Workshop on National Action Plan on Antimicrobial Resistance for Developing Countries: Focusing on Resistance Emanating from Antibiotic Use in Food Animals

10-11 November 2016, New Delhi, India

Distinguished participants, ladies and gentlemen,

At the 71st meeting of the UN General Assembly earlier this year, antimicrobial resistance featured as a core concern of Heads of State from across the world.

This was one of the rare occasions when a special session of the General Assembly was convened to deliberate on a public health issue. Since the Assembly first began meeting in 1948, similar discussions had been held just three times – for HIV AIDS, rising rates of noncommunicable diseases, and West Africa’s deadly Ebola epidemic.

As the declaration that followed the Assembly attests, combating antimicrobial resistance is now high on the agenda of national policymakers, international organizations and financial institutions, as well as the public in OECD and developing countries alike. After years of intense outreach and engagement, antimicrobial resistance has become one of the core political, social and economic issues of our time.

Each one of us here contributed to making this possible.

Indeed, it is because of these contributions that much of the public is now aware of the fact that if present trends continue, AMR is projected to kill 10 million people annually by 2050. There is now broad cognizance of the fact that AMR is already leading to the death of around 700 000 people each year, and is the cause of costly and unnecessary suffering across the world.

It is also because of these contributions that economists and policymakers are dedicating significant resources to studying AMR’s economic, political and social impact. As predicted by a World Bank report released earlier this year, AMR could lead to a decline in global annual GDP of between 1% and 4%, and could diminish global livestock production by between 3% and 8%. There is now widespread awareness of AMR’s potential to stymie economic growth and to inhibit the development aspirations of billions of people worldwide.

But alongside efforts to drive the public discourse and illuminate these truths and ongoing hazards, important AMR-related research and policy work has been going on for many years now.

At the regional level, as early as 2011 the Hon’ble Health Ministers of the South-East Asia Region acknowledged the seriousness of AMR and adopted the Jaipur Declaration on Antimicrobial Resistance. The Jaipur Declaration recognized the irrational use of antibiotics as the key driver of AMR, and advocated for a holistic and multidisciplinary approach to its control. The Declaration was an important tool for establishing awareness of AMR at the highest levels of government, as well as catalyzing the search for effective policy solutions.

Building on this momentum, at last year’s Regional Committee in Timor-Leste, Member States passed a key resolution on AMR’s prevention and containment. The resolution emphasized the need for steadfast political commitment and effective multisectoral coordination to combat the problem. It also called on Member States to ensure that AMR was placed at the top of their national agendas.

In 2016, a year of intense energy and drive that we have not yet concluded, two high-level ministerial meetings on AMR involving the Region’s Member States have already been held. In February there was the ‘Combating AMR: Public health challenge and priority’ meeting organized by the Government of India in New Delhi. At this meeting a roadmap for the creation of national action plans was developed, and countries pledged to have these plans finalized by May 2017. And in April a bi-regional meeting on AMR organized by Japan, in collaboration with the WHO South-East Asia and Western Pacific Regions, was held in Tokyo. This meeting allowed Member States the opportunity to troubleshoot the development of their national action plans, and reiterated the focus needed to reverse AMR’s rising tide.

Ladies and gentlemen,

These regional milestones have taken place as progress at the global level has accelerated. In addition to the discussion of AMR at the UN General Assembly which I mentioned earlier, several notable AMR-related developments have occurred. This includes WHO’s Global Action Plan on Antimicrobial Resistance, which is providing guidance to countries as they endeavor to meet the May 2017 deadline for developing national plans. And it also includes the featuring of AMR as a core agenda item at consecutive G7 meetings in 2015 and 2016 in Germany and Japan respectively.

Understandably, this burst of activity is helping to bring all partners on board and to illuminate the way forward for tackling AMR. As evidenced in the Global Plan and in a number of key reports produced by WHO and other partners in recent years, the broad policy areas for action have been staked out. Indeed, the need of the hour now is to engage in the minutiae of policy development and planning, and to be decisive in the next steps we take.

With this in mind, ladies and gentlemen, I would like today to focus on the critical importance of the ‘One Health’ approach, and of operationalizing the tripartite collaboration between the World Health Organization, the Food and Agriculture Organization of the United Nations, and the World Organization for Animal Health.

