Director’s Letter Dear Delegates, It is my honour to formally introduce myself as the Director of the World Health Organization (WHO) committee for CYDCMUN 2020. My name is Isabel Bae and I am a grade 12 senior attending North Surrey Secondary School. My initial steps into the world of MUN extend back to tenth grade. Vaguely I remember weekly MUN debate sessions, frequent roasts, and much enjoyment with my peers. Although my MUN experience started with small weekly club meetings, after two years of delegating, I can now finally give back the same experiences I was provided throughout those years as the Director of WHO. Regardless of skills, accomplishments, or experience, I welcome all delegates to indulge in those same experiences of not just learning and debating, but networking and meeting new peers. As much anticipation I have for CYDC, I hope delegates do as well. Alongside the Directors are the Chair and Assistant Director. I am most ecstatic to announce my Chair as Kate Seo, a grade 12 senior from North Surrey Secondary and my Assistant Director as Shirley Zhong, a junior from Richmond Secondary School. They are more than willing to dedicate their time enhancing or aiding the debate should you have any inquiries, concerns, or suggestions throughout the conference. As of now, one of the most prevailing issues urgently requiring the attention of the WHO committee is antimicrobial resistance. The diverse opinions of varying delegates on this topic will undoubtedly spur a debate of many conflicting arguments but one of many perspectives as some delegates strive for reducing antibiotics while others in need of healthcare pursue otherwise. To ensure the best experience, we encourage thorough research to be done and much participation during the conference. We can assure you, the day will leave you with no regrets. Finally, we, as the dais team, welcome you to the WHO committee of CYDC 2020. At any time, should you have any inquiries, please send me an email at who@cydcmun.org. Isabel Bae WHO Director CYDCMUN 2020

Committee Introduction The World Health Organization (WHO) was officially established on April 7th, 1948 with the purpose of improving international health and attaining the highest possible level of health across the globe. Composed of 195 member states, WHO has the authority for health within the UN system and provides leadership on global health matters. Under the WHO constitution, they acknowledge that “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This WHO constitution was signed by 61 countries 1

at the first meeting of the World Health Assembly on July 22nd, 1946 and has been maintained ever since. A few of the many responsibilities that fall under the organization include the mitigation and eradication of spreading illnesses and diseases, writing up the World Health Report, and improving the accessibility of medical assistance to everyone, both in developed and developing nations. WHO member states are divided into six different regions: Africa, Europe, Eastern Mediterranean, South-East Asia, Americas, Eastern and Western Pacific. Each region has its own regional office where officers oversee the health status of both national and sub-national sections of their region. Furthermore, there are 149 field offices scattered around the nations to help implement WHO policies and to reach a greater population. With the help of governmental, non-governmental organizations, health professionals, and researchers, WHO have shown its value through many successful initiatives and measures they have taken to health-related issues of the past. Under the many functions of WHO, one function states that the committee “establish and stimulate the establishment of international standards for biological, pharmaceutical, and similar products, and to standardize diagnostic procedures.” In such related issues such as antimicrobial 2

resistance (AMR), it is prominent that WHO plays a huge role in monitoring global health, recognizing an issue, and implementing a solution.

1 https://www.who.int/about/who-we-are/constitution 2 https://www.nationsencyclopedia.com/United-Nations-Related-Agencies/The-World-Health-Organization-WHO-PURPOSES.html

Topic Introduction The world was in celebration at the long-awaited discovery of the first antibiotic, penicillin, by Alexander Fleming. Saving the lives of numerous troops throughout World War II, at the time, 3

antibiotics seemed to be the ultimate solution and indeed, it has had its fair share of positive contributions to the medical field. Various other antibiotics quickly followed after the discovery of penicillin, and once the supply was sufficient, the medical market boomed. However, the excessive use of antibiotics was only giving birth to resistant organisms, otherwise known as superbugs. To more formally introduce antibiotics, they are defined as antimicrobial substances and have been around since the 1920s, contributing significantly to medicine since. The applications of antibiotics vary on an extensive scale from fighting numerous infections in humans, to acting as a preventative measure in case of future bacterial infection. Despite its numerous 4

accomplishments, they have been increasing the population and development of superbugs, antibiotic-resistant bacteria, primarily through natural selection. Natural selection is as described. As bacteria were demolished with the ever-growing demand for antibiotics, those that survived and honed better immunity, survived and reproduced, passing on its favourable genes to its offspring. Over time, this pattern would lead to an increasing 5

