Access to finance, technology and new medicines to fight AMR needed, says South
A WHO Executive Board meeting discussed the draft of a global plan to fight anti-microbial resistance. Below is a report of what the delegations said at the meeting.
By Mirza Alas
Developing countries made a strong call for access to finance, technology and new medicines to fight against antimicrobial resistance (AMR) during their interventions on WHO’s proposed Global Action Plan (GAP) on AMR at the 136th Executive Board (EB) meeting.
The 136th EB meeting took place in Geneva from 26 January to 3 February 2015.
The EB discussed AMR on 28th January and decided to further deliberate on and amend the draft GAP at the next meeting of the Strategic and Technical Advisory Group (STAG) in light of the comments made by Member States for its consideration in the upcoming World Health Assembly (WHA) in May 2015.
(The URL for the relevant documents are: http://apps.who.int/gb/ebwha/pdf_files/EB136/B136_19-en.pdf) and (http://apps.who.int/gb/ebwha/pdf_files/EB136/B136_20-en.pdf.)
Even though all Member States recognized the importance of the GAP, the draft document was criticized for its failure to address the critical concerns of developing countries.
Developing countries stressed that financial assistance, technology transfer, and access to affordable, current and new antibiotics for developing countries are critical aspects that need to be included as part of the GAP, in order to ensure that developing countries can actually develop and implement the plan in their own countries.
India and Pakistan, in particular, highlighted the need for a new Research and Development (R&D) model that delinks price from cost. This is a fundamental issue for ensuring research into new antibiotics and their affordability.
Highlights of the interventions of selected Member States’ statements can be found below.
South Africa on behalf of the African Region (AFRO) emphasized that AMR is a global concern for human and animal health. It also expressed concern about the spreading of resistance and the way it threatens the gains made in treating many diseases. South Africa also pointed out the importance of the rational use of medicines in combating AMR and noted the draft GAP is the first comprehensive plan which recognized problems of access, as well as excessive use. Further it stated that the AFRO region is committed to endorse the plan but it stressed the importance of support in order to implement the plan, particularly in the area of surveillance. South Africa reminded countries that AMR moves beyond borders, and there is need to act globally.
Kuwait on behalf of the Eastern Mediterranean Region reiterated that AMR is one of the biggest public health challenges and noted that all three organizational levels of WHO are part of the action plan. It encouraged the importance of implementation of the action plan and to allocate financial resources. Stating that there are rules and regulations in the region, it hoped for collaboration between the different sectors (human, animal etc).
Nepal on behalf of the South East Asian Region expressed some concerns about how the draft GAP failed to recognize that for developing countries the presence of political will alone is not sufficient to enable them to implement policies and measures required to address AMR. For developing countries, access to financial and technical resources for implementing actions to address AMR is critical and WHO’s role in implementation needs to be articulated with clearly defined targets. Nepal also noted that Member States are encouraged by the GAP to collaborate in the investigation of natural sources of biodiversity and biorepositories as sources for the development of new antibiotics. It stressed that the GAP must clearly state that such collaboration must be based on the principle of fair and equitable benefit sharing.
India noted that AMR today threatens all countries, big and small, rich and poor, developed and developing, and that is why it requires concerted action by all member nations. It stressed that the focus must be on prevention, systems of infection control, correct prescription and consumption practices, access to antibiotics, R&D and impact of antibiotic use in agricultural and animal husbandry sectors.
India also expressed some concerns about the two year-timeline for each nation to be ready with an action plan but without being given any assessment of the financial and other resources, which are required to achieve the objectives. It said that surveillance mechanisms, laboratory capacities, health system strengthening, human resources etc, need huge investments.
It further noted that the issue of access should not be linked to excess. Access is a much larger issue that not only includes availability and affordability of antibiotics but also encompasses access to health facilities, availability of adequate health care professionals, access to preventive technologies and ‘point of care’ diagnostics. India stressed that universal access to health care including to existing and new antibiotics should be identified as a stand-alone principle in the draft action plan. Moreover, it reiterated the urgency to accelerate R&D for new antibiotics. It is also critical that prices of new antibiotics are delinked from R&D costs, said India.
Furthermore, India pointed out that the Secretariat might not have the capacity and resources to be able to monitor the development and implementation of action plans by Member States. It also proposed that a sub-group be constituted to address various concerns expressed by different countries so that the final document to be considered by the WHA in May this year will be ready for adoption.
Pakistan endorsed the recommendation for development of national action plans. However, it stressed the need to chalk out how developing countries can actually operationalize the plan especially, with respect to financial and technical assistance for developing national capacity to implement monitoring and surveillance systems.
It also noted that the plan mentions exploring new private public partnerships and ignores the formulation of new research models which delink the cost of R&D from the actual price of the drug, as proposed by WHO’s own consultative expert working group. It emphasized the importance to remember that for resource constrained developing countries, obligations can be implemented only if they have the capacity to do so.
Thailand noted that AMR is a major health threat and a complex problem driven by interconnected factors. Coordination of action is urgently required and GAP could be a tool to combat AMR. Further it stated that AMR is a critical issue and it needs strong political support of WHO, international and national partners and multi-sectoral participation. Thailand also emphasized that financial and technical resources are fundamental for implementation and that the WHO should facilitate a mechanism to facilitate resources especially for developing and least developed countries. Access to antimicrobials is essential and it supports an R&D model for products and diagnostics delinking the price.
