No action today, no cure tomorrow - maff.go.jp · Source: ECDC 2007 Source: US CDC 2013 population 70m >38,000 deaths ... Journal of Medical Microbiology (2013), 62, 499-513 . Health

Health Security and Emergencies

No action today, no cure tomorrow

明日のために、今行動を

24 November 2016, Tokyo Takeshi KASAI

Director, Programme Management, WHO Western Pacific Region



Key messages

• AMR is caused by our action yesterday and WHO is so

concerned in particular about AMR in ASIA

• There are multiple driving forces causing AMR and it is

essential to adopt whole-of-government and whole-of-society

approaches with the joint-leadership of the health and animal

sectors

• AMR is a global agenda that requires action today for

tomorrow’s cure. AMR requires “imagination” to understand

AND a long-term system to address


Why we worry? なぜWHOは憂慮しているのか？

• Treatment of drug resistance is more difficult,

expensive and does not necessarily result in

good outcomes

• AMR has been increasing and spreading globally

• Antibiotic consumption has been increasing and

effective regulatory systems are not yet in place

• Less new drugs are entering the market


Drug resistant TB: A man-made disaster

• Drug resistance created through inappropriate treatment

• Patients have to undergo toxic and costly treatment for two years or more

• Treatment outcome is poor with high mortality

• 5-year survival rate of XDR-TB: 23%

* MDR-TB is defined as resistance to isoniazid and rifampicin. XDR-TB is defined as resistance to at least isoniazid and rifampicin, and to any fluoroquinolone, and to any of the three

second-line injectables.


薬剤耐

性菌による推計死亡者数

European Union population 500m

25,000 deaths per year

2.5m extra hospital days

Overall societal costs

(€ 900 million, hosp. days)

Approx. €1.5 billion per year

United States population 300m

>23,000 deaths

>2.0m illnesses


Up to $20 billion direct

Up to $35 billion indirect

Source: ECDC 2007 Source: US CDC 2013

Thailand population 70m

>38,000 deaths

>3.2m hospital days


US$ 84.6–202.8 mill. direct

>US$1.3 billion indirect

Source: Pumart et al 2012


Drug resistance spreads globally International dissemination of New Delhi metallo-ß-lactamase (NDM) —producing

Enterobacteriaceae

Alan P. Johnson1 and Neil Woodford

Journal of Medical Microbiology (2013), 62, 499-513


Increase use of antimicrobials in the health sector


Drug use in animal and fishery sectors

(A) Largest five consumers of antimicrobials in livestock in 2010.

2010年の使用

量の上位５カ国

20３0年の推計使用量

増加量の多い上位５カ国

増加の割合の多い上位５カ国


Global distribution of relative risk of an Emerging

Infectious Disease Event；新興感染症のリスク

10

Maps are derived for EID events caused by a, zoonotic pathogens from wildlife, b, zoonotic pathogens from non-wildlife, c, drug-resistant pathogens and d,

vector-borne pathogens. The relative risk is calculated from regression coefficients and variable values, categorized by standard deviations from the mean

and mapped on a linear scale from green (lower values) to red (higher values).


Dynamic development of Asian countries

Proportion of people access to internet

1995 1998 2001 2004 2007 2010 2013

0

2

4

6

8

10

General trends in health expenditure

as % of GDP

% o

f G

DP

Private Health Expenditure as % of GDP

General Government Health Expenditure as % of GDP

1995 1998 2001 2004 2007 2010 2013

0

20

40

60

80

100

Structure of Health Expenditure

a in current US$ per capita

Cu

rre

nt

US

$Out-of-pocket Expenditure per capita in US$

Other Private Health Expenditure per capita in US$

General Government Health Expenditure per capita in US$

1995 1998 2001 2004 2007 2010 2013

0

2

4

6

8

10

12

General Government Health Expenditure

as % of General Government Expenditure (GGE)

% o

f G

GE

1995 1998 2001 2004 2007 2010 2013

0

1

2

3

4

5

External Resources on Health

as % of Total Health Expenditure (THE)

% o

f T

HE


Hard-to-reach populations 少数民族の住む僻地


Drug Resistant Malaria in the Mekong subregion


New drugs 抗菌薬：Drying up after a golden age！


フレミング博士の予言

Early warnings by Sir Alexander Fleming on resistance

“It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them,

and the same thing has occasionally happened in the body.”

