The Strategic Research Agenda of the Joint Programming Initiative on Antimicrobial Resistance – Why is it necessary? Name of speaker: Date: Place:
Dec 15, 2015
The Strategic Research Agenda of the Joint
Programming Initiative on Antimicrobial
Resistance –Why is it necessary?
Name of speaker:
Date:
Place:
Outline
1. The antimicrobial resistance (AMR) problem
2. Collaborating to find a solution
3. The priority topics
History
In his 1945 nobel prize lecture, Fleming warned of the dangers of antimicrobial resistance:
“The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”
Antibiotics revolutionized medicine! • The introduction of penicillin in the 1950’s
increased the chance of survival for pneumonia patients from 25% to 80%
Antibiotic Resistance threatens to return us to the pre-antibiotic era•In Tanzania, Antibiotic Resistance has decreased the rate of
survival from neonatal gram-negative infections from 70% to 20%
In the EU, more than 25 000 patients die from multidrug resistant bacteria annually (EMA/ECDC report)
Extra health-care costs and productivity losses of at least 1,5 billion EURO per year
Modern medicine depends on access to effective antibiotics
Source: WHO
Antimicrobial resistance (AMR) is the ability of microorganisms that cause disease to withstand attack by antimicrobial medicines.
In some parts of the world, once powerful medicines against malaria and tuberculosis have now become virtually useless.
AMR is rapidly becoming a major public health risk and is threatening to undo decades of advances in treating disease.
What is AMR?
What has led to resistance?
Increased use of antibiotics Prescriptions taken incorrectly Sold without medical supervision Prophylactic use before surgery Antibiotics used for viral infection Spread of resistant microbes in hospitals due to
lack of hygiene Patients who do not complete course Antibiotics in animal feeds
Few new drugs being developed
Increasing number of resistant strains
Great societal costs
Global problem: a societal challenge
A Joint Programming Initiative is needed!
Facts/context
The AMR complexity……
…..leads to a problem which cannot be tackled by one scientific domain or even by research alone but that needs a collaborative approach
France
USA
Mexico
Colombia
Argentina Brazil S. Africa
U. K
Taiwan
Japan
Korea
Thailand
Singapore
By courtesy of Dr. Liselotte Diaz Högberg
A global problem!Worldwide spread of the 23F clone of
penicillin-resistant pneumococci:
AMR research facts– National research on AMR is dispersed– No common goals– So far no success in reducing the risk of AMR
The spread of AMR continues
The Strategic Research Agenda (SRA): uniting under one strategy
To bring together all players in the field for a multi-dimensional approach
To provide a platform for partners to collaborate in a tailor-made fashion on specific topics
To harmonise joint actions and create greater impact To reduce research overlaps To create awareness and knowledge To stand a chance of actually finding a solution to the AMR
problem
What can be achieved by working together? (1) New preventative and therapeutic approaches AMR relevant research elements more
embedded in health service and care infrastructure
A reduction of inappropriate consumption of antibiotics in humans and animals
A positive impact on treatment, care and quality of life
Increased visibility of the burden of AMR and the benefits of research
A catalytic effect on the development on national and international strategies
What can be achieved by working together? (2)
What exactly is the Strategic Research Agenda? The first step to drafting
future research programmes
A framework to begin joint actions
A framework for creating an extensive trans-European work programme on AMR
SRA’s priority topics
Will form a comprehensive approach for studies into strategies to reduce the use of antibiotics
Will minimise the emergence and spread of antibiotic resistant genes and bacteria
Will aim to reduce the burden of AMR by 2040
Therapeutics
• Development of novel antibiotics and alternatives for antibiotics – from basic research to the market.
Diagnostics
• Design strategies to improve treatment and prevention of infections by developing new diagnostics.
Surveillance• Standardisation and extension of surveillance systems to establish a global surveillance programme on antibiotic resistance and antibiotic
use.
Transmission
• Transmission dynamics
Environment
• The role of the environment as a source for the selection and spread.
Interventions
• Designing and testing interventions to prevent acquisition, transmission and infection caused by AMR.
Six priority topics
Therapeutics: what’s the story?
The discovery of new antibiotics has slowed in the last 40 years
Even the few recently developed classes of antibiotics report resistance already
Large pharma withdraw because of huge development costs
Antibiotics are undervalued and underpriced
Therapeutics: what the SRA aims to do
Find new targets for antibiotics
Develop new antibiotics
Improve pharmakinetics and pharmacodynamics of neglected antibiotics
What the SRA aims to do (cont’d)
Develop treatment protocols based on combination therapy using existing and new antibiotics
Develop alternatives for antibiotics (vaccines) Develop and study effect of policy measures and
economic stimuli to minimise barriers for the development and introduction of new antibiotics
Diagnostics: what’s the story?
