WHO strategic action plan on
antibiotic resistance in Europe Strengthening surveillance
WHO strategic action plan on
antibiotic resistance in Europe Strengthening surveillance
Strategic action plan on antibiotic resistance 23 – 25 November 2011
Dr Danilo Lo Fo Senior Adviser AMR
Dr Danilo Lo Fo Senior Adviser AMR
WHO strategic action plan on
antibiotic resistance in Europe –Strengthening surveillance
WHO strategic action plan on
antibiotic resistance in Europe –Strengthening surveillance
Dr Danilo Lo Fo WongSenior Adviser AMR
Dr Danilo Lo Fo WongSenior Adviser AMR
BackgroundBackground
� AMR costs money, livelihoods and
lives, and undermines health programmes
� World Health Assembly resolutions in
1984,1998, 2001, 2005
Strategic action plan on antibiotic resistance 23 – 25 November 2011
� WHO global strategy for containment of
AMR published in 2001
� Despite progress, strategies for AMR containment not
widely implemented
BackgroundBackground
AMR costs money, livelihoods and
lives, and undermines health programmes
World Health Assembly resolutions in
WHO global strategy for containment of
Despite progress, strategies for AMR containment not
WHD 2011 WHD 2011
Strategic action plan on antibiotic resistance 23 – 25 November 2011
2011 slogan 2011 slogan
World Health Day World Health Day
Toolkit for Health Ministers, stakeholders & partners:
� Policy Package background paper
� Policy Briefs
Strategic action plan on antibiotic resistance 23 – 25 November 2011
� Events and Press briefings
� Press kit (incl. news release, statement,
photos, videos)
World Health Day 2011World Health Day 2011
Toolkit for Health Ministers, stakeholders & partners:
Policy Package background paper
(incl. news release, statement,
Cornerstones of strategic directionCornerstones of strategic direction
I. Surveillance - to document the problem
II. Prevention - to slow the emergence of HAI and AMR
III. Containment - to reduce the spread
Strategic action plan on antibiotic resistance 23 – 25 November 2011
IV. Research & Innovation -
new tools, new drugs & guidelines
Multi-dimensional aspects - multisectoral
Cornerstones of strategic directionCornerstones of strategic direction
to document the problem
to slow the emergence of HAI and AMR
to reduce the spread
to develop
new tools, new drugs & guidelines
multisectoral, interdisciplinary
Eur
Directo
E
Di
uropean strategic action plan on
antibiotic resistance
2011–2016
Dr Guenael Rodier
ctor, Division of Communicable Diseases, Health Security
and Environment
European strategic action plan on
antibiotic resistance
2011–2016
Dr Guenael Rodier
Director, Division of Communicable Diseases, Health Security
and Environment
Regional Committee for Europe
Resolution, Baku, Azerbaijan,
Regional Committee for Europe
Resolution, Baku, Azerbaijan,
Member States
� Ensure political commitment and resources for developing
and implementing national plans
� Strengthen surveillance and monitoring of antibiotic
resistance and consumption
Strategic action plan on antibiotic resistance 23 – 25 November 2011
resistance and consumption
� Establish multisectoral and comprehensive
coordination and cooperation mechanisms
� Adhere to infection control
� Raise awareness through national campaigns
Regional Committee for Europe
Baku, Azerbaijan, 12-15 September 2011
Regional Committee for Europe
Baku, Azerbaijan, 12-15 September 2011
Ensure political commitment and resources for developing
and implementing national plans
Strengthen surveillance and monitoring of antibiotic
and comprehensive
coordination and cooperation mechanisms
Raise awareness through national campaigns
Regional Committee for Europe
Resolution, Baku, Azerbaijan,
Regional Committee for Europe
Resolution, Baku, Azerbaijan,
WHO Regional Office for Europe
� Provide strategic leadership, guidance and tools for
implementing the strategic action plan
� Support Member States in implementing national plans
Strategic action plan on antibiotic resistance 23 – 25 November 2011
� Support Member States in implementing national plans
� Create platforms for sharing and analysing data and
experience
� Engage in broad regional and global partnerships
� Promote innovation and research
Regional Committee for Europe
Baku, Azerbaijan, 12-15 September 2011
Regional Committee for Europe
Baku, Azerbaijan, 12-15 September 2011
WHO Regional Office for Europe
Provide strategic leadership, guidance and tools for
implementing the strategic action plan
Support Member States in implementing national plansSupport Member States in implementing national plans