“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.”


The future we see


Global Action Plan on Antimicrobial Resistance

• Awareness

• Surveillance and research

• Reduce incidence of

infection

• Optimize use of drugs

• Sustainable investment

Endorsed at World Health Assembly

on 27 May 2015


• 37 countries & areas

• Wide geographical range

• Various climate zones

• Economic situation

• Population sizes


Mechanism for progress

19

National Coordination

National Plan

Awareness Campaign


National Plan

Awareness Campaign


National Plan

Awareness Campaign


National Plan

Awareness Campaign

National Coordination/

Plan

Awareness Campaign Surveillance

Health System

WHO

Country

office

Regional

Office for

the

Western

Pacific Technical

Support

AMR

Campaign

antimicrobial stewardship

surveillance Monitoring consumption

Health system


Progress on National Action Plans on AMR

1. Launched National Plans (9):

• Australia (2015) • Cambodia (2015) • China (2016) • Cook Islands

(2016) • Fiji (2015) • Japan (2016) • Philippines

(2015) • Republic of

Korea (2016) • Viet Nam (2013)

20

2. In progress (8): • Hong Kong

SAR (China) • Lao PDR • Mongolia • Papua New

Guinea • New Zealand • Samoa • Singapore

3. Priority countries for 2017:

• Kiribati • Solomon Islands • Tonga • Vanuatu • Additional Pacific

Island Countries


World Antibiotic Awareness Week 14-20 November 2016

Regional Platform: joint planning (July 2016)

• 2 National action plans launched

• 5 Countries launched guidelines

(Antimicrobial Stewardship,

Antibiotic Guidelines, Infection

Prevention and Control)

• 12 countries held high level

multisectoral events

• 16 conducted training

workshops of health

professionals


World Antibiotic Awareness week

Samoa: held 1st Annual AMR Summit opened by the Prime Minister



Lao PDR: 1st multistakeholder workshop to develop the National Action Plan –

supported by FAO-OIE-WHO



Philippines: launched National Antibiotics Guidelines, Manual of Procedures in

Implementing Antimicrobial Stewardship in Hospitals, and Methods Guide for

Antimicrobial Use Monitoring.



What we learned from HPAI

Public Health Sector alone cannot control the disease effectively

Requires effective coordination with animal and food safety sectors

We know so little about the epidemiology particularly in the ecosystem including the role of wildlife

Photo: courtesy to FAO


One Health

One Health

EMPRES-Asia

OIE PVS Pathway


アジア太平洋感染症対策戦略

APSED-Zoonoses

Research Analysis

Surveillance information from

human health sector

Surveillance information from

animal health sector

Coordination Mechanism

Research Analysis

Coordinated Risk Reduction

Coordinated Response

Human

Health Animal

Health

Wildlif

e


Ching et al. Outbreak of Henipavirus Infection,

Philippines, 2014. Emerging Infectious Diseases

• www.cdc.gov/eid • Vol. 21, No. 2, February

2015

Examples from Mongolia and Philippines


Tokyo Meeting of Health Ministers on AMR in Asia

Biregional Technical Consultation on AMR in Asia

14-15 April 2016

Outcome Statement to

support the

implementation of the

Tokyo Communiqué

16 April 2016

Communiqué of Tokyo

Meeting of Health

Ministers on AMR in Asia


持続可能な開発目標

No body left behind! 誰も取り残されることのない未来に向けて


Framing of AMR as a Development Agenda in Tokyo

IHR and UHC


If you want to go faster, go alone, if you want to go far, go together.

アフリカのことわざ

Documents

No action today, no cure tomorrow - maff.go.jp · Source: ECDC 2007 Source: US CDC 2013 population 70m >38,000 deaths ... Journal of Medical Microbiology (2013), 62, 499-513 . Health