Download Strategic approach slides - with videos

International priorities for antimicrobial resistance:
a need for consensus, collaboration, & coordination
Oslo 10 May 2016
Antimicrobial Resistance Why react?
The thoughtless person playing with penicillin is morally responsible for the
death of the man from penicillin-resistant organism.
I hope this evil can be averted.
Alexander Fleming 1945
Drug-resistant infections are a challenge on the scale of climate change.
Jeremy Farrar
2016
Antimicrobial resistance is a slow-motion tsunami. It is a global crisis that
must be managed with the utmost urgency.
Margaret Chan
2016
Our philosophy
We are an independent global charitable foundation,
dedicated to improving health.
Good health makes life better. We want to
improve health for everyone by helping great
ideas to thrive.
Science and research expand knowledge by testing
and investigating ideas. This new understanding can
be applied to health and change medicine, behaviour
and society.
That’s why we support thousands of curious, passionate
people all over the world to explore great ideas, at every
step of the way from discovery to impact.
What we do
We fund health-related research, across the world.
We pursue new understandings of the body, disease, or the
environment we live in, ideas about how to change medicine,
culture or even the world.
We support thousands of curious, passionate people all over
the world to explore great ideas, at every step of the way from
discovery to impact.
Where we do it: our active funding
UK
£2,300m
Europe &
Central Asia
£113m
North
America
£77m
India:
£156m
Latin America &
the Caribbean
£10m
Sub-Saharan
Africa
£225m
South-east Asia
& Pacific
£92m
How we work
Investments: We are funded from a private endowment – the assets
stand at around £18 billion
To improve health, we have spent (and plan to spend):
1936
2005
2015
2020
£11 BILLION
£6 BILLION
£5 BILLION
Our strategic approach. Describes our philosophy and establishes
a framework that sets out our modes of working and gives us the
flexibility to set new priorities over time
Our framework
Advancing ideas
We support great ideas
and inspired thinking
Seizing opportunities
We bring ideas together
to make a difference
Driving reform
We change ways of
working so more ideas
can flourish
What’s new?
We have developed a strategic approach, instead of a plan.
This:
• builds on our last plan, but has no fixed time frame
• give us the flexibility to set new priorities over time
• seeks to reach out to new audiences and partners
• allows us to be directive and purposeful when the time is right
Seizing opportunities
We bring ideas together to make a big difference
We identify times when our concerted intervention can
accelerate progress towards better health.
We identify a critical need and set ambitious goals.
We connect experts from different disciplines, build partnerships, and lead
advocacy, policy development, communications and public engagement.
We do this by providing focused, intensive support that creates
a step change over five to ten years.
Wellcome funding since 2004
Distribution by pathogen type and stage of development
Other
Basic
Preclinical
Clinical
Human
£247.4m
Bacteria
Vector control
Parasites
Viruses
Cross-species
£15.8m
£5m
Multiple
Animal
Fungi
0
20
40
60
80
100
120
140
Enviroment
£1.7m
£0.4m
Total Awarded (£m)
Significant investment in translational research for therapeutics in a smaller number of projects compared to basic
science.
Notably there has been little support for diagnostic development and very little in public engagement.
DRI Wellcome strategic priority
Wellcome strategy development
1) Identify how Wellcome can improve health outcomes and deliver on an
agenda that promotes Access, Conservation and Innovation of medicines.
2) To identify the opportunities where Wellcome can have an additional
significant impact beyond current efforts and activities to address the threat of
DRI.
