Speech @ Brussels Institute of Advanced Studies (BrIAS)Geplaatst op 27 april, 2023 om 12:40
Dinsdag 25 april 2023 was ik te gast op de VUB om een keynote speech te geven over de beleidsontwikkeling rond antimocribiële resistentie.
Het event werd georganiseerd in samenwerking met VUB – ULB – BrIAS
“Mijn speech bestond uit 4 onderdelen:
- Landen moeten de AMR problematiek erkennen;
- Internationaal en nationaal moeten er strategieën ontwikkeld worden over hoe we dit probleem kunnen aanpakken;
- Uitvoering van deze strategieën, dit kan zijn door middel van wet-en regelgeving;
- Het is ook belangrijk om in te zetten op de monitoring en evaluatie om de doeltreffendheid en effectiviteit van de strategieën te analyseren en zo nodig bij te sturen.”
Thank you for inviting me, I am honored to be the Policy of AMR here today at this special event of the Brussels Institute for Advanced Studies (BrIAS).
Ladies and gentlemen,
AMR is a global health emergency that threatens to undermine the achievements of modern medicine. As you know, every year, nearly 1,3 million people die from infections that cannot be treated by antibiotics, and this number is expected to rise to 10 million by 2050 if we don’t act now. The political decision-making process relating to AMR involves multiple stakeholders, including governments, international organizations, healthcare providers, and the pharmaceutical industry.
The global community has responded to the AMR threat with a series of initiatives and policies aimed at tackling AMR. Today, I will focus on the Global Action Plan on AMR by the WHO, the work of the Global Leaders Group on AMR, and the National Action Plans on AMR that national governments have developed. In particular, I will highlight the critical issue relating to AMR, namely a lack of funding for National Action Plans on AMR.
The first step in the political decision-making process is to recognize the problem. This involves raising awareness among policymakers and the general public about the dangers of AMR and the urgent need for action. The WHO has played a crucial role in this regard by issuing a series of reports on the issue since 2014. In 2015, the WHO released the Global Action Plan on AMR, which outlined a comprehensive strategy to combat AMR.
The Global Action Plan on AMR is based on a One Health approach, which recognizes that AMR is a complex problem that requires collaboration across different sectors, including human health, animal health, and the environment. The plan includes five strategic objectives: improving awareness and understanding of AMR; strengthening surveillance and research; reducing the incidence of infection; optimizing the use of antimicrobial agents; and ensuring sustainable investment in the fight against AMR.
The second step in the political decision-making process is to develop a national or international strategy to address AMR. This strategy should be based on the principles outlined in the Global Action Plan on AMR. Which was adopted in 2015 by the WHO Assembly and has been the guideline ever since. In the report, measures are given to promote the appropriate use of antibiotics, increase surveillance and monitoring of resistant strains, improve infection prevention, and control, and stimulate research and development of new antimicrobial agents. The Global Action Plan also called for an establishment of a Global Leaders Group on AMR.
This group has been established in 2020 to provide political leadership and advocacy on AMR. The group includes heads of state, government ministers, and leaders from the private sector and civil society. I am very honored to have been involved in this group from the beginning in 2020. I still experience first-hand how much work we are doing in this group to promote the implementation of the Global Action Plan on AMR.
One of the most important recommendations of the Global Action Plan that the Global Leaders Group support is the development of National Action Plans on AMR.
These National Action Plans on AMR are plans developed by individual countries to address the growing problem of antimicrobial resistance. These plans are tailored to the specific needs and circumstances of each country.
These plans include:
- clear objectives, targets, and indicators for monitoring progress;
- measures to promote responsible use of antibiotics, such as restricting the use of antibiotics in agriculture;
- promoting appropriate prescribing in healthcare settings;
- the need for improved surveillance of AMR;
- strengthening infection prevention and control measures;
- promoting research and development of new antimicrobial agents;
As of April 2023, 149 countries have finalized their National Action Plans. This has been achieved with the help of the Global Leaders Group on AMR to support countries in developing and implementing the National action plan.
