry of Agriculture, FAO and OIE is vital and welcomed. We are inspired by the presence of the Honorable Ministers of Bhutan and Nepal. We are encouraged to see Permanent Secretaries of Health, many experts from countries of our Region and beyond, including France, Japan, the Netherlands, the UK and the US. It is indeed an opportunity to collectively develop meaningful and practical next steps in the fight against AMR. I urge you all to work together to take forward this momentum, both at this meeting and thereafter.

The stakes are high. We must guard our health security and fight Antimicrobial Resistance; we can only do it together. Ladies and Gentleman, I wish the meeting all success.

Thank You.

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