population of resistant bacteria that would have all the advantageous genes necessary to avoid the effects of antibiotics. This population is otherwise known as the one that is to come in the near future, should delegations not act upon a solution. The concerning increase in this population predicts a humanitarian crisis in the years to come when antibiotics are no longer an effective cure for bacterial infection. Even at the present moment, diseases that were once thoroughly controlled are emerging again, as bacteria build resistance against the currently established antibiotic medications. Examples of these returning diseases include malaria as well as tuberculosis. This is a global concern as antibiotics are a universal and standard measure to fight bacterial infections, meaning antimicrobial resistance is occurring throughout the world, rather than solely within a couple of nations. Root causes of antimicrobial resistance that should concern the UN include the unnecessary prescription of antibiotics, overuse of antibiotics in agriculture as well as a lack of sanitation in hospitals. 6

3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520913/ 4 https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/types-of-medicine/antibiotics 5 https://www.reactgroup.org/toolbox/understand/antibiotic-resistance/mutation-and-selection/ 6 Ibid

Timeline Pre-antibiotic Era - Ancient cultures used molds, soil and plants as remedies to treat infections. It is later discovered that these treatments worked efficiently because of the natural antimicrobial substances produced in the mold. 7

1910 - German physician Paul Ehrlich discovered Salvarsan, the first synthetic antimicrobial agent, to cure syphilis (once known as an incurable disease). 8

September 28th, 1928 - Alexander Fleming, the British physician-scientist, discovered the first antibiotic: penicillin. 9

1940 - Soon after penicillin is introduced, the penicillin-R Staphylococcus is found to have antibiotic resistance. 10

1940s - Antibiotics Growth Promoter is added to the diet of livestock to combat sickness, improve feed efficiency, and achieve a faster growing rate. 11

July 1941 - Alexander Fleming’s colleague, Howard Florey and Ernst Chain collaborate with the Office of Scientific Research and Development (OSRD) to further investigate penicillin. 12

March 1942 - Mrs. Ann Miller became the first patient to be treated with penicillin. Ten more cases were successfully treated by June. 13

1943 - The War Production Board (WPB) with the US Department of Agriculture (USDA), generated a massive production of penicillin for British and US troops during WW2. 14

1944 - The first commercial plant for large-scale production of penicillin is opened in New York by Pfizer. 15

7 https://www.reactgroup.org/toolbox/understand/antibiotics/development-of-antibiotics-as-medicines/ 8 https://www.youtube.com/watch?v=YWn3JnCEc24 9 https://www.acs.org/content/acs/en/education/whatischemistry/landmarks/flemingpenicillin.html 10 https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf 11 https://www.researchgate.net/publication/328308665_A_review_of_hot_and_sweet_pepper_added_in_animal_nutrition_alternative_against_ the_use_of_antibiotics 12 https://www.sciencehistory.org/historical-profile/howard-walter-florey-and-ernst-boris-chain 13 https://www.acs.org/content/acs/en/education/whatischemistry/landmarks/flemingpenicillin.html 14 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673487/ 15 https://www.acs.org/content/acs/en/education/whatischemistry/landmarks/flemingpenicillin.html

April 7th, 1948 - The World Health Organization is established in Geneva, Switzerland. 16

March 30th, 2011 - The Pew Charitable Trusts published a report on reforming industrial animal agriculture to reduce the overuse and misuse of antibiotics. 17

September 20th, 2013 - The Strategic and Technical Advisory Group on antimicrobial resistance (STAG-AMR) is the leading technical advisory group to WHO on antimicrobial resistance. 18

May 2015 - The Sixty-eight World Health Assembly, led by the World Health Organization Secretariat, endorsed a Global Action Plan on Antimicrobial Resistance in resolution WHA 68-7.

