Conference Synthesis: Summary & Recommenda6ons ... - PMAC€¦ · Rao MDR:DS 5.7 6.3 23.1 4.7 Source: PharmacoEconomics (2015) 33:939–955 hcps://goo.gl/H8QxxQ Saturday, February

ConferenceSynthesis:Summary&Recommenda6ons

Saturday3February2018

Saturday, February 3, 18

2

• Pre-conference:29–31January2018• 40sidemee;ngs• 6fieldtrips

• Mainconference1–3February2018• 4Keynoteaddresses• 4plenarysessions• 20parallelsessions• 5Booklaunches• 60E-posterpresenta;ons• WorldArtContest:468entriesfrom14countriespar;cipated

• Totalregisteredpar;cipants• 1,263par;cipantsfrom85countries(F48%,M52%)

Conferenceprogrammestructure


3

24Plenaryandparallelsessions142Moderators/speakers/panelists

Gender

Exper6se

WHORegions


Problemstreams

4Source:SlidefromPS2.4,KohlK.


ExamplesYellowFever,Angola2016• 2016(January–July):3,552YellowFevercasesfromallprovincesofAngola,355deaths

• Interna;onalspread:fromAngolatotheDRC(59confirmedcases),Kenya(2confirmedcases)andChina(11confirmedcases)

MDRTB• MDR-TBisapublichealthcrisisandahumansecuritythreat.WHOes;mates600,000newcasesgloballywithresistancetorifampicin–themosteffec;vefirst-linedrug-ofwhich490,000areMDR-TB.

• Costoftreatment(USDperpa;ent)

5

HIC UMIC LMIC LICDrugSensi;veTB 14,659 840 273 258MDRTB 83,365 5,284 6,313 1,218Ra;oMDR:DS 5.7 6.3 23.1 4.7

Source:PharmacoEconomics(2015)33:939–955hcps://goo.gl/H8QxxQ


https://goo.gl/H8QxxQ

https://goo.gl/H8QxxQ

ExamplesArtemisininresistantMalaria• SoutheastAsiaistheepi-centreofan;-malarialdrugresistanceandoneofthemostpopulartraveldes;na;ons,with104millioninterna;onaltravellersin2015,facilita;nginterna;onalspread

• 38and90%oftheartemisininmedicinesonthemarketweresubstandardorfalsified

FigureMapofprevalenceofK13muta;onsfromK13MolecularSurvey,accessed16November2016.

6Source:LancetInfectDis2017;17:491–97hcps://goo.gl/3uYa9w


https://goo.gl/3uYa9w

https://goo.gl/3uYa9w

ExamplesARTdrugresistance• Prevalenceofvirologicfailurewas10.4%ageroneyearofan;viraltreatmentinChina[BioMedResearchInterna;onal,2016]

• OverallprevalenceofprimaryHIVdrugresistancewas7.9%inThailand[PLOSOne].

AMRchallenges

• InOECDin2014,15%ofoveralladmissionshadanAMRinfec;on,andforthetopthreecountriesthiswas25%,11;meshigherthanthelowestthreecountries[OECD2016];

• mostcommonpathogens• 3rdgenera;oncephalosporin-resistantE.Coli• Carbapenem-resistantK.pneumoniae

7


Objec;vesofPMAC2018ACTIONFOCUSEDaddressingEIDandAMR1. Problemstream

• UnderstandthedriversofEIDandAMR2. Solu;onstream

• Accelerateprogressonmul;-sectoralac;ons• Advocateevidence-basedpriorityselngandpolicies• PMACaslearningandsharingplamorm

3. Evidenceforpolicydecisions• Underscorethesecurity,socio-economicanddevelopmentbenefitsfromOneHealthac;on

Structureofthesynthesis• Drivers,consequences,costofinac;onforEIDandAMR• Solu;ons• Crossculngrecommenda;ons

8


I.EmergingInfec;ousDiseases

Maindrivers

9Source:SlidefromPL0,FinebergH. Source:TerrolioZ.etal.2015.fromPS4.5


Maindriverscon;nued• Increasedcontactsbetweenhumansandanimals• Moreoutbreaksofemergingorre-emerginginfec;ousdiseasesaffectmorepeople.Urbaniza;onhasledtomoreurbanoutbreaks(e.g.yellowfeverinAngola)whichposesignificantchallengesintermsofscaleofresponseandpoten;alinterna;onalamplifica;on

• Poorandmarginalizedpopula;onspar;cularlyaffected,e.g.peopleonthemove—internal,interna;onaldisplacedpersons,pastoralists

• UNICEF’sresponsetopoten;alCholeraoutbreakhcps://youtu.be/FvCexK18hiU

10


https://youtu.be/FvCexK18hiU





Costofinadequatesurveillanceandresponse

• Thecostofpreparednessisatleast10;mesless• “Preparednesscostsmillions,responsecostshundredsofmillionsandrecoverycostsbillions”.