Scope
• All Infectious diseases focus on NTDs: bacterial, viral, fungal, parasitic and
inclusive of HIV, TB and malaria
•
One Health: humans, animals, environment
AMR areas for action
New interventions and tools innovative therapeutics & diagnostics, medicines quality
assurance, experimental medicine/clinical trials
Stewardship optimising use
Surveillance access to and use of surveillance data
Communication public awareness
Education behaviour change
Prevention vaccines, infection prevention and control
Policy regulation and facilitating utilisation of evidence
Research agenda to support all of the above
People and Skills developing thinkers and doers to promote ideas and
actions
Equipping the world to address the threat of drug resistant infection Opportunities
Improving Treatment
Enabling Policy
•Improve and promote scientific understanding of drug
•Proactively drive evidence-based policy interventions,
resistance
working to align stakeholders to integrate emerging
•Practical diagnostic tools for DRI
evidence and implement policy actions, along with
developing tools to measure impact of interventions
•chemical matter for antibacterial discovery
•Work
with others to highlight the value of antibiotics for
•Understand and overcome barriers to drug penetration
public
health, combined with mechanisms to ensure access
and efflux avoidance for Gram-negative bacteria
to
essential
medicines to those who need them most
•Conduct key proof-of-concept studies for non-traditional
therapies. Validate combination therapy for treatment of
systemic bacterial infections
•Improve models for PK/PD studies and accelerate PK/PD
studies in humans
Halt AMR
•Optimise drug use
•Share data, materials, and knowledge across disciplines
and between sectors
Education
Public Engagement
•Develop the skills and expertise to address the scientific
challenges in microbiology, chemistry, pharmacology,
medicine and epidemiology
•Support research to better understand impactful
communications
AMR Call for Action
A world equipped to address the threat of drug resistant infection
To contain antibiotic resistance, we need to create incentives—for patients,
doctors, hospitals, [food producers,] drug companies—to act in ways that
slow the depletion of antibiotic effectiveness. - Ramanan Laxminarayan
Goals
1. Maintain effectiveness of existing treatments (stop the increase of drug
resistance)
2. Regain effectiveness of treatment where drug resistance has happened
AMR a complex problem with multiple drivers
AMR global strategic aims
Key priorities to avert or delay a post-antibiotic era1
•
Prioritise access for children and neonates
•
Encourage innovation in markets and medicine and repurposing of existing instruments
•
Balance universal access with effective oversight and investment in basic public health
•
Advocate for multisectoral attention and inclusive public health practices
1. Lancet 2016; 387: 10014. 188-198
AMR international priority
Gaps in international collaboration2
• Surveillance
• Infection Control
• Universal Access
• Responsible use in human beings
• Responsible use in animals
• Innovation
2. Lancet 2016; 387: 10014, 296-307
AMR international priority
Gaps in international collaboration1 research needs
• Surveillance sampling, data harmonization, analysis
• Infection Control implementation studies, innovative tools
• Universal Access technologies suitable for global access
• Responsible use in human beings improved clinical guidelines
• Responsible use in animals therapeutic use only
• Innovation new tools, new products, new approaches
1. Lancet 2016; 387: 296-307
Dx workshop
• Optimising patient treatment and antibiotic use
• Avoiding unnecessary antibiotic use
• Identifying high-risk patients
• Improving drug development
AMR immediate international priority
There is an urgent need to develop better local understanding of antibiotic
use and resistance levels, in human and animal medicine
• Surveillance systems Surveillance and monitoring are essential to provide a
clear picture of local situations and to assess the impact of interventions;
expanded data are required on both antibiotic usage and resistance (in humans
and animals).
• Targets Quantitative data will enable policymakers to track progress over time,
increase accountability and set targets to motivate changes in behaviour.
• Labelling Labelling has a potentially important role to play in establishing the
‘protected’ status of antibiotics, supporting tracking mechanisms, and ensuring
drug quality.
• Education Community-level education is necessary to ensure that all people,
ranging from parents of ill children to farmers, understand what antibiotics can do
and cannot do and why minimizing use is in the interest of all.
AMR immediate global health priority
Public health & food production systems need to be adjusted to optimise
antibiotic use
• Public health Consistent with the Sustainable Development Goals, emphasis
should be placed on improved sanitation and access to clean water, and in
promotion of public health measures such as good hand hygiene practices and
enhanced infection prevention and control in hospitals; such moves would
address antimicrobial resistance as well as deliver direct public health benefits.
• Development assistance International development agencies need to
integrate antimicrobial resistance prevention as a core aspect of their work.
• Education Healthcare worker education and professional development should
have a stronger emphasis on antibiotic stewardship.
• Economics Financial incentives that link rewards to volumes of antibiotic sales
need to be eliminated.
• Guiding use Enhanced ‘gating’ of antibiotics is required, so more use is routed
through informed healthcare professionals and over-the-counter use is
minimised, with due consideration for the need to enhance access to antibiotics
in many countries of the global South.
AMR immediate cross-sector priority
Antibiotic use in agriculture must be reduced, without compromising the
food system’s capacity to meet increasing global demand
• Growth promoters Use of antibiotics for growth promotion and disease
prevention should be replaced by improved animal husbandry practices.
• Insurance Innovative insurance schemes should be developed to mitigate
the risk of income loss among producers during this transition.
• Food production Food production systems should do more to limit
consumer exposure to drug-resistant microbes (e.g. through increased use
of surface cleansing).
• Alternatives Alternative treatments and husbandry practices should be
investigated to support reduced antibiotic use in agriculture.
Opportunities Near-term priorities with long-term outputs
Important needs requiring near-term efforts for delivering outputs in the long- term
• Therapeutics
• Diagnostic tools
• Clinical trial networks
• Regulatory frameworks
• Fiscal frameworks
Opportunities Horizon-scanning
Long-term scientific opportunities with transformational opportunity
• Host-pathogen interaction
• Microbiome
• Alternative therapies
• Transmission dynamics
• Environment
AMR international action requirements
A world equipped to address the threat of drug resistant infection
Consensus
general agreement
Collaboration
working together
Coordination
effectively
organizing different activities to enable them to work together
Cooperation
assistance, sharing and willingly fulfilling requests
Drug Resistant Infection
strategy development
Tim Jinks PhD
[email protected]