19

October 2015 - The Global Antimicrobial Resistance Surveillance System (GLASS) is launched to support global surveillance and research in antimicrobial resistance. 20

16 https://www.who.int/about/who-we-are/history 17 https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2011/03/30/save-antibiotics-the-campaign-fact-sheet 18 https://www.who.int/antimicrobial-resistance/events/stag/en/ 19 https://www.who.int/antimicrobial-resistance/global-action-plan/en/ 20 https://www.who.int/glass/en/#scope

Historical Analysis In 1928, Alexander Fleming invented the first synthetic antibiotic: penicillin. It marks a milestone for the medical field, proving that bacterial infections are not incurable. Howard Florey and Ernest Chain, a pathologist and a biochemist, further tested penicillin at Oxford University. During WW2, penicillin successfully cured pneumonia, blood poisoning, strep throat, scarlet fever, diphtheria, syphilis, gonorrhea, meningitis, tonsillitis, rheumatic fever, and many other common diseases found in hospitals. While the production of penicillin is merely 21

enough for a few hundred people in 1942, it jumped to 21 billion units in 1943, to 1,663 billion units in 1944, and to more than 6.8 trillion units in 1945. Large amounts of antibiotics are 22

produced commercially, becoming accessible to almost every citizen in the US in the last century. The mid-20th was called the “Golden Age of Antibiotics”. Followed by the discovery of penicillin, numerous new antibiotics were also created simultaneously. Many once believed they are “miracle drugs” that could cure all sickness. Doctors prescribe antibiotics to patients as the primary treatment regardless of whether they had a bacterial infection or a viral infection. Due to the overuse and misuse of medications, some patients have developed antibiotic resistance bacteria. For instance, bacterial pneumonia was once treatable with penicillin; however, in a recent study, 25% of bacterial pneumonia cases were shown to be resistant to penicillin, while an additional 25% of cases were resistant to more than one antibiotic. More than 35,000 people 23

died each year in the US because of antibiotic-bacterial infections. Antibiotic, the weapon 24

against bacterial infections, is losing its efficacy. It is stimulating changes in bacteria rather than killing them. Unfortunately, in contrast to the fast-developing rate of antibiotic resistance in bacteria, the number of new drugs approved is declining, as suggested by the graph, “Number of Antibacterial New Drug Application (NDA), Approval vs. Time Intervals”. Technology is 25

falling behind the evolving speed of the bacteria. Infections are threatening the lives of many again.

21 http://www.botany.hawaii.edu/faculty/wong/BOT135/Lect21b.htm 22 https://www.acs.org/content/acs/en/education/whatischemistry/landmarks/flemingpenicillin.html http://www.botany.hawaii.edu/faculty/wong/BOT135/Lect21b.htm 23 http://textbookofbacteriology.net/resantimicrobial.html 24 https://www.cdc.gov/drugresistance/about.html 25 https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf

Figure 1: Number of Antibacterial New Drug Application (NDA) Approvals vs. Year Intervals 26

26 https://www.cdc.gov/drugresistance/pdf/11-2013-508.pdf

Current Situation Antibiotic Overuse

To this day, there is an increasing number of cases where there is an overuse of antibiotics. Ultimately, this is a key driving factor in multiplying the immunity and resistance of bacteria. 27

Antibiotic overuse can be divided into two distinct categories: an overuse in human healthcare, and overuse in agriculture. Antibiotic Overuse in Humans

According to Dr. Nate Smith, a director and state health officer from the Arkansas Department of Health, approximately 30% to 50% represent the fraction of antibiotic use in hospitals that are deemed unnecessary while another 50% of antibiotic prescriptions are said to be needless. 28

Although this seems like the core of the issue, the root cause is derived from the hassiling environment of the hospital. The growing pressure doctors work under as well as the fact they run against time are two major factors affecting a physician’s ability to reasonably prescribe antibiotics. As a result, antibiotics are prescribed often with ambiguity. Regardless, in the short term, there are no consequences, specifically towards that patient as antibiotics don’t harm their health. Thus, this ambiguous approach of prescribing antibiotics regardless of uncertainty has become a natural habit of doctors working with antibiotics. Further studies and statements based on the general practice of medicine in the United Kingdom show that half of the patients stricken with coughs, colds or viral sore throats are prescribed antibiotics, although this is heavily unrecommended in reducing antibiotic resistance. 29

Additional studies further discourage these prescriptions for minor infections as other analyses demonstrate that antibiotics minimally impact the duration and harshness of these infections, proving a smaller purpose in antibiotic usage for colds. In summary, one of the causes of 30

antibiotic overuse can be seen to be found in the centre of healthcare itself, down to the core of simply doctors. Despite the inevitable pressure and hassle of the working environment, alternative solutions are still available to initiate reductions in antibiotic resistance which are further explained throughout the backgrounder.

