GHF2010 – PS19 – Shared Responsibility and Concerted Responses to Antibiotic Resistance

Session Outline

Parallel session PS19, Tuesday, April 20 2010, 11:00-12:30, Room 4
Chair(s): Rachel Nugent, Deputy Director, Global Health, Centre for Global Development, USA
Dominique Monnet
, Senior Expert & Programme Coordinator, Antimicrobial Resistance and Healthcare-Associated Infections Scientific Advice Unit European Centre for Disease Prevention and Control (ECDC), Sweden
Summary: Two approaches to the complex issue of antimicrobial resistance exist: One argues that relying on the development of new drugs to overcome the problem represents the main solution, while the other prefers to focus on the containment strategies to limit the misuse and abuse of antimicrobial drugs. Goran Tomson and Stephen Harbarth will represent these opposing views, preceded by a keynote address by Dominique Monnet.
European Perspective on Antimicrobial Resistance Prevention and Control: A Success Story to Follow? 
Dominique Monnet, Senior Expert & Programme Coordinator, Antimicrobial Resistance and Healthcare-Associated Infections Scientific Advice Unit European Centre for Disease Prevention and Control (ECDC), Sweden
Should the Development of New Antibiotics Be a Public Health Priority? Yes!
G. B. Tomson, IHCAR Global Health, Karolinska Institutet, Stockholm
Should the Development of New Antibiotics Be a Public Health Priority? No! 
Stephan Harbarth, Associate Professor, Infection Control Programme, Geneva University Hospitals, Switzerland

Session Document

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Session Report

Submitted by: Jane Marriott (ICVolunteers); Contributors: Josefine Ridderstrale (ICVolunteers), Christoph Wirth (ICVolunteers)

Photo by John Brownlee, ICVolunteers.org

In response to the alarming increase in global antibiotic resistance, resulting in increasing numbers of deaths and non-treatable infections, countries have been forced to prioritise the need to find solutions for this. There have recently been far more active discussions pertaining to future policies; however, there is still a difficulty in deciding the key priorities and actions needed.

Due to the continued no-fly policy Mr. Dominique Monnet from the European Centre for Disease Prevention and Control (ECDC), an independent agency with a mission to prevent and control the spread of communicable diseases, opened the debate by video link. He provided an overview of the European perspective on this topic. Only in 1991 was there a wake-up call in Europe with the renewed out-break of the superbug MRSA. This, along with renewed research in 1998, resulted in the new Copenhagen recommendation which prompted the search for new antibiotics and other preventative measures to stop the spread of infections. Mr. Monnet explained the role of his agency in identifying the threat to public health from communicable diseases, in providing technical assistance and disseminating warnings and advice in specific health crises. The ECDC have several priorities including surveillance of outbreaks, reviewing euro-policies, country visits and training. As a result of country investments, levels of MRSA in the UK, Italy, France and Spain have fallen dramatically, while remaining high in many other southern European countries. The cost of these infections is high resulting in 25,000 deaths per year costing 6.9 million Euros in extra hospital costs per annum. There is a strong correlation between greater antibiotic use and the number of antimicrobial resistant strains. Finally there still remains a misconception amongst some populations that antibiotics can kill viruses.

Prof. Goran Tomson provided a more global view promoting the point that the development of new antibiotics should be a public health priority. His agency ReAct links groups around the world to respond to antibiotic resistance and access effective bacterial treatment. He commented that during the last 40 years very few new antibiotics have been invented. He thinks that there will be very few successful product launches in the near future. As a result of 70 years use/misuse of antibiotics, many newborn babies die due to infections caused by antibiotic-resistant bacteria, whereas only 10 years ago they could have been successfully treated. He feels strongly that new antibiotics should be a priority alongside other measures such as the prevention of infections and the spread of bacteria, as well as the minimisation of irrational use of antibiotics.

Dr. Stephan Harbarth, from Geneva University Hospital (HUG) in Switzerland, agreed with many of Mr. Tomson’s points, but stated that rather than being a priority for public health, they should be a priority for the pharmaceutical industry. His first point was the damaging misuse of any new antibiotic giving the example of India, where new agents are available over the counter without prescription. Secondly, excessive marketing raises the level of awareness of products and therefore overuse of antibiotics in any given population. The amount of money spent on campaigning for the appropriate use of antibiotics is a tiny fraction of the amount that pharmaceutical companies spend on promoting antibiotics. There are positive aspects to the lack of new antibiotics, as it is a strong incentive for governments to improve their infection control without the use of drugs. Controversially, the speaker questioned whether, if developed, new drugs would actually get to the poorest countries. In reply, Mr. Tomson felt much more optimistic, giving the example of HIV drugs which have successfully reached the poorest people and have had a positive effect. Mr. Harberth’s personal view is that public health priority should be given to other areas such as investment in vaccines, improved diagnosis and education.

There is still much to be discussed and views on how to move forward differ. However, everyone agreed on the need for the development of new antibiotics alongside much more stringent control on their use. Moreover, other ways of continuing to minimise the outbreak and spread of bacterial infections on a national and international scale have to be promoted. Today, at least, there are ongoing discussions, which in turn help to raise public awareness of the dangers of the current global situation.

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