I am sure I don’t need to remind you that negotiations between governments, with the private sector, the civil society and so on are easy. When I was minister of public health and social affairs, I organized site visits, policy dialogues and (general) public consultations to have as much information from the field as possible. We then went to have negotiations between the federal government and the region’s which was not easy. Everyone must agree on specific policy measures to battle AMR. We then drafted the National Action Plan.
The Belgian NAP-AMR goes one step further than most countries as our plan is based on a One Health approach, which recognizes the interconnectedness of human, animal, and environmental health in the spread of AMR. The plan is divided into four strategic pillars:
- Strengthening the knowledge base on AMR and its impact on public health
- Optimizing the use of antimicrobial medicines in humans and animals
- Preventing the emergence and transmission of AMR through infection control measures
- Stimulating innovation and research on new antimicrobial medicines, alternative treatments, and diagnostics
Under each of these pillars, the NAP-AMR outlines specific objectives and actions to be taken, as well as indicators for monitoring progress.
The Belgian government has also established a national coordinating body, the Belgian Antibiotic Policy Coordination Committee (BAPCOC), to oversee the implementation of the NAP-AMR. BAPCOC brings together representatives from various sectors, including human and veterinary medicine, public health, and the environment, to coordinate efforts to combat AMR.
In addition to the NAP-AMR, Belgium has taken other steps to address AMR. For example, Belgium has implemented a national antibiotic consumption surveillance system, which provides data on the use of antibiotics in human medicine. Belgium has also implemented a national action plan for the prudent use of antibiotics in veterinary medicine.
Currently, my successor is already conducting negotiations will all parties involved to develop a new National Action Plan for the period 2024-2028.
The third step in the political decision-making process is to implement the strategy through legislative and regulatory measures. National governments play a critical role in implementing measures to restrict the use of antibiotics in agriculture, promote regulations for appropriate use of antibiotics in healthcare settings, and incentives to encourage the development of new antimicrobial drugs. All these measures are included in each country’s national Action Plan.
However, there are many challenges relating to the National Action plans, but one is really important: funding. Without adequate funding, countries may struggle to implement the necessary measures to reduce the spread of antimicrobial-resistant infections, including improved surveillance, infection prevention and control, and appropriate use of antimicrobials.
This can lead to increased mortality, as well as increased healthcare costs. Furthermore, inadequate funding can result in a lack of investment in the development of new antimicrobial medicines, vaccines, and diagnostic tools, which are critical for addressing the long-term threat of AMR. You can see that the loss of adequate funding has a detrimental effect on the whole society.
From the 149 countries that have finalized their National Action Plans, only 24% of those Member States both have a plan and report effective capacities to implement and monitor it. Only 10%, so 17 out of 149 Member States have allocated financing in their national budget to implement and monitor their national action plan.
The problem of inadequate funding for National Action Plans on AMR is particularly acute in low- and middle-income countries. These countries may have limited resources to allocate to healthcare, and may also face competing priorities for funding, such as infectious disease outbreaks or other public health emergencies.
Addressing the lack of funding for National Action Plans on AMR will require increased investment from national governments, as well as support from international donors and organizations. In 2019, the Global Leaders Group on AMR called for increased investment in the fight against AMR, including increased funding for the development and implementation of National Action Plans on AMR.
The Global Leaders Group on AMR has called for a range of measures to address AMR, including increased funding for research and development, the establishment of global targets for reducing the use of antibiotics in agriculture, and the promotion of alternative treatments for bacterial infections.
The fourth step is to monitor and evaluate the effectiveness of the strategy. This involves collecting and analyzing data on antibiotic use, resistance patterns, and infection rates to assess the impact of the measures that have been implemented.
The WHO has established a Global Antimicrobial Resistance Surveillance System (GLASS) to monitor trends in AMR at the global level. The GLASS system provides a platform for sharing data on AMR and for identifying trends and patterns that can inform the development of policies and interventions.
Belgium also has its own monitoring report. We call it the BELMAP report. It’s especially useful as it summarizes the results and trends of many different existing monitoring programs.
Thank you for your attention.