27 https://www.who.int/en/news-room/fact-sheets/detail/antimicrobial-resistance 28 https://www.beefmagazine.com/antibiotics/how-antibiotic-overuse-human-medicine-impacts-beef-producers 29 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4240113/ 30 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805475/

Antibiotic Overuse in Agriculture

Globally, approximately 73% of antibiotics are used in agriculture. There are a number of 31

reasons explaining the excessive use of antibiotics in farming. A majority of the use stems from a farmer’s efforts to allow their cattle, pigs, and poultry to thrive in an environment of poor conditions in which diseases are easily spread and vulnerability is high. Moreover, such a use is one of a routine which increases antibiotic use all the more. Additionally, antibiotics are used to effectively improve and enhance the growth rates of farming animals. Unfortunately, such a practice is one that is expected to dramatically increase in terms of its wide use over the span of the next fifteen years. 32

Emerging Resistant Diseases

Malaria

In June of 2016, five countries in the Greater Mekong subregion, including Cambodia and Vietnam, were confirmed to have developed resistant malaria. A specific bacteria, P. falciparum, was found to be particularly resistant along the Cambodian border. The severity of this issue is 33

found in the fact that this bacteria has built up resistance against nearly all antimalarial treatments. This calls the attention of thorough surveillance in order to prevent the spread of the 34

population of this resistant bacteria in other regions of the area as well as other parts of the world. Recent successes accomplished by malaria control are threatened with the growing difficulties in the curing and treatment of malaria. If this issue were to spread globally, a serious threat would be imposed on all malaria patients. Tuberculosis

In 2014, the World Health Organization (WHO) estimated there were approximately 480,000 new cases of multidrug resistant tuberculosis. These cases required treatments of longer durations compared to those of non-resistant tuberculosis. WHO further stated that the treatment of only half of these cases were eventually successful in 2014. These statistics would increase if antibiotic resistance were to be overlooked and a reasonable were not to be implemented. Further statements warn delegations, revealing that a type of tuberculosis that is resistant to at least four of the core anti-TB drugs, otherwise known as extensively drug-resistant tuberculosis (XDR-TB), has been identified in 105 countries, expressing a need in the global attention of delegates. 35

31 https://www.ciwf.org.uk/our-campaigns/antibiotics-health-crisis/?gclid=Cj0KCQiAovfvBRCRARIsADEmbRI1v0zAGUc4CuqgUWjQRxsvvc zFMoomyCPxUD_NKOFw0ecUrfq_W2UaAldyEALw_wcB 32 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4638249/ 33 https://www.who.int/en/news-room/fact-sheets/detail/antimicrobial-resistance 34 Ibid. 35 https://www.who.int/en/news-room/fact-sheets/detail/antimicrobial-resistance

International Involvement In 2016, the UN General Assembly had a High-Level Meeting on the topic of Antimicrobial Resistance in New York. This was the fourth time the UN General Assembly ever had a meeting on a health issue, which showed the urgency and significance of the antimicrobial resistance. Through this meeting, the nations, along with Centers for Disease Control (CDC) and other federal agencies, recognized the importance of finding a method to combat antimicrobial resistance and agreed to increase awareness on usage of antibiotics and have stronger commitments from the national, regional, and international community to fix this issue. Furthermore, they pledged to develop national plans to effectively fight this serious medical problem, which included aspects of promoting better practices with antibiotics and finding new technology for diagnosis and treatment of illnesses. One Health Approach

One method that was mentioned and agreed upon by many world leaders was the One Health Approach. The One Health Approach is a method which recognizes that the health of the people is connected to other factors such as the health of animals and the environment. Many physicians, ecologists, and veterinarians have agreed that it is crucial to research the antimicrobial resistance in both humans and animals to develop the strongest method to ensure the best health outcome. Transatlantic Taskforce on Antimicrobial Resistance (TATFAR)

Created in 2009 to seek a solution to antimicrobial resistance, Canada, the European Union, Norway, and the United States of America created a multilateral group made up of experts of antibiotics called the “Transatlantic Taskforce on Antimicrobial Resistance (TATFAR).” The 36

work of this taskforce divides into three topics: improving antibiotic use in humans and animals, preventing infections and their spread, and strengthening the drug pipeline. This taskforce sees the importance in not only providing a solution for antimicrobial resistance but in limiting the need for antibiotics as a whole. AMR Challenge

The Antimicrobial Resistance Challenge (AMR Challenge) was launched by the United States of America in 2018 to “accelerate the fight against antimicrobial resistance across the globe.” 37

This challenge was a one year project where federal governments, companies, and other organizations were required to plan and submit a specific task plan combating antimicrobial

36 https://www.cdc.gov/drugresistance/tatfar/index.html 37 https://www.cdc.gov/drugresistance/intl-activities/amr-challenge.html

resistance. As the biggest global initiative regarding this issue, it was highly successful in that nearly 350 commitments from 33 different countries were submitted. Many unique and innovative plans were formed, which opened many new pathways for world leaders to approach this serious problem.