Create platforms for sharing and analysing data and
Engage in broad regional and global partnerships
Promote innovation and research
Action Plan Strategic ObjectivesAction Plan Strategic Objectives
• Comprehensive national action plans
• Multisectoralmechanisms
1. Strengthen intersectoralcoordination
1. Strengthen intersectoralcoordination
• National surveillance systems, collecting, analysing and reporting data to monitor trends
• Regional databases, tools and standards2. Strengthen surveillance of
antibiotic resistance2. Strengthen surveillance of
antibiotic resistance
Strategic action plan on antibiotic resistance 23 – 25 November 2011
• National mechanisms for coordination
• National guidelines on prudent use of antibiotics
• Surveillance of antibiotic consumption
3. Promote rational use of antibiotics and strengthen surveillance
3. Promote rational use of antibiotics and strengthen surveillance
• Prevention of hospital
• Hospital infection control and surveillance committees4. Strengthen infection control and
surveillance in health care settings
4. Strengthen infection control and surveillance in health care settings
Action Plan Strategic ObjectivesAction Plan Strategic Objectives
Comprehensive national action plans
Multisectoral and interdisciplinary national coordination mechanisms
National surveillance systems, collecting, analysing and reporting data to monitor trends
Regional databases, tools and standards
National mechanisms for coordination
National guidelines on prudent use of antibiotics
Surveillance of antibiotic consumption
Prevention of hospital-acquired infections
Hospital infection control and surveillance committees
Action Plan Strategic Action Plan Strategic
• Prudent use of antibiotics in these sectors
• Integrated systems for surveillance of antibiotic resistance and use
5. Prevent emerging resistance in veterinary and food sectors
5. Prevent emerging resistance in veterinary and food sectors
• International surveillance networks and information sharing on promising research areas
• Active role in research for governments and academic networks; national and international task forces
6. Promote innovation and research on new drugs
6. Promote innovation and research on new drugs
Strategic action plan on antibiotic resistance 23 – 25 November 2011
networks; national and international task forceson new drugs on new drugs
• Educational initiatives, behaviour change campaigns and awareness programmes for health care providers and the public
• Broad partnership at national, regional and global levels7. Improve awareness, patient
safety, and partnership7. Improve awareness, patient
safety, and partnership
Action Plan Strategic ObjectivesAction Plan Strategic Objectives
Prudent use of antibiotics in these sectors
Integrated systems for surveillance of antibiotic resistance and use
International surveillance networks and information sharing on promising research areas
Active role in research for governments and academic networks; national and international task forcesnetworks; national and international task forces
Educational initiatives, behaviour change campaigns and awareness programmes for health care providers and the public
Broad partnership at national, regional and global levels
Considerations for implementation
and monitoring
Considerations for implementation
and monitoring
� Strategic action plan with:
– time frame for implementation
– estimated resource needs
– input, process and output indicators to monitor progress
� Stepwise approach:
Strategic action plan on antibiotic resistance 23 – 25 November 2011
� Stepwise approach:
– mapping of available data,
– identification of current practices
� Support to Member States in:
– developing and implementing national action plans
– establishing national coordinating mechanisms
Considerations for implementation
and monitoring
Considerations for implementation
and monitoring
time frame for implementation
input, process and output indicators to monitor progress
identification of current practices
Support to Member States in:
developing and implementing national action plans
establishing national coordinating mechanisms
Cycle of (Veterinary) Public Health
Protection
Cycle of (Veterinary) Public Health
Protection
Surveillance
Risk management
Strategic action plan on antibiotic resistance 23 – 25 November 2011
Research
Risk management
Cycle of (Veterinary) Public Health
Protection
Cycle of (Veterinary) Public Health
