Author: Anna Sundin

“To unravel the dynamics of transmission and selection of antimicrobial resistance (AMR) at genetic, bacterial, animal, human, societal, and environmental levels, in order to design and evaluate preventive and intervening measures for controlling resistance.” This is the topic of JPIAMR’s 3rd call for research proposals which opened on 18 January 2016. It is the first ever call on transmission dynamics. Research in this field is neglected, a fact which was demonstrated by JPIAMR’s research mapping across 19 countries from 2007-2013 which showed that only 9% of the total amount of research funding in this period had gone to projects within the field of transmission.

In this call, JPIAMR has joined forces with the European Commission under the ERA-NET Co-fund scheme to generate a total fund of over 24 million euro (for all participating countries) with a 6-million-euro European Commission “topping up” fund.

The main aim of the third joint call is to combine the resources, infrastructures, and research strengths of multiple countries in order to address transmission of antibiotic resistance following a ‘One Health Approach’. The goal is to foster multinational research collaborations to add value to and to build upon the research conducted independently at national level and to work together to improve the control of resistant bacterial infections of clinical and/or veterinary importance only.

The call is conducted simultaneously by 22 participating funding organisations from 17 JPIAMR member countries, Portugal and Latvia, and coordinated centrally, with a single proposal submission and peer review system. The call has a two-step procedure, with a first stage (pre-proposal submission) from which selected applicants will be invited to submit a full proposal. Applications are invited from collaborative consortia of researchers from participating countries according to JPIAMR and national eligibility criteria (see Call text and Specific regulations below). Under Horizon 2020, the European Commission is providing additional funding to ‘top up’ the funding that is being made available through national/regional funding organisations.

Deadline: The pre-proposal submission deadline is 17:00 (C.E.T) on the 21st of March, 2016.

More information and how to submit your application.

Brussels 19 December 2015. National and European research funding in the field of antibacterial resistance is unbalanced and underfunded, according to new research by the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) published in the journal Lancet Infectious Diseases today. The study, which is the first of its kind, highlights the need for increased and new investment across all Member States. The work was led by the UK‘s Medical Research Council (MRC).

The study mapped out antibacterial resistance research undertaken across 19 countries from 2007-2013, identifying 1,243 projects with a total public investment of €1.3 billion. The study looked at national investments and European Union organisations investments, including the European Commission’s investment in the Innovative Medicines Initiative (IMI) and found that funding varies considerably across countries and within the different research areas. The 19 countries covered by the study are Belgium, Canada, Czech Republic, Denmark, Estonia, Finland, Germany, Israel, Italy, The Netherlands, Norway, Poland, Romania, Spain, Sweden, Switzerland, Turkey and the UK.

Antibiotic resistance has been highlighted as one of the main threats to human health worldwide. In 2007 alone, 25,000 patients died in Europe from infections caused by bacteria that were resistant to more than one antibiotic – and current trends predict this to grow to 390,000 deaths a year by 2050.

In order to address antimicrobial resistance, research across a wide range of areas in humans, animals, and the environment is critical. There is a need to develop new and preserve existing antibiotics and alternatives to antibiotics, improve diagnosis to reduce unnecessary and inappropriate antibiotic prescribing, implement surveillance systems to monitor resistance and antibiotic use, understand the development and transmission of resistance, and improve infection prevention and control strategies. The Lancet study is the first systematic study to look at national and European Union funding in antibacterial resistance across a range of research areas in order to identify gaps and opportunities to be exploited.

The JPIAMR mapping study has shown that across 19 countries from 2007-2013, 66% of funding was awarded to projects in the field of therapeutics. This is a stark contrast to the other fields such as transmission, which received 9% of the funding, 14% of funding went to diagnostics, 5% to interventions and only 2% awarded to projects on antimicrobial resistance in the environment and 4% in surveillance.

“Funds have been invested in AMR research, however this study clearly shows us a gap between the funding of studies needed to reduce resistance and the actual research funded. As well as increased funding, we need to tackle this growing concern together, by strengthening national and international collaborations, co-ordinating research activities, and combining resources “ said Mats Ulfendahl, Chair of JPIAMR’s Management Board.

91% (1,129/1,243) of projects identified in this study were funded at national level. However, they only accounted for 49% of total investment, suggesting that these are relatively small awards and highly focussed projects.

“National research investment is too low compared to that committed at European Union level. To achieve greater impact, nations need to come together and pool available resources. This entails working together in a more efficient way to increase the impact of research through strengthening national and international coordination and collaborations as well as harmonising research activities and national strategies. The results demonstrate the need for a Joint Programming Initiative on Antimicrobial Resistance,” said Herman Goossens, Chair of JPIAMR’s Science Advisor Board.