Figure 2: The AMR Challenge Number of Commitments by Country 38

38 https://www.cdc.gov/drugresistance/intl-activities/amr-challenge.html

Seeking Resolution Improving Animal Welfare

Potential approaches to reducing antibiotic resistance in regards to antibiotic use in agriculture would include improving animal welfare and the conditions of their farms. In this way, an animal’s vulnerability to disease would decrease. Already in the Netherlands, grocery stores are demanding healthier and steadily-growing breeds of chicken while dutch studies reveal that these breeds are three times less prone to needing antibiotic treatment for infections. As the number 39

of antibiotic treatments needed decrease, more antimicrobial resistance is avoided. Increasing Awareness

There is an evident lack of awareness surrounding antimicrobial resistance across the globe. Although certain measures have already been implemented, such as the global “World Antibiotic Awareness Week” initiated by WHO, further steps to spread awareness are definitely necessary and available. 40

One solution delegates can pursue is prioritizing the education of antimicrobial resistance during the Antibiotic Awareness Week. Citizens will be well-notified early on as global citizens of the current issue at hand and have a higher likeliness of improving their personal habits and usage of antibiotics, while further educating their families. Antimicrobial resistance could also be further educated in universities for those studying and pursuing a career in the medical field. This particular group of students is one that is just as important in which awareness must be spread, as these are the potential doctors that may be prescribing antibiotics in the near future. On the other hand of this solution, to this day, while some countries may have been thriving with education for numerous years, there are yet delegations that still lack an availability of education to a majority of its population, specifically amongst the developing nations. As a result, although this solution may be effective in some regions of the world, such an implementation may minimally impact antimicrobial resistance in other countries. Regulation of Antibiotics

One popular solution that has been widely and commonly discussed in combating antimicrobial resistance is the regulation of antibiotics. This solution would be most effective if targeted towards the regulation of antibiotics in agriculture, as globally, 73% of antibiotics are used in

39 https://www.ciwf.org.uk/our-campaigns/antibiotics-health-crisis/?gclid=Cj0KCQiAovfvBRCRARIsADEmbRI1v0zAGUc4CuqgUWjQRxsvvc zFMoomyCPxUD_NKOFw0ecUrfq_W2UaAldyEALw_wcB 40 https://www.who.int/campaigns/world-antibiotic-awareness-week

agriculture, contrary to the common belief that the majority comes from healthcare. Such a 41

solution could be implemented in various ways from enforcing stricter regulations with prescribing antibiotics or limiting the accessibility of antibiotics used in farming. When advocating this solution, delegates should be mindful of the possible consequences while considering the potential mitigations that can reduce the severity of the possible negative outcomes. Some consequences to consider would be the increase in food prices. If antibiotic use were to be limited and farmers are forced to raise their animals healthily and naturally without medical influence, growth and reproduction rates would decrease and such an impact would influence an upward fluctuation in the prices of the food market. Promoting Global Data Surveillance

Promoting the sharing of data surrounding antimicrobial resistance is a key aspect in resolving this growing global concern. The terms of the word “data” refer to a variety of topics from emerging resistant diseases, their origins and locations of spreading, antibiotic usage in different regions of the world and statistics contrasting the changes of antibiotic usage in agriculture and human medicine over time as well as its impacts on the overall resistance of bacteria. Such a solution is already similarly being implemented with the Antimicrobial Resistance Information Bank. Antimicrobial Resistance Information Bank (AR Isolate Bank)

