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An exemplary challenge for PUM: Action against Antimicrobial Resistance!

Innovation

During PUM’s recent Multisector-day taking place in The Hague on 24 September, Antimicrobial Resistance was one of the hot topics. Titus Vissers (Executive Committee PUM) invited experts of several relevant areas to discuss PUM’s AMR programme and share first success stories.

Picture this: an Orthopaedical Hospital in Armenia. After each operation, patients receive a standard preventative antibiotical treatment of seven days. In April this year Bartelt de Jongh, a clinical microbiologist who has joined PUMs AMR programme, attends an advisory mission to this hospital. He speaks to the staff, educates them and shares hands-on advice – and the outcome of his visit is a reduction of the standard antibiotic treatment to just 1 single administration 20 minutes before an operation.

The escalation of the problem

Antibiotics are a special kind of medical drug, attacking the bacteria in our body: Every time we expose our bacteria to antibiotics, they might develop a resistance. The case described therefore is significant and typical, in many ways: Antibiotics have become widely available in Armenia after 1989 – even without prescription – and have been administered blindly, often because of the lack of good diagnostic tests. What looked like a blessing in the beginning – the promise to successfully fight any infection – developed into a nightmare within just a few years, namely to a 50% resistance for 3rd generation antibiotics. In many other countries, especially in Asia and Africa, the situation is even worse; Antimicrobial Resistance can reach up to 75%. On the background of this global escalation, the World Health Organisation issued a clear warning in 2016. Antimicrobial Resistance needs to be tackled with urgency to prevent the scenario of a post-antibiotic era where – according to UK economist Jim O’Neill – 10 million deaths would occur globally per year due to this problem. In other words: By 2050 more people could die of Antimicrobial Resistance than of cancer today, if we do not act now.

"Every time we expose our bacteria to antibiotics, they might develop a resistance."

Antimicrobial Resistance is a very complex problem, affecting questions of human health, animal health, pharmaceutical production, water supply and wastewater management, transport and travel and many other aspects. “We don't really know where to start, but we have to start and learn, regardless. We don't really agree on what exactly needs to be done, there are many different stakeholders with different interests … and possible solutions might lead to new problems …”, says Prof. Heiman Wertheim, who heads the clinical microbiology department at Radboud University Medical Center. Until 2015 Heiman was director of the Oxford University Clinical Research Unit in Hanoi, Vietnam where he got to observe the escalation of the issue first-hand; being approached frequently by retired doctors, microbiologists etc. who offered help, he developed the idea of cooperating with a network of senior specialists to battle Antimicrobial Resistance. After the Dutch Embassy had introduced him to PUM he realised the potential quickly: PUM has experts in all relevant areas available who are able and eager to contribute.

Action against AMR

PUM teamed up with the Center for Infectious Diseases at the Radboud UMC and the Netherlands Society of Medical Microbiology (NVMM) to cooperate in the common, broad-based “Action against AMR”-programme. The programme is very much a work in progress, constantly expanding and adapting. It currently entails training for PUM experts of various disciplines on best practices, attendance of the Dutch Antimicrobial Stewardship Courses at the Radboud UMC and 1-on-1 coaching of its graduates, organising business links as well as advisory missions on the topic in various disciplines throughout the value chain, as Titus Vissers stresses.

Caroline van Oene, Associate Director Medical Affairs of MSD Netherlands, shares insights from the perspective of the pharmaceutical industry. “Antibiotics are like the fire brigade”, Caroline says, “we want to have them for when they are really necessary. We want to be able to take them off the shelf and put them to use effectively and efficiently in emergencies.” MSD, pioneers in antibiotics production, have signed the UN joint declaration to fight Antimicrobial Resistance and engaged on a concrete action plan. Apart from sponsoring the Dutch Antimicrobial Stewardship Courses at the Radboud UMC they have committed to avoiding antibiotic contamination of the environment and to weight economical interest vs global impact carefully: “The goal is not to sell as much antibiotics as possible, but to promote its responsible usage”, Caroline summarises. There is a whole series of dilemmas that go with these commitments though, starting from economical consequences (the current economic model does not work for antibiotics), scientific aspects (resistances emerge faster than new antibiotics can be developed) to policy restrictions (there are different registration processes to deal with in different countries and regions, which makes it hard to get the reserve antibiotics we so urgently need approved).

The integral One Health approach

“There is no quick fix or magical cure against Antimicrobial Resistance, it is a management issue”, agrees Mark Schippers, CEO of MS Schippers who have developed the HyCare concept to fight Antimicrobial Resistance in the livestock sector. Farmers from all over the world visit the MS Schippers research facilities and learn how to prevent infections and thus the need for applying antibiotics. Simple measures like hygiene, avoiding porous floors in stables (making it hard for bacteria to settle there), fighting rats and mice and using good quality drinking water have great effect.

“Antibiotics are like the fire brigade, we want to have them for emergencies, to use them effectively and efficiently.”

Animal health is a priority in the fight against Antimicrobial Resistance, after all two thirds of all antibiotics worldwide are used in the animal health sector, from where they end up in our soils, ground water and in the food chain, a seriously vicious circle. An integral strategy is needed; the WHO calls it “One Health”: “… an approach to designing and implementing programmes, policies, legislation and research in which multiple sectors communicate and work together to achieve better public health outcomes”. Sounds like an exemplary challenge for PUM, the speakers and the workshop audience equally agreed.

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Author: Sylvia Szely

Photography: Pixabay