State of discussion on AMR action, two years after
the WHA Global Plan
by Mirza Alas, 22 August 2017
Two years after the World Health Assembly adopted
the Global Action Plan on Antimicrobial Resistance, there
is significant but uneven progress with many countries
still preparing their national plans. Developing countries
also face problems of implementation, while stressing
the need to hear their concerns about access to antibiotics
and the need for a “delinkage” innovation model. The
report below summarises the discussions on AMR held at
the World Health Assembly.
Two years after the World Health Assembly adopted the
Global Action Plan (GAP) on Antimicrobial Resistance,
many countries are grappling with the challenges of formulating
and implementing national action plans based on the GAP
The national plans on antimicrobial resistance (AMR)
were supposed to be ready by May 2017, or two years after
the GAP’s adoption in May 2015, but almost half the countries
have yet to submit them.
A report on the progress of the global and national
action plans was given by the WHO Secretariat at the World
Health Assembly on 22-31 May in Geneva.
No new decision was taken on AMR issues at the WHA.
But there was a session in the WHA agenda during which
many countries gave their views on various AMR issues.
Among these were progress and challenges regarding the
national action plans, the Development and Stewardship
Framework on AMR that the WHA is scheduled to adopt to
complement the GAP, and the Inter-agency Coordination
Group (IACG) on AMR set up by the UN General Assembly
and which has started functioning.
Several developing countries, including Brazil and India,
stressed the need to place access to affordable existing
and new antibiotics and diagnostic tools as priority issues,
as it was not enough to take action on the control and
distribution of antibiotics. They also highlighted the
need to use innovation models based on the “delinkage”
principle, to ensure affordable medicines. These two
issues of access and delinkage were prominent in the UNGA
Declaration on AMR (adopted in September 2016) but were
not given recognition in the Development and Stewardship
Framework document, complained Brazil (see details below).
The WHO’s progress report on the Global Action Plan
two years after its adoption showed there is uneven progress
at national level, as 67 countries had completed their
National Action Plans (NAPs) and 62 were in the process
of doing so.
During the discussion at the AMR session, it became
clear that there is a need to assess the designs of NAPs
and prospects for implementation. It was clear from the
interventions made by Member States that implementation
of and operationalizing the NAPs is the biggest challenge.
This is especially so for many developing countries that
need technical and financial assistance.
Discussion also took place on the Development and Stewardship
Framework which is still being drawn up. WHO presented
a report on several initiatives that have taken place
and a road map, and asked for further guidance from countries.
It was agreed that consultations would take place in the
second part of 2017 to advance this framework. The third
item that was discussed was the setting up of the Inter-agency
Coordination Group (IACG) with many countries welcoming
this step and looking forward to its work in the coming
Regarding the Stewardship and Development Framework,
Brazil emphasized the need to have intergovernmental consultations.
It said the current draft does not provide enough attention
to the elements emphasized in the UNGA Political Declaration
on AMR, adopted in September 2016. Brazil mentioned in
particular the need to address two issues -- access and
affordability of existing and new antibiotics and diagnostic
tools, and the need to develop innovation models based
on the principle of delinkage, both of which were prominent
in the UNGA Declaration.
India supported Brazil’s statement, adding that AMR
has emerged as a major public health challenge and is
rightly receiving increasing attention globally. India
stressed that there should not be any imbalance in a Stewardship
Framework that focuses only on controlling the production,
distribution and sale of antibiotics. The framework also
should focus on the equally important and interrelated
issues of affordable access to new and existing antibiotics
and diagnostics and research and development (based on
models that enable access).
India gave its support to all the three interconnected
issues of antibiotic stewardship namely, R&D in new
antibiotics, access to new and existing antibiotics and
stewardship. It stressed this should be reflected in
a balanced manner in any eventual global framework on
AMR. The delineation of such a framework should be done
through an intergovernmental process and not left to experts
India also noted that it has amended its drugs law and
rules to better regulate the sale of antimicrobials and
promote rational use of drugs. India also proposed to
ensure the primacy of the WHO, FAO and OIE tripartite
in any initiative, with WHO in the coordinator role. India
also proposed to increase the Global Antimicrobial Resistance
Surveillance System (GLASS) to include animal health,
agriculture and environment besides monitoring of human
India reiterated that adequate attention shall be given
to the development and equity related aspects of AMR.
There should be a clear focus on supporting member states
in proper implementation of such plans through adequate
technical support and mobilization of resources.
Thailand noted that in the last two years there has
been good progress made by the tripartite (WHO, FAO and
OIE), development partners and Member States in addressing
AMR. Thailand also welcomed the establishment of the IACG
to strategically and effectively coordinate and move the
UNGA Political Declaration on AMR forward. The Philippines
also welcomed the IACG and noted that it will be pushing
for AMR to be part of the ASEAN declaration and for the
alignment of action between the ASEAN region and WHO efforts.