• Theimpactisnotonlyfinancialoreconomicitisalsosocialandpoli;cal

Examples• MERS-CoVoutbreakintheRepublicofKorea,2015

• atotalof186personshavebeeninfected,38ofwhomhavedied

• Foreigntouristsdecreasedby41%comparedwithMay2014.TotaleconomiclossofUS$10billion;0.1%reduc;oninGDPgrowthin2015.[EuroSurveill.2015;20(25)]

12


Ebolaaffectedcountries:Guinea,LiberiaandSierraLeone(2014-16)

Source:SlidefromYamamotoN.(PS1.4)

13

• 11thousanddeathsfromEbolaepidemic,althoughEbolawasdiagnosedin1976

• Inadequatecapacitytorespond

• Fragilehealthsystems• Lackofinvestmentinhealthandhealthsystems

• Poorhealthdeliveryinfrastructure

• Novaccinehadbeendeveloped


Thailand’sresponsestoMERS-CoV• AnOmanipa;ent(2015)

• Day1:withheartcondi;onwasdiagnosedwithpneumoniaonhospitaladmission

• Day2and3:twofalsenega;vetestsonupperrespiratorytractsamples• Day3:subsequentsputumexamconfirmedMERS-CoV• Pa;entwasmovedbackintothenega;vepressureunitandtransferredtoInfec;ousDiseaseIns;tute,MOPH

• Over170contactsweretraced;48werequaran;nedand122self-monitoredsymptoms.High-riskclosecontactsexhibi;ngnosymptoms,andthosewhoselabteston12thdayagerexposurewasnega;ve,werereleasedonthe14thday

• TheOmaniMinistryofHealth(MOH)wasno;fiedusingIHR2005mechanisms.Outbreakinves;ga;onwasconductedinOmanandfindingswerepublishedonWHOintranetandsharedwithThailand’sIHRfocalpoint

• Keytosuccessfulinfec;oncontrol,withnosecondarytransmission,wascollabora;veeffortsamonghospitals,laboratoriesandMOHsofbothcountries

14


Solu;onstoEID• ImproveandsustaintheIHRcorecapaci6es• Strengtheninterven;onsatthehumananimalinterface• Peoplecenteredresponsesincludingcommunityandcivilsocietyengagement,leavingnoonebehind,focusonthemostvulnerablepopula;ons

• Renewedgovernance• Transparencyandaccountabilityofna;onalgovernmentforpreparednessandresponse

• Trustandcollec;vecommitment• Coordina;on:mul;-partner,mul;-disciplinaryandmul;culturalresponseteams

• Op6mizepartnerships:incen;vizecollabora;on;jointobjec;vesbasedonlocalneeds

• Buildcapaci6esdealingwithexis;ngthreatsandepidemicstoensureadequatesystems

• Approaches• Investinsystemsnotprojects• 2facesofthesamecoin:healthsecurityandprimarycare• Engagepoli;ciansandfinancialstakeholders,increasetheirawarenessbefore

15


Lessonsofexperienceandgoodprac;ces• Engagethemediaproac;velyandatanearlystageoftheresponse,shapethenarra;ve,remainflexibleinmessagedevelopment(e.g.BrazilYellowfever)

• Preparethehealthsystemtorespond,trainhealthworkerstocopewithunexpectedoutbreaks,improveinfec;onpreven;onandcontrol

• Improvegeneralpublicliteracyabouttherisksandpreven;onmeasures• Learnfromothercountries’experience• Integratesurveillancedatasources(human,animal,communitysurveillance)• Usebigdataforsurveillancebutfocusonqualityanalysis(“reducenoise”)• Produceeconomicmetricsonhealthsystemspreparednesstoraiseandsustainawarenessofpoli;ciansanddecisionmakers

• Includeprivatesectorinpreparednessandresponse• Includepastoralistsandnomadicpopula;onsinsurveillance,biosecurityandpolicydialoguetofindinnova;veandcostefficientsolu;ons

16


II.AMR

17


ThekeydriversofAMR

• An;microbialmisuseandoveruse• Environmentalcontamina;on• Health-caretransmission• Subop;malrapiddiagnos;cs• Subop;malvaccina;on• Subop;maldosing• Interna;onaltravelfacilita;ngspreadofAMRpathogens• Substandardandfalsifiedan;microbials

18


Consump6onofan6microbialsinfoodanimals

19

Source:SlidefromPL0;FinebergH.

