Cooperation to combat antimicrobial resistance

Resistant bacteria and other microorganisms have long been an important issue for Sweden. The World Health Assembly in Geneva has now endorsed a global action plan to tackle the increased risks.

Photo: Johnér

Modern medical care is dependent on effective antibiotics to combat bacterial infections, but also for the treatment of cancer and other diseases. Bacteria that are resistant to antibiotics can make it difficult or impossible to treat common infections. If the spread of resistance cannot be stopped, the world will find itself without any effective medicines for treating a host of diseases.

Resistance spreads across national borders, making cooperation necessary at all levels – internationally, nationally and regionally.

UN resolutions following high-level meeting in Seoul, South Korea, 7–9 September 2015

On 7–9 September 2015, a Swedish delegation led by Minister for Health Care, Public Health and Sport Gabriel Wikström took part in the Global Health Security Agenda High-Level Meeting in Seoul, South Korea. During the meeting, the World Health Organisation (WHO), the World Organisation for Animal Health (OIE) and the Food and Agriculture Organisation of the United Nations (FAO) presented their enhanced efforts to combat antimicrobial resistance. The decision-making bodies of all three organisations have now adopted resolutions on joint measures to combat antimicrobial resistance.

Minister for Rural Affairs Sven-Erik Bucht took part in the conference where the FAO resolution was adopted, and said in his speech: “Bacteria and diseases don’t have passports and don’t respect borders. Antimicrobial resistance is already killing more than half a million people globally every year and this is just the beginning. Coordinated global efforts are urgently required and the UN organisations’ resolutions are a step in the right direction.”

Speach by Minister for Health Care, Public Health and Sport Gabriel Wikström at the  the Global Health Security Agenda High-Level Meeting in Seoul, South Korea.

Seoul declaration on future direction of GHSA

The Food and Agriculture Organisation of the United Nations (FAO) resolution

Global action plan endorsed by the World Health Assembly

Sweden has a long history of participation in international efforts to combat antibiotic resistance and has played a leading role in efforts to bring about a global action plan under the leadership of the World Health Assembly, the decision-making body of the World Health Organisation (WHO).

On 18–26 May 2015, health ministers from around the world met for the annual session of the World Health Assembly in Geneva. A global action plan to tackle antimicrobial resistance, including antibiotic resistance, was one of several major issues discussed.

Breakfast initiative resulted in ministerial declaration

On Tuesday 19 May, Gabriel Wikström and Professor Dame Sally Davis, Chief Medical Officer for England, hosted a ministerial breakfast to launch an alliance of health ministers against antimicrobial resistance, including antibiotic resistance.

The meeting resulted in a ministerial declaration – a Call to Action – including commitments to implement the global action plan against antimicrobial resistance (to be dealt with by the World Health Assembly later that same week) and to ensure that heads of government, ministers and global leaders take on the challenge of growing resistance. The ministers also called for a high-level meeting on antimicrobial resistance during the UN General Assembly in 2016.

In addition to Mr Wikström and Ms Davis, participants at the meeting included health ministers from China, Germany, Norway, Pakistan, South Africa, South Korea, Thailand, the United States and Zambia, and the deputy health minister from Brazil.

On 25 May, the World Health Assembly adopted a global action plan.

Sweden

Sweden has long taken measures to combat antibiotic resistance and is in a good position compared with many other countries. Previous governments have also prioritised this issue, and Sweden’s existing strategy was established in 2005.

At the same time, Sweden is affected by a deteriorating situation internationally at global level. The number of cases of infections involving antibiotic-resistant bacteria is growing in Sweden as a result of Swedes travelling more often and more widely, and more Swedes seeking medical treatment abroad. Resistant bacteria are thus being spread by the people who carry them. Reducing the use of antibiotics internationally is consequently the key to combating resistance. It is crucial that antibiotics are used only when they are absolutely necessary, when they are effective and for a short duration.

In animal nutrition as well, it is essential in the EU and internationally to combat routine use of antibiotics on animals by promoting better animal welfare. Antibiotics must not be used to conceal deficient animal husbandry systems.

New cross-party talks on 20 August 2015

On 20 August 2015, a second meeting was held in a series of cross-party talks on revitalisation of the Swedish strategy to combat antimicrobial resistance. Representing the Government at the meeting, in addition to Minister for Health Care, Public Health and Sport Gabriel Wikström, were the two ministers who are also those most affected – Minister for Rural Affairs Sven-Erik Bucht and Minister for Higher Education and Research Helene Hellmark Knutsson.

Earlier that day, in connection with the meeting, the Government had decided to task the Public Health Agency of Sweden with producing a project plan to draft proposals for one or more models on how to make new antibiotics – as well as older antibiotics, if national access is inadequate – available in Sweden. This must be done under circumstances in which the risks are minimal for resistance to develop, while providing patients with the best possible care. In the absence of an effective model, future antibiotics risk becoming ineffective relatively rapidly, as resistance develops also against these pharmaceutical products.

In connection with the Public Health Agency of Sweden’s remit, Minister for Health Care, Public Health and Sport Gabriel Wikström said:

“Antimicrobial resistance is a serious problem which we must tackle on several fronts. The Public Health Agency of Sweden’s remit means we must launch efforts on how to use the new antibiotics, once they arrive, so as to ensure that bacteria do not develop resistance also against these,” he continued.

Minister for Rural Affairs Sven-Erik Bucht:
“When it comes to animals in Sweden, we have come a long way, but it is not enough. It is important to have an overall perspective – a ‘one health perspective’. To succeed in these efforts, a coherent strategy is needed which includes antibiotics use in animals as well as humans.”

Minister for Higher Education and Research Helene Hellmark Knutsson:
“It is high time to update the strategy, as a great deal is happening in this area,” said Ms Hellmark Knutsson. “Research plays an important role, not least with regard to efforts to produce new antibiotics and other treatment strategies,” she concluded.

Update of the Swedish strategy has begun

Representatives of the Government, the Moderate Party, the Centre Party, the Liberal Party, the Christian Democrats and the Left Party met in early 2015 for the first time to update Sweden’s strategy to combat antibiotic resistance. At the meeting, the responsible ministers gave an account of the Government’s ambitions and the desire to achieve these ambitions with cross-party consensus. The participating parties gave their views, which are included in the ongoing process.

Representatives of the National Board of Health and Welfare, the Swedish Board of Agriculture, the Public Health Agency of Sweden, the National Veterinary Institute, the National Food Agency and the Swedish Research Council also attended the meeting.

Global action plan

A global action plan to tackle the growing threat posed by antibiotic-resistant bacteria and other microorganisms was endorsed by the 194 Member States during WHO’s World Health Assembly in Geneva. This is an important step forward since no country alone can create the conditions necessary to ensure continued availability of effective treatments.
The plan contains five strategic objectives with the overall aim of ensuring the long-term possibility of treating and preventing infectious diseases with effective and safe medicines.

The five strategic objectives are:

Objective 1: Improve awareness and understanding of antimicrobial resistance through effective communication, education and training.

Objective 2: Strengthen the knowledge and evidence base through surveillance and research.

Objective 3: Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures.

Objective 4: Optimise the use of antimicrobial medicines in human and animal health.

Objective 5: Develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.

The action plan also includes a framework for the actions that Member States, the Secretariat and international and national partners need to take in order to meet these objectives. All Member States are urged to have in place, within two years of the endorsement of the draft action plan by the Health Assembly, national action plans on antimicrobial resistance that are aligned with the global action plan.

These national action plans should provide the basis for an assessment of the resource needs, take into account national and regional priorities, and address relevant national and local governance arrangements.