Notes to editors:
Media contacts:
Sofia Kuhn, JPIAMR communications
Email: sofia.kuhn@vr.se
Phone: +32 486 67 39 42

Link to paper (open source): http://dx.doi.org/10.1016/ S1473-3099(15)00350-3

Ruth Kelly, MPH, Ghada Zoubiane, PhD, Desmond Walsh, PhD, Rebecca Ward, PhD, Prof Herman Goossens. Lancet Infectious Diseases (Dec 2015). Public funding for research on antibacterial resistance in the JPIAMR countries, the European Commission, and related European Union agencies: a systematic observational analysis

Further information
Currently, there is no comprehensive database to document research at both national and international levels, and from conducting this work it is clear that improvements in data sharing and communication need to be achieved at national level in several countries. The JPIAMR is actively working to improve this and has turned the research data collected for this work into a useful, freely accessible, and searchable database available on the JPIAMR website. This will enable researchers and funders to determine what has already been funded across the different areas and determine what is yet required in order to set strategic priorities. It is likewise hoped that it will be used by researchers for networking and collaboration and to avoid duplication. If funders from other countries provide similarly detailed information of projects on ABR research, global gaps and priorities could be assessed.

About JPIAMR
The Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) joins forces across nations to fight AMR through effective collaborative actions in areas of unmet needs. A shared common research agenda enhances multi-disciplinary collaboration and ensures that knowledge gaps are quickly identified and filled.

At the moment, European AMR funding is skew towards research in therapeutics, largely ignoring other areas such as transmission dynamics and the impact of the environment, crucial areas to understand in order to reduce resistance.

The gap between research funding into chronic diseases and antimicrobial resistance is large but difficult to document. However, national AMR funding does exist but is relatively small and targeted. In addition, countries with low national AMR prevalence allocate more money towards research than countries with greater needs for AMR solutions. This suggests a need for greater coordination across Europe in order to fill knowledge gaps.

JPIAMR coordinates national funding and supports collaborative action to fill existing knowledge gaps. The goal is to shape cohesive and coordinated AMR funding and actions that maximise on resources and reduce duplication of research. Mobilising existing and new resources will create a greater critical mass and attract new researchers into the AMR field. A Strategic Research Agenda (SRA), which outlines key [neglected] areas to tackle, guides JPIAMR and focuses research actions.

JPIAMR cannot address all aspects of the AMR problem, but can show a way forward by producing new research, engaging new researchers and creating networks that create long-term momentum for other areas in society. There is an urgent need for interdisciplinary and public-private partnerships to support research in the antimicrobial resistance area. Exchanges between industry, public health bodies, and academic bodies will entail not only sharing costs, but also coordination of the respective research activities. This is where JPIAMR will make a difference.

To date 22 countries have joined forces in the Joint Programming Initiative on Antimicrobial Resistance.

utveckling.jpiamr.eu

About MRC
The Medical Research Council is at the forefront of scientific discovery to improve human health. Founded in 1913 to tackle tuberculosis, the MRC now invests taxpayers’ money in some of the best medical research in the world across every area of health. Thirty-one MRC-funded researchers have won Nobel prizes in a wide range of disciplines, and MRC scientists have been behind such diverse discoveries as vitamins, the structure of DNA and the link between smoking and cancer, as well as achievements such as pioneering the use of randomised controlled trials, the invention of MRI scanning, and the development of a group of antibodies used in the making of some of the most successful drugs ever developed. Today, MRC-funded scientists tackle some of the greatest health problems facing humanity in the 21st century, from the rising tide of chronic diseases associated with ageing to the threats posed by rapidly mutating micro-organisms.

www.mrc.ac.uk

Blog by:

Hannah Boley, Science & Innovation Officer, Berlin
Part of Science & Innovation Network, Europe

Bugs don’t work in silos!

Antimicrobial Resistance (AMR) is a topic that is difficult to escape at the moment, but that’s a good thing because it means it is getting the attention that it really does need. The news recently of bacteria being found in China that were resistant to the drug of last resort – colistin – in a way which allowed them to transmit this resistance to other bacteria, has only increased fears of further world-wide spread of this phenomenon and the coming of a post-antibiotic era. It also highlights the importance of international cooperation and the need for further research into how resistance spreads – it is said that the resistance in China emerged after colistin was overused in farm animals. The AMR Review Team, chaired by Economist Jim O’Neill, has today published its latest report on antimicrobials and the environment, giving an overview of the scale of antimicrobial use in global food production and making suggestions about how policies to lower their use could be implemented. The report is well worth a read.