Globalconsump;onofan;microbialsinfoodanimalproduc;on

• 2010:Es;matedat63,151(±1,560)tonnes• 2030:Projectedtoriseby67%,to105,596(±3,605)tonnes• Increasedconsump;onisdrivenbythegrowthinconsumerdemandforlivestockproductsinmiddle-incomecountries,andshigtolarge-scalefarmswherean;microbialsareusedrou;nely.

• HotspotssuchasIndiawhereareasofhighconsump;on(30kgperkm2)forindustrialpoultryproduc;onareexpectedtogrowby312%by2030


20

Source:Van Boeckel et al., 2015, PNAS (slide from PS4.5, LaxminarayanR.)

An6bio6cconsump6oninlivestock,toptencountries2010–2030(projectedfor2030)

Source:SlidefromPS4.5,LaxminarayanR.


Useofan;microbialagentsforGrowthPromo;on

In2015,atotalof96outof130(74%)OIEMemberCountriesdidnotauthorizean;microbialagentsforgrowthpromo;oninanimals;increasedfrom77outof151(51%)in2012

21

Authorisa6onofAn6microbialGrowthPromotersin130OIEMemberCountries,2015

Source:OIEAnnualReportontheuseofan;microbialagentsinanimals.2016


Substandardandfalsifiedan;bio;cs:notadequatelyaddressedbyGAP-AMR

Costofinac6on• Ofthe48,000samplesofmedicinestestedforquality(66%An;microbials)

• 10.6%failurerate,equivalenttoannualspendof$30.5billiononSFproducts

Impactsofsubstandardandfalsifiedan6bio6csandan6microbials• Es;mated72,430-169,271deathsofchildhoodpneumoniaduetoSFan;bio;cs

• Addi;onal116,000deathsfrommalariainSubSaharanAfricaduetoSFan;-malarialdrugs,and$38.5m.addi;onaltreatmentcostduetofailureofini;altreatment.

Rootcauses• Poorgovernance:corrup;on,unethicalprac;ces,poorprocurement• WeakNa;onalRegulatoryAuthoritycapacity

22


23

Source:SlidefromPS1.3,BondK.


Solu;onsforAMR

1. Ac;veimplementa;onofna;onalac;onplanonAMR,strengthenins;tu;onalcapaci;esontwomajorfronts

2. Monitoringstrand:surveillanceforpolicy:• An;microbialconsump;oninhumanandanimalsectors• AMRinhumanandanimals• Integratedsurveillanceinfoodchain• ABresiduesandAMRinenvironment• Pointprevalencesurveystocaptureprevalenceofhealthcareassociatedinfec;onsandAMR,AMUinhealthfacili;es,AMRacributedmortalityandeconomiclossas%GDP

• Post-marke;ngqualityofmedicines,recallofSFproductsandlegalac;on

• Disposalofexpiredan;bio;cs

24


Ac;onStrand1.Redesignlivestockproduc;onsystemse.g.breedsandvaccines;husbandry–stockingdensi;es;qualityofwaterandfeed

2.Improvean;bio;cstewardship• Developandenforceclinicalprac;ceguidelines,dispensingandprescrip;onaudits,peer

support,counsellingandcon;nuedprofessionaleduca;on• Improvean;bio;cliteracyandAMRawareness• Strengthenan;bio;cliteracyinprofessionals• Regula;on:reclassifica;onofan;bio;csintothreegroups:access,watchandreserve;and

limiteduseofreservegroup• Regulatebycappingan;microbialsper‘popula;oncorrec;onunit’

3.Strengtheninfec;onpreven;onandcontrolinhealthcarefacili;es

4.ResearchandDevelopment• HealthpolicyandsystemsresearchonAMR• PublicinvestmentinR&Dinnovelmoleculesanddiagnos;cs• Researchforalterna;ves,e.g.autogenousvaccines

Needtoaddresshugeimplementa6oncapaci6esgap

25


III.CrossCulngRecommenda;ons

26


1. RaiseEIDandAMRtothena;onalhumansecurityagenda2. Goodgovernance,accountabilityandtransparencyto

addresscorrup;on• Mul;sectoralac;onforhealth• Public-private-community-civilsocietyengagement

27


3.RoleofLeadership

28


4.Trustamongpartners• trustbuildingbeforediseaseoutbreak• sharedvision,sharedunderstanding• commonvalues• ac;ngwisely

29


5.OneHealthSystemStrengthening:human,animalandenvironment

30

Source:SlidefromPS4.4,PolicarpioS.L.


