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Please read and make suggestions for changes to this document before January 10, 2019.
THE WORLD MEDICAL ASSOCIATION, INC.
Proposed revision of the WMA Statement on Antimicrobial Resistance
Constituent and associate members
As part of the 10-years revision process, the Council in Riga (April 2018) agreed on a major revision of the WMA Statement on Antimicrobial Resistance. The British Medical Association (BMA) was appointed lead rapporteur for this revision with the support of Dr Caline Mattar, Junior Doctors Network.
The 210th Council in Reykjavik (October 2018) decided to circulate the document for comments.
- Antimicrobial Resistance (AMR) is a growing threat to global public health that transcends national boundaries, socioeconomic divisions that affects human, animal and environmental health. This has created a multi-faceted problem of crisis proportions with significant economic and human implications.
- AMR threatens the effective prevention and treatment of an increasing range of infections caused by bacteria, parasites, viruses and fungi, as well as providing effective treatment for infectious diseases, antimicrobial drugs form an essential component of modern medicine, ensuring that complex procedures, such as surgery and chemotherapy, can be performed with low risk.
- AMR occurs when microorganisms develop the ability to resist the actions of antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics). Infections caused by bacteria that are resistant to multiple classes of antibiotic are increasingly documented.
- While AMR is a natural evolutionary phenomenon, it is accelerated by the overuse and misuse of antimicrobials in medicine, as well as in veterinary practice and modern farming, and can be exacerbated when given as growth promoters in animals or used to prevent diseases in healthy animals. The emergence and spread of drug resistance is also further enhanced through the availability of substandard and falsified products, increased global travel, medical tourism and trade, and poor application of infection control measures.
- Another major cause of AMR is the release of antibiotics into the environment, either as a result of poor manufacturing practices, or through human and animal excretion and inadequate disposal at the end of life.
- In many countries, particularly in low- and middle-income countries, access to effective antimicrobials as well as complementary technologies including vaccines and diagnostics continues to remain a significant challenge, furthering AMR.
- The ramifications of resistance manifest themselves not just in the impact on human health, but also in potentially heavy economic costs. The World Health Organization has warned that resistance has reached alarming levels in many parts of the world, and that continued rise in resistance by 2050 would lead to 10 million people dying per year and a reduction of 2-3.5% in global gross domestic product.
- At the rate at which resistance is growing globally, it poses a great risk to achieving the UN Sustainable Development Goals, and without harmonized and coordinated action on a global scale, the world is heading towards a post-antibiotic era.
- AMR has reached great prominence at the highest political levels including the UN general assembly, and the agenda of the G7 and G20.
- Addressing the threat of microbial resistance is a fundamental global health priority, and the responsibility of all countries.
- Tackling resistance requires better use of antimicrobial drugs while preventing and controlling the transmission of resistance already present.
- There is a need for an effective ‘one health’ approach to tackling antimicrobial resistance, which recognises that action is required across human medicine, veterinary practice and agriculture to minimise unnecessary or inappropriate use of antimicrobials, to ensure they continue to be effective in treating infections.
13. Nations have varying resources available to combat antimicrobial resistance, and must cooperate with the World Health Organisation (WHO), Food and Agriculture Organization and World Organization for Animal Health that support the global action plan which provides the framework for national action plans.
14. The World Medical Association and its member national medical associations should advocate for:
- Investment in the surveillance of drug resistant infections across human health, veterinary medicine, and agriculture, and international cooperation for data-sharing procedures to improve global responses. This will foster the collection, quality, and sharing of data; the monitoring of progress in combating antimicrobial resistance; the establishment of appropriate formularies; and scientific support for interventions.
- The WHO in coordination with its Tripartite partners as well other UN agencies to examine the role of international travel and trade agreements on the development of antimicrobial resistance. The World Health Organization should encourage the use of TRIPS flexibilities to help ensure affordable access to quality medicines and safeguards against the globalization of drug-resistant pathogens in our food supply through international trade.
- The widespread application of verifiable technology such as track-and-trace systems to ensure the authenticity of pharmaceutical products.