The S&I Network in Europe has also been busy with its fair share of events to highlight the importance of AMR, working closely with the UK Chief Medical Officer Professor Dame Sally Davies to raise awareness of the UK’s work to tackle the issue. Our team in Germany, for example, hosted an event back in May with Dame Sally to promote the Longitude Prize to potential German competitors, and Switzerland hosted a similar event just last week. For those of you who don’t know about the Longitude Prize, it is a £10m prize managed by NESTA to encourage innovation to develop a rapid diagnostic tool that can differentiate between bacterial and viral infections – something which would help reduce the overuse of antibiotics, which greatly contributes to resistance.

But back to how resistance spreads – or transmission dynamics, as the experts say. This is a topic that the EU’s Joint Programming Initiative on AMR and its member countries and the UK’s Medical Research Council have identified as one of the key areas where we need to know more. And what is interesting about transmission is that you need to get a lot of different people with different expertise in the room – not just doctors and clinicians, but veterinarians and environmental scientists too. And it needs to be an international affair. That was why the S&I Network teams in France and Germany teamed up with the JPI-AMR and the MRC to bring together a diverse group of scientists who have different pockets of expertise to bring to the overall knowledge base. At a workshop in Berlin in October 2015 chaired by Professor Bruno Gonzalez-Zorn , we heard from specialists about transmission within the hospital setting, as well as scientists working to understand how resistance is disseminated in the environment and others who look at how transfer occurs between animals and humans. We were also lucky enough to have Dame Sally Davies come to set out how she and others are explaining to politicians across the globe about why we need multidisciplinary research around transmission to build up an evidence base for effective policymaking. It was great to see the reactions from the researchers – they were glad to have someone advocating the necessity of their work at the highest levels.

At the end of one of these workshops, I always get the sense that I have really started to understand the topics under discussion. But as time goes on and I start to concentrate on other work strands I start to forget what the real challenges are. That’s why it is always good to have a reminder at hand to explain it again. And so I leave you with a short video from Dame Sally about why the One Health approach is so important – because unfortunately bugs don’t work in silos…

For more videos, go to the JPIAMR video page.

If you’re a researcher, JPIAMR is soon launching a call on transmission dynamics. Read more!

At the conference ‘Tackling Societal Challenges’ in Lund on 3 December 2015, the chairs of the different Joint Programming Initiatives summarised how to move forward with the JPI scheme.

Publicly-funded research activities in Europe have increasingly been focused on the grand challenges; health, food, water and energy supply, climate change and societal transformation. The Joint Programming Initiatives (JPI) were created to help tackling these grand challenges. Beyond the considerable progress accomplished during their first phase there are still barriers to break down in order to improve the conditions for transnational research collaboration and to move towards more aligned research systems. Within this process JPIs will continue to strengthen the momentum supported by Member States (MS), associated countries and the European Commission (EC) but also research communities, private sector and the civil society in order to enhance Europe’s ability to generate solutions for complex societal and multidisciplinary issues.

The chairs recommend the 28 MS and associated countries to:

• Increase commitment and cooperation
• Simplify and shorten interactions between EC and JPIs
• Reduce operational bureaucracy between the various networks and have key actors
• Proactively promote awareness, visibility, attractiveness and legitimacy of JPIs throughout the different layers of a diverse research system to reinforce commitment
• Align key national actions incl. research infrastructures, mobility, capacity building, databases, organisation incentives
• Develop European synergies for knowledge based solutions and policies
• Favour global participation in JPIs
• Ensure a better international coordination between JPIs, MS bilateral cooperation, EC Directorates-General and ERAC (GPC and SFIC)
• Engage in frontier research
• Generate evidence, solutions and implementation for Europe
• Exchange and disseminate the best practices of the JPIs continuously
• Develop a transparent metric of key indicators to follow progress of JPI impacts

Read the entire declaration

On 23 October 2015, Jim O’Neill, economist appointed by David Cameron, released the fourth report published by the Review on Antimicrobial Resistance ‘Rapid diagnostics: treating patients with infections better and more sustainably’. The Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) welcomes this report which highlights the area of diagnostics use and development to reduce antimicrobial resistance. Research mapping carried out within the initiative has demonstrated that this field is underfunded. Only 11% of competitive national AMR funding goes towards research projects on diagnostics and only 10% of European funding. There is a clear need for more resources.