Established in July 2015, the Antimicrobial Resistance Information Bank, operated and managed by the Centres for Disease Control (CDC) while collaborating with the Food and Drug Administration (FDA), is one that increases the availability of high-quality resistant samples to seeking experts in need of such products in order to fight antimicrobial resistance. These 42

experts vary from manifold career fields, some examples being microbiologists attempting to improve patient care as well as drug and diagnostic manufacturers accelerating the development of new antibiotics. Other purposes of the AR Isolate Bank include gathering and providing accessible information on surveillance networks monitoring antimicrobial resistance and other relevant data on antimicrobial resistance. 43

41 https://www.ciwf.org.uk/our-campaigns/antibiotics-health-crisis/?gclid=Cj0KCQiAovfvBRCRARIsADEmbRI1v0zAGUc4CuqgUWjQRxsvvc zFMoomyCPxUD_NKOFw0ecUrfq_W2UaAldyEALw_wcB 42 https://wwwn.cdc.gov/ARIsolateBank/Overview 43 http://apps.who.int/medicinedocs/en/d/Jh1461e/3.6.html

Bloc Positions Canada, The European Union, Norway

These nations recognize the emergency and critical need for a solution to the growing problem of antimicrobial resistance and have been actively contributing ideas and resources to this cause. These nations have formed and agreed to create the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) in 2009 where they researched, organized, and implemented numerous action plans to combat AMR. Apart from creating the taskforce, these nations have constantly been contributing to this cause with an open mind to new solutions, and the willingness to help developing nations to participate in their movement as well. The United States of America, The United Kingdom, India

These three nations have shown one of the greatest amounts of interest and passion for this cause throughout the years. The USA was one of the nations that contributed to the establishment of TATFAR and has also shown initiative by launching the AMR Challenge in September 2018. The AMR Challenge was a one year project in which various countries, companies, and NGO’s submitted a specific action plan to combat antimicrobial resistance. The USA contributed 268 ideas through this project, which was significantly more than the country which contributed the second most, which was the United Kingdom with 10 submissions. This project not only gave new ideas to world leaders in regards to solving this problem, but raised a significant amount of awareness to both citizens and other countries who weren’t as willing to solve this issue. Developing Nations

Although these countries understand the consequences rising from the over usage of antibiotics, many developing nations are reluctant to come up with action plans or implement solutions already presented due to the lack of resources and recognition of the serious nature of antimicrobial resistance. These nations are continuously facing other prominent issues that require immediate attention and do not have a stable health care system built in to be able to effectively research, plan, and implement solutions regarding this issue. Furthermore, due to the lack of funds that they are able to allocate towards medical supplies, these nations are often found to be in favour of using antibiotics as their primary treatment options as it’s cheap and easily accessible. However, the antibiotics that these nations generate are often poor quality, which furthers the problem of using antibiotics on top of antimicrobial resistance. The lack of awareness and resources to combat antimicrobial resistance causes the growing resistance towards antibiotics for many citizens, and slowly causes the decline of optimal health around the globe.

Guiding Questions

1. To what degree are antibiotics available in the country? What are the existing regulations?

2. Is your country aware of the issue of antimicrobial resistance? a. If yes, what actions has your country taken? Are they successful or not? Why? b. If no, what reasons make your country believe that this is not a problem?

3. How can we control the use of antibiotics while maintaining its accessibility to patients? 4. What steps could the nations take to control antibiotic usage in agriculture while aware of

the disadvantages: such as reductions in the number of livestock? 5. Considering the different circumstances between developed and developing nations, how

can countries help each other to make the best of both sides? 6. How can we cope with bacteria or viruses infections that have already developed

antibiotic resistance? 7. How could WHO cooperate with third-party organizations (such as NGOs) to better

implement the solution? 8. What are the challenges that we are facing in existing solutions? How can we solve

them?

Further Reading Current Status of the Use of Antibiotics and the Antimicrobial Resistance in the Chilean Salmon Farms https://www.frontiersin.org/articles/10.3389/fmicb.2018.01284/full Water, Sanitation and Hygiene: An essential ally in a superbug age https://www.who.int/southeastasia/news/opinion-editorials/detail/water-sanitation-and-hygiene-an-essential-ally-in-a-superbug-age Case-based surveillance of antimicrobial resistance with full susceptibility profiles https://academic.oup.com/jacamr/article/1/3/dlz070/5670902 Causes of Antimicrobial (Drug) Resistance https://www.niaid.nih.gov/research/antimicrobial-resistance-causes Consequences of Bacterial Resistance to Antibiotics in Medical Practice https://academic.oup.com/cid/article/24/Supplement_1/S17/283536

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