6.Riskcommunica;onsduringepidemics/pandemics

31


7.R&Dandevidencebasedpolicy

32


8.Healthsecurityfinancing:size,sources,flowoffund• Donorsneedtoinvestmoreinna;onalpreparedness• Innova;veapproachestomaximizeefficiencyofspending–digital,newtechnology,buildingonhumangenomeproject

• Poli;calcommitmenttosecuredomes;cresources• Integra;onofhealthsecurityfinancingprocessintocountrybudge;ngprocess

33Source:SlidefromPS4.5,YameyG.


Summary

• Economicinvestmentforpreven6ngEIDandAMR• Strengtheneconomicevidencebase,e.g.costofinac;on(“hiddenlosses”),calculateReturnonInvestment

• Scaleeconomicallyinformedinnova6ons,e.g.land-useplanningthataccountsforeconomicimpactofdiseaseemergencefromdisruptedlandscape

• Incen6vizeriskmi6ga6on,e.g.incorporateepidemicriskprofilesintomacro-economicanalysesandbondra;ngs

• Mobilizefunds:domes;candODA• KeeppandemicsandAMRattopoftheagenda:G7,G20,GlobalHealthSecurityAgenda

34


Specialthanks

Mr.SamBradd,fromDrawingChangeforthewonderfulgraphicrecording.

35


Rapporteurcoordinator:WalaipornPatcharanarumol,WarisaPanichkriangkrai,AngkanaSommanustaweechai

LeadRapporteur1.Prof.DameAnneMills2.Dr.SylvieBriand3.Dr.JulieRSinclair 4.Dr.JuanLubroth5.Dr.VirojTangcharoensathien1 Aimee Lee 23 Kanokwaroon Watananirun 45 Noppawan Piaseu 67 Suladda Ponguca

2 Anond Kulthanmanusorn 24 Kanthika Imsaengjan 46 Orana Chandrasiri 68 Sunicha Chanva;k

3 Arisa Hisamatsu3rd 25 Karnsinee Yotsakulsate 47 Orarat Wangpradit 69 Supanan Inphlang

4 Benjaporn Niyomnaitham 26 Kasama Thongbaeb 48 Palita Rodanant 70 Suphanna Krongthaeo

5 Bowwarn Juengwacanasirikul 27 Keiko Tsukamoto 49 Pan;la Taweewigyakarn 71 Surangrat Jiranantanagorn

6 Cameron Tabrizi 28 Konvika Chantarat 50 Pa;nya Srisai 72 Suriwan Thaiprayoon

7 Carol DayoObure 29 Kritchavat Ploddi 51 Payao Phonsuk 73 Taketo Tanaka

8 Chainarong Sukputanan 30 Li Niu 52 Piyawan Kanan 74 Tanapat Laowahutanon

9 Charay Vicahthai 31 Maho URABE 53 Pranpriya Chaypho 75 Thanachol Wonghirundecha

10 Chayanis Kositamongkol 32 Maki Sakuma 54 Raththar Benchapalanont 76 Theerut Densathaporn

11 Chayut Pinichka 33 Manushi Sharma 55 Rei Haruyama 77 Thuyen Nguyen

12 Chu;ma Akaleephan 34 Mariam Parwaiz 56 Rick Brown 78 Ti;porn Tuangratananon

13 EiEi Aung 35 Myelone Tharmasselan 57 Sakditat Ilphisit 79 Uravadee Chanchamsang

14 Hathairat Kosiyaporn 36 Nareerut Pudpong 58 Saowaluk Srikajornlarp 80 Vasinee Singsa

15 Huijuan Liang 37 Nicolas Rosemberg 59 Sarayuth Khuntha 81 Voleak Van

16 Inthira Yamabhai 38 Nisachol Cechakrikul 60 Saudamini Dabak 82 WeiPin Hung

17 Jaruayporn Srisasalux 39 Nissara Spence 61 Shaheda Viriyathorn 83 Wilailak Saengsri

18 Jeannece Wong 40 Nitchakorn Tangsathapornpanich 62 Sirinard Nipaphorn 84 Woranan Wichayapipopsakul

19 Jing WANG 41 Nongnapas Assawamasbunlue 63 Smith Kuprasertvong 85 Xian Sun

20 Jintana Jankhotkaew 42 Nongnuch Jaichuen 64 Sophavanh Thitsy 86 Yasmeen Vaheng

21 Joseph Harris 43 Nongyao Kasatpibal 65 Suchunya Aungkulanon 87 Yumiko Miyashita

22 Jurairat Phromjai 44 Noppakun Thammatacharee 66 Sukanya Numsawat


Documents

Conference Synthesis: Summary & Recommenda6ons ... - PMAC€¦ · Rao MDR:DS 5.7 6.3 23.1 4.7 Source: PharmacoEconomics (2015) 33:939–955 hcps://goo.gl/H8QxxQ Saturday, February