As we know, the rise of antibiotic-resistant pathogens cannot be contained in the absence of close cooperation between the human health, animal health and environmental health sectors. And as we also know, while establishing this cooperation is of vital concern within countries, it is doubly so at the international level given the cross-border nature of AMR and ongoing concerns regarding emerging zoonotic diseases.

In taking the One Health approach forward WHO is focusing on developing integrated responses across sectors, and capitalizing on the comparative advantages of WHO and partners agencies such as FAO and OIE so as to create more targeted, efficient, and cost-effective responses.

Beyond advocating interventions at our respective meetings, for example, the Tripartite should aim at joint country support to ensure participation of all relevant ministries and stakeholders. Similarly, beyond pursuing fragmented attempts at strengthening surveillance of AMR, the Tripartite should help integrate surveillance data so as to further establish the relationship between agriculture practices and their impact on human health. This strategy is well aligned with the Global Plan and will stimulate interventions that are people-centered, comprehensive, context-specific and preventive.

Fortunately, we are in an outstanding position to bring our joint expertise to bear. As many of you will know, WHO has worked for a number of years with FAO and OIE. Through this collaboration we have been providing governments a neutral platform for dialogue and negotiation, and coordinating global activities to address health risks at the animal-human-ecosystems interfaces.

It brings me great pleasure to note that this collaboration has been immensely successful. Indeed, at the global level it has led to many effective initiatives. The FAO-OIE-WHO Global Early Warning and Response System for zoonoses is one example. This system works to inform prevention and control measures related to zoonotic diseases, and to ensure rapid detection and risk assessment of health threats and events of potential concern.

WHO and FAO’s INFOSAN initiative is another example. This mechanism promotes the rapid exchange of information during food safety related events; the sharing of information on important food safety related issues of global interest; the promotion of partnerships and collaboration between countries, and between networks; and helps countries strengthen their capacity to manage food safety emergencies.

At the regional level, our collaboration has primarily focused on advocacy related to the One Health approach, with a specific focus on three priority areas: food safety, avian influenza, and AMR. But despite growing awareness and recognition of the importance of the One Health approach, as well as the need for interdisciplinary and intersectoral cooperation in the control of zoonotic diseases and other emerging infectious diseases, the application of the One Health approach in practice is relatively limited. Long-standing challenges have been recognized, including difficulties in managing multi-sectoral collaboration and coordination, insufficient decision-making based on scientific evidence, limited capacity and the absence of adequate guidance.

Ladies and gentlemen,

WHO is committed to overcoming these barriers and operationalizing the One Health approach across the South-East Asia Region. To do so we must work towards a joint understanding of risks and the joint development of activities and recommendations. The resulting synergy will better guide national authorities in their efforts to draft AMR-specific national action plans and implement One Health measures more broadly.

At the same time as focusing our efforts on informing policy at the national level, we must also work to raise awareness among NGOs and civil society more generally. ‘One Health’ must become part of the common lexicon, with widespread understanding of what it means and the responsibilities and action points it entails. Indeed, the One Health approach must be considered an inseparable part of achieving health security, a concept that has now entered the mainstream and which has become a core part of WHO’s work.

As part of this wider push, in coming months I shall make the case for obtaining sustainable funding to implement the One Health approach. I will also be seeking external evaluations of the impact and lessons learnt from past efforts to stimulate multisectoral engagement.

As WHO South-East Asia moves this agenda forward, ladies and gentlemen, I take this opportunity to applaud the Centre for Science and Environment’s leadership in organizing this workshop. This is the first workshop with high-level WHO, FAO and OIE officials in the Region to focus on the specific concerns of developing countries as they relate to AMR and the One Health approach.

And at the outset of this most valuable of workshops, I also take this opportunity to assure you that WHO stands committed to supporting these efforts with advocacy, capacity building and technical assistance, as well as aiding resource mobilization. WHO looks very much forward to achieving Region-wide compliance with the Global Action Plan, and welcomes the important milestone this workshop represents.

I wish you all an informative and productive workshop.

Thank you very much.