World Health Assembly Adopts Resolution To Fight Sepsis; Antimicrobial Resistance Major Threat

Antimicrobial resistance is a growing health concern as was acknowledged by countries at the World Health Assembly this week, and a resolution was adopted to fight sepsis, which is a life-threatening blood stream infection for which there is growing resistance.

WHO members underlined the urgent need for new accessible and affordable antibiotics. Brazil and India remarked on some omissions in the WHO secretariat’s report of what they consider as key elements in the solution to antimicrobial resistance, such as affordability, and the delinkage from research and development costs from the price of medicines.

The World Health Assembly is taking place from 22-31 May. WHA members noted a report [pdf] by the WHO secretariat, providing an update on the implementation of the global action plan on antimicrobial resistance (AMR), and agree on a resolution to improve the prevention, diagnosis, and management of sepsis, which was approved at the WHO Executive Board meeting in January for submission to the WHA.

The sepsis resolution notes that sepsis causes approximately 6 million deaths worldwide every year, which are mostly preventable.

The resolution was adopted this morning by Committee A, one of the two committees working through the agenda of the WHA. The resolution has to be formally adopted by the full membership of the WHA, at the end of the Assembly.

In particular, the resolution requests the WHO director general to collaborate with other organisations in the United Nations systems, partners, international organisations, and other relevant stakeholders “in enhancing access to quality, safe, efficacious and affordable types of treatments of sepsis.”

On the report of the WHO secretariat on antimicrobial resistance (AMR), several countries positively underlined the setting up of an Ad-hoc Interagency Coordination Group, which was established following the adoption by the United Nations General Assembly in September 2016 of the Political Declaration of the High-Level Meeting on Antimicrobial Resistance [pdf].

The group was set up in consultation with the WHO, the Food and Agriculture Organization (FAO) of the UN, and the World Organisation for Animal Health (OIE).

Norway suggested that beyond the FAO and the OIE, WHO works with the UN Environment Programme, and noted contamination by agriculture and other industries, in particular food production. Paraguay and the Bahamas agreed that the agriculture and environment aspects should be integrated into the global issue of antimicrobial resistance.

Netherlands said it is concerned that many countries do not have national plans on antimicrobial resistance yet, and some countries seem to “pick and choose,” just focusing on “easy measures.” He mentioned in particular the monitoring of the use of antibiotics for growth promotion in animals, and the discharge of biological waste during production.

A number of countries underlined the need for new medications, such as France, Russia, and the Bahamas.

Sweden underlined the importance of sharing information through the Global Antimicrobial Resistance Surveillance System (GLASS). According to the WHO, GLASS “has been developed to facilitate and encourage a standardized approach to AMR surveillance globally and in turn support the implementation of the Global action plan on antimicrobial resistance.”

Where Is Affordability, Delinkage?

Brazil said the country was surprised about how little attention was given in the secretariat’s report on the central elements of the UN political declaration on AMR.

In particular, Brazil said, the aspects of access and affordability of new and existing antibiotics, vaccines, and diagnostics are not included in the secretariat’s report. The concept of delinking the cost of R&D and the prices of medicines is not either in the report, the Brazilian said.

The political declaration has 14 references to access to medicines, while the WHO report only has one mention, he said And there are 12 mentions of affordability in the political declaration, when it is only mentioned once in the WHO report, he said. In the same manner, the WHO report “completely ignores” the call of UN members to acknowledge the importance of delinking the cost of research and development from prices and volume of sales.

Brazil also challenged paragraph 15 of the WHO report. Paragraph 15 explains that the WHO, the FAO, and the OIE have developed a monitoring questionnaire to review and summarise each country’s progress. Countries are called on to assess their progress, and self-reported data will be verified through the Joint External Evaluation of the International Health Regulations process, the report says.

Brazil underlined that the evaluation is voluntary in nature. The Brazilian intervention was supported by India, who added that the focus should not be only on controlling production of new products, but on affordable access too, including for malaria, tuberculosis, and HIV.

Capacity Building Needed, Affordability, Access Key

Indonesia for the Southeast Asia region called for the strengthening of laboratory capacities. Algeria called for the strengthening of the health care systems. Fiji, on behalf of the Pacific Island countries and territories, underlined the lack of veterinary expertise in the islands and the lack of monitoring and diagnostics capabilities. Ethiopia also noted the lack of capacity, while Ecuador asked for capacity building in human resources.

The new challenge of AMR, said the delegate from Congo, on behalf of the African region, requires technical and financial support. Ghana concurred, and said the AMR issue must be linked to the UN Agenda for Development 2030 and the Sustainable Development Goals. He added the need to mobilise resources both at the local and international level in the context of the “one health” approach. Jamaica also underlined the need of support for countries.

Algeria underlined the importance of access to high quality health products, to both old and new ones, such as vaccines and antibiotics. Unaffordable products lead to the use of counterfeit medicines, the Algerian delegate said.

Congo underlined the cost of medicines, which places them out of reach of the majority of people, and that the African continent needs effective medicines to fight multi-resistant tuberculosis, often linked to HIV. Gabon, on behalf of the African region, also underlined the difficulty to access good quality medicines. Ecuador underlined the essential financial and technical support, and affordable diagnostic tools. South Africa said access to antibiotics remains a challenge and called for equitable and affordable access to existing and new antimicrobials.

Although some countries, such as India and Brazil, had remarks on the report, it was noted by member states, as the WHO legal counsel explained that reports from the secretariat do not set policies for the organisations and cannot be changed. Concerns, he said, will be recorded in the report of the WHA.


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