Protection
Surveillance
Epidemiological evaluationRisk assessmentRisk assessment
Research
AMR SurveillanceAMR Surveillance
Needed to:
� Detect resistant strains of public health importance
� Support prompt notification and investigation of outbreaks
Strategic action plan on antibiotic resistance 23 – 25 November 2011
� Inform clinical treatment decisions
� Guide policy recommendations
� Monitor efficacy of interventions
(incl. infection control measures)
SurveillanceSurveillance
Detect resistant strains of public health importance
Support prompt notification and investigation of outbreaks
Inform clinical treatment decisions
Guide policy recommendations
Monitor efficacy of interventions
(incl. infection control measures)
European Antimicrobial ResisEuropean Antimicrobial Resis
Strategic action plan on antibiotic resistance 23 – 25 November 2011
sistance Surveillance Networksistance Surveillance Network
Antimicrobial Use MonitoringAntimicrobial Use Monitoring
Needed to:
� Track use, overuse and misuse
of antimicrobials
� Provide insights to assess the
Strategic action plan on antibiotic resistance 23 – 25 November 2011
� Provide insights to assess the
public health consequences
Antimicrobial Use MonitoringAntimicrobial Use Monitoring
Track use, overuse and misuse
Provide insights to assess the Provide insights to assess the
European Surveillan
Consumption (ESAC)
European Surveillan
Consumption (ESAC)
Strategic action plan on antibiotic resistance 23 – 25 November 2011http://app.esac.ua.ac.be/public/
ESAC is a project funded by ECDC
ance of Antimicrobial
Consumption (ESAC)
ance of Antimicrobial
Consumption (ESAC)
http://app.esac.ua.ac.be/public/
ESAC is a project funded by ECDC
Strengthening surveillanceStrengthening surveillance
� Focus on non-EU Member States
� Promote national committees and action plans
� Gradually set up a surveillance network compatible with
EARS-Net and ESAC-Net
Strategic action plan on antibiotic resistance 23 – 25 November 2011
EARS-Net and ESAC-Net
� Close coordination with EC and ECDC
� Collaboration with strong technical partners
Strengthening surveillanceStrengthening surveillance
EU Member States
Promote national committees and action plans
Gradually set up a surveillance network compatible with
Close coordination with EC and ECDC
Collaboration with strong technical partners
WHO Collaborating Centres (Europe)WHO Collaborating Centres (Europe)
� WHO CC for Reference & Research on Hospital Infections
– Health Protection Agency, London, United Kingdom
� WHO CC on Patient Safety
– University of Geneva Hospitals - Geneva, Switzerland
� WHO CC for Antimicrobial Resistance in
Strategic action plan on antibiotic resistance 23 – 25 November 2011
� WHO CC for Antimicrobial Resistance in
– National Food Institute, Copenhagen, Denmark
� WHO CC for Research and Training in Surveillance of
Communicable Diseases and Antimicrobial Resistance
– National Centre for Infectious and Parasitic Diseases, Sofia, Bulgaria
� WHO CC for Drug Statistics Methodology
– Norwegian Institute of Public Health
WHO Collaborating Centres (Europe)WHO Collaborating Centres (Europe)
WHO CC for Reference & Research on Hospital Infections
Health Protection Agency, London, United Kingdom
Geneva, Switzerland
WHO CC for Antimicrobial Resistance in Foodborne PathogensWHO CC for Antimicrobial Resistance in Foodborne Pathogens
National Food Institute, Copenhagen, Denmark
WHO CC for Research and Training in Surveillance of
Communicable Diseases and Antimicrobial Resistance
National Centre for Infectious and Parasitic Diseases, Sofia, Bulgaria
WHO CC for Drug Statistics Methodology
Norwegian Institute of Public Health - Oslo, Norway
� ECDC
� DG SANCO/ DG Research
� RIVM (National Institute for Public Health and the Environment )
� ESCMID (European Society of Clinical Microbiology and Infectious Diseases)
PartnersPartners
Strategic action plan on antibiotic resistance 23 – 25 November 2011
� HPA (UK Health Protection Agency)
� EMA (European Medicines Agency)
� EFSA (European Food Safety Authority)
� CDC (Centers for Disease Control and Prevention, United States of America
� … and many more
(National Institute for Public Health and the Environment )
(European Society of Clinical Microbiology and Infectious Diseases)
PartnersPartners
for Disease Control and Prevention, United States of America)
Thank you for
your attention
Strategic action plan on antibiotic resistance 23 – 25 November 2011
your attention
Thank you for
your attentionyour attention