Up to 70% of antibiotics are prescribed incorrectly– Physicians cannot make precise diagnosis
Diagnostic strategies can help identify patients and animals who really need antibiotics
Reimbursements structures used by governments and health insurers need to allow for diagnostics
What’s the story (cont’d)
Diagnostic technologies exist but are costly and have not been developed with the current reality of health care in mind
Behaviour change to use diagnostic technologies is needed:– clinicians, veterinarians, farmers, patients
Diagnostics: what the SRA aims to do? Improve existing and develop new diagnostic
tools: – that more effectively distinguish between viral and
bacterial infections– that can promote the use of narrow spectrum
antibiotics– for the identification of antibiotic resistance bacteria;
including their resistance profile
Identify and remove current barriers that inhibit the acceptance of rapid diagnostic tests
Surveillance: what’s the story? Human travel and migration and the transport of
food and animals enable greater spread of the genetic elements responsible for AMR
Crucial surveillance data is so far lacking Countries have different levels of surveillance
and many lack national reporting systems
What’s the story (cont’d) Current surveillance programmes do not meet
the needs of policy makers, professionals and researchers
No existing international surveillance reporting system allowing for integration of data
Lack of existing data on:– Morbidity and mortality– Economic costs– Associations between the emergence of resistance in
humans and in animals
Surveillance: why do we need it?
To quantify the burden of resistance To serve as a warning system To guide policy makers To track transmission routes To detect and control localised outbreaks To document impact of interventions and efforts
to reduce AMR
Surveillance: what the SRA aims to do
Perform operational research on the standardisation and extension of existing surveillance systems
Carry out a pilot study on the feasibility of a global phenotypic and genotypic surveillance programme for AMR
Initiate a surveillance programme for antibiotic use in people and animals
Transmission: what’s the story?
Understanding the complexity of how resistance is spread is crucial to be able to design preventative measures
Transmission: what the SRA aims to do Determine by which mechanisms and how efficiently
AMR can spread among bacteria that populate the human and animal intestinal tract
Determine whether food is an important vector for the spread of AMR
Determine the effect of migration, tourism, different health care systems and agricultural exposure of humans to antibiotics and AMR
Provide testable hypothesis for intervention studies that are aimed at controlling the emergence and spread of AMR
Environment: what’s the story? Environmental risk factors for the spread of
resistant bacteria have not been assessed Lack of systematic analysis of food contamination,
in particular in relation to environmental contamination
Unclear how current practices in food production could contribute to the spread of AMR
No systematic programme that addresses the impact of sewage on resistance in the environment, animals, food contamination and potable water
Environment: what the SRA aims to do Perform risk assessment studies to estimate the
various transmission pathways from the environment to humans
Perform a meta-analysis of current national and international activities that are aimed at reducing the contamination of the environment by human and animal waste and by human activity with antibiotics and resistant bacteria
What the SRA aims to do (cont’d)
Determine the exact role of various environmental reservoirs (eg surface water, soild, air) on the emergence and dissemination of AMR
Understand the basic biological process that underlies these phenomena to develop remediative and preventative measures
Interventions: what’s the story?
Little biomedical research on resistance has been translated into interventions to improve health care
Most interventions to control AMR to date have been based on experience, empiricism and common sense; rather than strong evidence
Lack of evidence base also in veterinary science Controlled integrated studies in society, health
care and agricultural settings are urgently needed
Interventions: what the SRA aims to do
Initiate large-scale, international projects in which interventions to prevent and control the spread of AMR can be tested in different settings
Compare and combine AMR prevention and control practices in cost efficacy trials
Perform research to optimise implementation strategies of interventions aimed at reducing AMR
JPIAMR anchors the priority topics
By establishing a biobank of clinical specimens and
strains establishing a database containing information on
on-going AMR research (including veterinary and environmental samples)
collaborating with stakeholders raising awareness of AMR putting focus on antibiotic resistance in bacteria that
cause life-threatening infection during hospitalisation
JPIAMR Participating countries (19) Belgium Canada Czech
RepublicDenmark Finland
France Germany Greece Israel Italy
Netherlands Norway Poland Romania Spain
Sweden Switzerland Turkey United Kingdom
SRA launch conference“Implementing a Global Research Agenda for AMR”
Brussels, 3rd April 2014
Conference Objectives: Recognition and awareness for the SRA Future collaboration between research funding
agencies in the field of AMR Participation of private funders Developing global funding opportunities Work towards a global Joint Programming
Initiative