- Equitable access to, and appropriate use of existing and new quality-assured antimicrobial medicines requires applying effectively the Access, Watch and Reserve lists of the WHO Essential Medicines program. For the WHO global action plan, and national action plans to be effective, access to health facilities, health care professionals, veterinarians, knowledge, education and information are vital.
- Greater use of vaccinations to address AMR, which will reduce the burden of infectious disease, reducing the need for antibiotics and therefore limiting the emergence of resistance.
- For the WHO, Food and Agriculture Organization of the United Nations (FAO), World Organization for Animal Health (OIE) and governments to scale up their action and coordination in promoting appropriate antibiotic use and work together in a One Health approach to reduce the spread of resistance.
15. The World Medical Association and its national medical association should encourage their governments to:
- Fund more basic and applied research directed toward the development of innovative antimicrobial agents, diagnostic tools and vaccines, and on the appropriate and safe use of such therapeutic tools. Ensure parity between financial and technical resources towards the development of innovative antimicrobial medicines, vaccines, and diagnostics as well as innovative infection control and prevention methods across human health, veterinary, and agricultural sectors.
- Support Research and Development (R&D) efforts for novel antimicrobial agents, vaccines, and rapid diagnostic methods that are needs-driven and guided by the principles outlined in the UN Declaration on AMR adopted in September 2016 including affordability, effectiveness, efficiency, and equity.
- Initiate regulatory measures to control the environmental pollution that allows the spread of antibiotic- resistant genes across soil, water and air.
16. National medical associations should:
- urge their governments to require that antimicrobial agents be available only through a prescription provided by licensed and qualified health care and/or veterinary professionals.
- urge their governments to initiate national campaigns to raise awareness among the public of the harmful consequences of overuse and misuse of antibiotics. This should be supported through the introduction of national targets to raise public awareness.
- urge their governments to support professional societies, civil society, and healthcare delivery systems to pilot and adopt proven behaviour change approaches to ensure appropriate use, but not overuse of antibiotics.
- urge their governments to ensure access to point-of-care diagnostics in hospitals and clinics to support decision making and improve antibiotic use.
- urge their governments to mandate the collection of data on antibiotic use, prescriptions, prices, resistance patterns, and trade in both the healthcare delivery and food production sectors. This data should be made publicly accessible to ensure greater accountability.
- effective programs of antimicrobial stewardship and training on the appropriate use of antimicrobials agents as well as infection control.
- actively pursue the development of a national surveillance system for antimicrobial resistance, and support participation in the WHO’s Global Antimicrobial Surveillance System (GLASS) to ensure a standardized approach to the collection, analysis and sharing of data on AMR globally. This should be supported through the development of a national surveillance system for sale of antimicrobials.
- encourage medical schools and continuing medical education programs to renew their efforts to educate physicians about the appropriate use of antimicrobial agents and appropriate infection control practices, including antibiotic use in the outpatient setting.
- in collaboration with veterinary authorities, encourage their governments to introduce regulations to reduce the use of antimicrobials in agriculture, including restrictions on the routine use of antimicrobials for both prophylaxis and growth promotion, and on the use of classes of antimicrobial that are critically important in human medicine.
- actively support antimicrobial resistance as a priority area for future research, including the development of new antimicrobials, improving surveillance and developing novel diagnostics, vaccines and infection prevention.
17. Healthcare professionals have a vital role in preserving antimicrobial medicines.
18. Physicians should:
- have access to high-quality and reliable, evidence-based information free of conflict of interest to support their leadership role in local hospitals, clinics, and communities regarding appropriate antimicrobial agent usage, and antimicrobial resistance prevention and control programs.
- raise awareness amongst their patients about antimicrobial therapy, its risks and benefits, the importance of compliance with the prescribed regimen, infection prevention practices, and the problem of antimicrobial drug resistance.
- actively participate in and lead antimicrobial stewardship programs in their hospitals and clinics to help optimizing antibiotic use in human health.
- ensure compliance with hand hygiene and infection prevention practices.