According to O’Neill, around two thirds of the total antibiotic prescriptions in the US in one year are needlessly given to adults. These prescriptions were likely to have been ineffective in tackling the patient’s particular complaint, and they would have also each have contributed to worsening resistance, in the context of both the individual patients and wider society.
With better diagnostics hospitals will be able to diagnose patients much more quickly. This will have many benefits to both them and their patients.

“To develop better and faster diagnostic tools, we need research. We have to collaborate across national and topical borders to prevent duplication of results and to maximise on resources. Developing private-public partnership will also play a big part. These are the cornerstones of JPIAMR,” said Mats Ulfendahl, Chair of JPIAMR’s Management Board.

The Review on Antimicrobial Resistance report considers the role that rapid diagnostics can play in improving how we use antimicrobials to treat infections better, slow the rise of drug-resistance by reducing the over-use and misuse of medicines, in particular antibiotics, and ultimately change much of our approach to treating bacterial infections by allowing the advent of more targeted and precise therapies.

O’Neill recommends that we need:
• Rapid diagnostics within 5 years in pharmacies, primary care and hospital settings across the globe,
• To focus development of the right diagnostics,
• More grant funding to companies investing in early stage and translational research and;
• To support the building of hard evidence to show that diagnostics work: including clinical, operational and financial evidence.

Dedicated to the One Health approach, JPIAMR and MRC organised a workshop in London on 11 May 2015 which resulted in key recommendations in the areas of regulation, adoption and implementation, resources and sharing and connections in relation to diagnostics. The recommendations included starting up an EU wide network for diagnostic development centres, developing better mechanism for advocacy, centralising biobanks and sponsoring multi-disciplinary activities including research. This has resulted in JPIAMR funding a call for Research Networks within the field of Diagnostics in 2016.

“We need to support research in the area [of diagnostics] to develop the proper tools and change the policy to support the uptake of diagnostics by prescribers as well as change the behaviour of prescribers,” said Arjon Van Hengel, Scientific Officer for Research Funding and Research Policy in the Area of AMR, European Commission, during a podcast interview with JPIAMR.

More information:

Podcasts

Arjon Van Hengel, Scientific Officer for Research Funding and Research Policy in the Area of AMR, European Commission
Why do we need to be able to better diagnose disease to reduce antimicrobial resistance? Arjon Van Hengel explains.

Jorge Villacian, Chief Medical Officers at Janssen Diagnostics
Jorge Villacian shares the success story of how better diagnostics turned the tide for HIV sufferers and explains why diagnostics development in the field of antibacterial resistance is still lagging behind.

Key recommendations from the JPIAMR/MRC Diagnostics Workshop

1. Regulation
There is a need to:

• Foster talks between US and EU regulators e.g. sponsored meeting
• Start to develop an EU wide network of diagnostic development centres e.g. building on infrastructures work, identify key centres, identify standards, capabilities etc.
• Develop better links between regulatory science and methodology development e.g. sandpits, workshop

2. Adoption and implementation
There is a need to:

• Encourage better engagement with purchasers
• Develop better mechanisms for advocacy across Europe

3. Resources and sharing
There is a need to:

• Identify existing biobanks across EU and opportunities to network
• Develop a centralised biobank of samples that is fully accessible across the EU
• Sponsor specific working groups to establish how data can be better shared
• Sponsor specific working groups to determine what exactly is needed to be collected and how
• Workshop or specific working groups on “lessons learned in biobanking” from other functioning biobanks in the EU

4. Connections
There is a need to:

• Foster/sponsor multidisciplinary meetings on specific key issues, keeping them relatively small and focussed.

Read the full report here

Top lines from the report ‘Rapid diagnostics: treating patients with infections better and more sustainably’

• Within 5 years we need rapid diagnostics in pharmacies, primary care and hospital settings across the globe to get the right drugs to the right patients and combat antimicrobial resistance (AMR) by improving the way we prescribe and use antibiotics.
• To focus development of the right diagnostics, we need Target Product Profiles (TPPs) for specific areas of high clinical need to combat AMR, combined with advanced market commitments to give more certainty to developers that there will be a market for diagnostic devices that serve a critical need.
• More grant funding should be available to companies investing in early stage and translational research. A global innovation fund that operates across disciplines or across borders could play a key role. This would provide a significant boost to innovation and help companies take early innovation towards the mid and late stages of development.
• We need to support the building of hard evidence to show that diagnostics work: including clinical, operational and financial evidence. We particularly need more evidence of the efficacy and cost-effectiveness of diagnostics in the clinical setting, and should provide public support for clinical trials for diagnostics that serve a critical need.