On the other hand, developed countries advocated for the draft to be supported as it stood. The United States was the only country that proposed amendments related to regulations in the agricultural sector and the use of the precautionary principle to combat AMR.
The United States said AMR has potential to affect economic activities and that President Barack Obama has taken note and has proposed a national plan that includes many similar components to the GAP. Several countries represented (at the EB) are part of activities. AMR is part of the global health security agenda and was part of the discussion with Prime Minister Modi in India. It said that the draft GAP is a comprehensive response and it had a few suggestions to strengthen the plan, and will give them to the Secretariat directly and look forward to see how they will be integrated in the run up to the WHA.
The WHO Director-General, Dr. Margaret Chan, asked the US to please read its suggestions. In response the US said that ‘medically important antibiotics’ should be the limitation on restrictions in agriculture, and that it does not support inclusion of the term ‘precautionary principle’ which has been suggested by some Member States.
Belgium speaking for the European Union, Turkey, Macedonia, Bosnia, Moldova and Georgia commended the work of the Secretariat and the wide-ranging consultations. It agreed on the importance of urgent concerted action to tackle AMR. It also noted the importance of human and animal health and the ‘one health’ concept. It stressed the importance of reaching a consensus now. It said that effective and prudent use of antimicrobials is core and it is also necessary to invest in new research and development. It welcomed a mechanism to mobilize resources and would like a monitoring and evaluation mechanism to be included as part of the progress report every two years. Belgium urged the EB to support the draft and recommended that it be adopted in May.
The United Kingdom supported the statement made by Belgium. It reiterated the vital need to tackle AMR since at least 25,000 lives are lost in the EU every year. Prime Minister David Cameron has asked economists to review the cost of AMR; without effective action now, by 2050 AMR will cost 3.5 % of global GDP and kill more than cancer. This will be severe in low and middle-income countries. Scientific consensus is that antibiotics in humans are the main driving force, but the use in animals and agriculture are also part of the issue. It welcomed the need for an integrated holistic ‘one health’ approach and pointed out that AMR needs to be reflected in the post-2015 Sustainable Development Goals. It urged Member States to show their support for the action plan, otherwise we will have a situation as with Ebola.
Norway pointed out that the health perspective needs to be strengthened in the document and the environment as a possible source of AMR should be described. Additionally, pollution of antibiotic waste from pharmaceutical companies could also be an important issue and should be mentioned. It also talked about the importance of preventive measures such as vaccines, adding that fish farming in Norway is using vaccines and no antibiotics now. The GAP will have an impact and its implementation is crucial, said Norway, adding that WHO tie action with implementation.
The People’s Health Movement made a joint statement on behalf of itself and Medicus Mundi International pointing out that the report misses the importance of strong health systems to prevent the spread of AMR. Also, promotion and advertising of antibiotics, including marketing for inappropriate uses or incentivizing medical and veterinary personnel to prescribe, is harmful to health and should be prohibited. It urged Member States to include in Objective 5 the regulation and control of promotional practices by industry and to explicitly state the principles that need to be met. It also expressed concern regarding the use of the term “SSFFC” to refer to sub-standard medicines and urged Member States to demand the removal of the former in the context of AMR.
(The full statement can be accessed at:https://apps.who.int/ngostatements/content/medicus-mundi-international-%E2%80%93-international-organisation-cooperation-health-care-mmi-5.)
After all the statements the WHO Assistant Director-General (ADG) Dr. Keiji Fukuda addressed the Member States. Fukuda highlighted that given all the health priorities that we have, AMR conveys the sense of urgency and the impact of this issue. He underscored the overwhelming support for the development of the plan and adoption at the WHA and noted the consistency of the themes and the need for an interdisciplinary perspective, international and intersectoral approach that involves working with FAO and OIE under the ‘one health’. The ADG also remarked that not all countries are in the same place and that reality has been reflected in the plan. There are needs for middle-income and developing countries. He also mentioned that further work was needed on how we fund this, how do we build capacities and these calls (of Member States) have been heard.
The ADG asked Member States to provide their statements in writing so that this discussion can continue as needed and that all those inputs will be taken for a revision of the draft to the Strategic Technical Advisory Group (STAG) on antimicrobial resistance to provide advice. Fukuda emphasized that this is the start of a long process and the plan is just the beginning. He said that the plan is not perfect and is not detailed and what it does is to get us started and as we move forward into this process there will be more discussions.
WHO Director-General Dr. Margaret Chan underscored the need for action: “You want urgent action and you want to take this issue and move it along. Let’s move ahead”.
The STAG met on 24 to 25 February. After this meeting, and the revision of comments, an amended version of the draft was submitted to the WHA.
The global action plan was revised by the secretariat and a ‘newer’ version reflecting the concerns expressed by Member States should be ready before the WHA in May. However, as the earlier draft stood, there were many details that should have been unpacked, especially in terms of implementation. It is necessary for Member States to ensure that their concerns are actually reflected on the plan and that problematic areas are truly solved. In the case of developing countries it is necessary to recognize, as clearly expressed by Pakistan, “the importance to remember that for resource constrained developing countries obligations can be implemented only if they have the capacity to do so.”
Mirza Alas is a Researcher specialising on public health with the Third World Network.