Bahrain, on behalf of countries of the Eastern Mediterranean
region, observed the need for a multi-sectoral response
and need for more alignment. Bahrain called for working
groups on AMR at national level. It called for the IACG
to provide practical advice and coordinate the mobilizing
of resources for NAPs.
Algeria, on behalf of the African region, highlighted
the urgency for a response to AMR and emphasized the critical
needs of developing countries including access to high
quality health products, vaccines, and diagnostic tools.
Congo pointed out the heavy burden that AMR represents
on hospital budgets, its limited resources to address
this burden and how this impacts on its ability to implement
national action plans.
Kenya mentioned its commitment to mobilizing resources
and working to increase awareness among public and health
professionals as well as for collaboration with the veterinary
sector. Kenya also called on WHO to support states technically
and financially in development of and operationalizing
the national plans.
Ecuador highlighted the need to strengthen the health
system and create healthy environments. It also emphasized
the need for capacity building of human resources and
to receive financial and technical assistance. Ecuador
also pointed out that AMR is not only about medicines
but that there is a need to work on the prevention and
the factors that are causing the resistance.
South Africa remarked that there is unequal access to
antibiotics among countries and regions and that WHO should
ensure equitable access to new vaccines and diagnostic
tools. South Africa also noted that the implementation
of the One Health approach faces challenges due to many
conflicts of interest and this should be a factor to consider.
Malta, on behalf of the European Union, stressed WHO’s
role as the leader for the implementation of the national
action plans. Malta welcomed the draft road map for the
framework. Malta noted the importance of the IACG to provide
guidance across the UN system for AMR issues. Malta asked
for greater clarity in how the WHO Secretariat would engage
with the IACG and mentioned the need for greater cooperation
in research and development. It noted current EU programs
on push and pull mechanisms for developing new antibiotics,
the need for prudent and reasonable use of antibiotics
and the importance to strengthen health systems with infection
prevention and control efforts. Norway called for IACG
to work closely with other UN agencies particularly on
the environmental aspects of AMR.
The USA noted the report of progress and emphasized
the need to maintain prioritization of gram-negative bacteria.
It supported the development of the stewardship framework
and asked how it would be operationalized. The USA also
called on WHO to develop guidelines of AMR in animal foods
and increase surveillance and data collection.
The United Kingdom spoke of the need to make the stewardship
framework effective and efficient. The UK also noted that
national action plans should drive the efforts of people
on the ground.
The Netherlands pointed out the tremendous progress
in raising the political profile of AMR but it noted that
many countries have not yet developed NAPs and that some
countries have picked and chosen some elements and only
focused on the easy sectors and not addressing others.
Examples of the difficult issues were the use of antimicrobials
as growth promoters in animals, waste management issues
and prescription practices; the Netherlands said neglecting
these issues should not happen. There was need to think
about what would be presented in 2018, the need to work
together and to ensure that AMR continues to be a priority.
Germany pointed out its 2.2 million euros contribution
to WHO and its support of the Global Antibiotic Research
and Development Partnership (GARDP) and encouraged other
countries to also step up support. It said AMR is a priority
of its G20 presidency and emphasized also the need to
ensure implementation of NAPs. Germany also mentioned
key elements of the Berlin declaration such as: awareness,
infection prevention and control, the sharing of data,
need for new antibiotics, vaccines and diagnostics. Germany
also pointed out the importance of affordable access to
all patients in need and the criticality of addressing
the environmental aspect of AMR. Germany welcomed the
draft road map of the Development and Stewardship Framework,
supported its approach and observed that it was essential
that the framework address all areas and that member states
should be involved closely in the development of the framework.
In response to the country statements, Dr. Hajime Inoue,
Senior Advisor to the WHO Director-General and Special
Representative for Antimicrobial Resistance, recognized
the strong commitments expressed by countries and the
recognition about the substantial progress made. About
the joint external evaluation, he assured countries that
it would be a voluntary process and it will not be mandatory
for the countries that do not wish to go through that
process. He further commented that for countries that
do not yet have a NAP, and countries that are behind schedule,
that there is a need to support them. Dr. Inoue pointed
out that countries that are still preparing their national
plans will be invited to a workshop to support them in
finishing their plans and that WHO is planning to announce
a global training practice in collaboration with the Centers
for Disease Control and Prevention (US).
Dr. Inoue added that engagement with health care professionals
is important and that they have been invited to consultations.
Regarding guidelines for animal health, OIE and FAO have
been fully involved and will continue to be. He also
noted that WHO is working to make information available
on prices and availability of antibiotics. The World
Health Assembly took note of the Secretariat progress
reports on AMR.
Author: Mirza Alas is an Associate Researcher of
the South Centre.