On 19 October 2015, the Joint Programming on Antimicrobial Resistance voted in Japan, represented by the Japan Agency for Medical Research and Development (AMED) as its newest partner member. The initiative is now encompassing almost all G7 countries enabling close ties with the G7 goals and greater collaborative strength.

“We are pleased that JPIAMR has welcomed us as a partner. I am aware that AMR is a critical issue to be tackled globally and that the topic has been discussed at the recent G7 Health Ministers meeting. We hope to contribute to medical R&D solutions in this area by collaborating with the JPIAMR members,” says Dr. Makoto Suematsu, President of AMED.

Japan has an extensive track record in addressing antimicrobial resistance with initiatives such as their ‘area network for infection control’ which involves advanced hospitals and small hospitals, clinics and nursing care facilities which share best practices and educate each other through mutual site visits to promote infection control.

Another initiative, the Directly Observed Treatment Short-course (DOTS) prevent development of drug resistant tuberculosis. Due to the comprehensive DOTS program, the proportion of multi-drug resistant TB cases remains quite low at 0.7% among culture-positive cases in Japan.

“Japan has been mentioned as a best practice example for AMR stewardship amongst other things, in the G7 best AMR practice report. We are very pleased to welcome Japan as our newest partner member and look forward to learning from their experience as we move forward towards greater collaborative actions to reduce antimicrobial resistance” says Prof. Mats Ulfendahl, Management Board Chair of the Joint Programming Initiative on Antimicrobial Resistance.

In the Japanese national fee schedule, incentives are given to promote prudent use of antibiotics. Also, many professional societies have their own certification programmes which contribute to antimicrobial stewardship and human resource development. In fact, Japan has dedicated the last decade to human resource development to promote antimicrobial stewardship. It is characterised by its inter-professional approach: good collaboration between health professionals is a key to its successful implementation.

Japan is embracing the One Health approach which is demonstrated by their guidelines of responsible and prudent use of antimicrobials in the livestock sector. As a complimentary action, the country has the Japanese Veterinary Antimicrobial Resistance Monitoring System (JVARM) to monitor the occurrence of antimicrobial resistance in bacteria in food-producing animals, and to monitor the quantities of antimicrobials used in animal. JVARM allows the efficacy of antimicrobials in food-producing animals to be determined, prudent use of such antimicrobials to be encouraged, and the effect on public health to be ascertained.

One of the core values of JPIAMR is the One Health approach and the initiative believe that the issue of AMR cannot be tackled by working in silos. Welcoming Japan as partner reinforces the initiative’s main aim to joins forces across nations to fight AMR through effective collaborative actions in areas of unmet needs.

Additional information:

About JPIAMR
JPIAMR joins forces to enable impactful collaborative actions in areas of unmet needs. A shared common research agenda enhances multi-disciplinary collaboration and ensures that knowledge gaps are quickly identified and filled.
The Joint Programming Initiative on Antimicrobial Resistance provides a collaborative platform to take the AMR combat from awareness to action by supporting European research and facilitates its translation to industry and policy.
The reality of antimicrobial resistance is ‘no antibiotics – no cure’, even to simple infections. Without action we might face a situation in 2050 where 10 million people per year will die from AMR related problems. In addition, European AMR and more specifically anti-bacterial resistance [ABR] funding is skew towards research in therapeutics and national funding efforts are relatively small and targeted. For example, countries with low AMR [ABR] prevalence spend more on research suggesting a need for greater coordination across Europe. The only way to win the AMR battle is to look at the AMR in a holistic way, from diagnostics via the environment to interventions, and align resources to target neglected research domains.

About AMED
The Japan Agency for Medical Research and Development (AMED) engages in research and development in the field of medicine, establishing and maintaining an environment for this R&D, and providing funding, in order to promote integrated medical R&D from basic research to practical applications, to smoothly achieve application of outcomes, and to achieve comprehensive and effective establishment / maintenance of an environment for medical R&D.

The role of AMED
Providing a one-stop service for research expenses, AMED consolidates budgets for research expenses, which had previously been allocated from different sources — the Ministry of Education, Culture, Sports, Science and Technology, the Ministry of Health, Labour and Welfare, and the Ministry of Economy, Trade and Industry. In addition to making possible an integrated approach to providing research funding and establishing / maintaining research environments, the unification of points of contact and procedures for research expenses can be expected to reduce the administrative burden on institutions and researchers receiving allocations for research expenses. AMED aims to achieve the world’s highest level of medical care / service and to form a society in which people live long, healthy lives by promoting integrated research and development, from basic research to practical application, and by establishing and maintaining an environment therefor, and linking this to various forms of growth in medical R&D.