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.

Latest JPIAMR Newsletter

That there is a need for collaboration in the field of antimicrobial resistance (AMR) is becoming more and more evident. For example, at the launch of the Antimicrobial Research Collaborative – a multidisciplinary project at Imperial College London, UK– the UK’s chief medical officer Dame Sally Davies said ‘not enough’ is being done to prevent drug-resistant infections spreading through hospitals. Leading researchers at the event called for greater collaboration to tackle AMR. This reflects that the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR)’s approach is what is needed.

Dame Sally Davies also emphasised, when she spoke at the JPIAMR-MRC-SINet transmission dynamics workshop, that the challenge of AMR is too large for any one nation to tackle alone but that we need initiatives like the JPIAMR. Collaboration which maximises on existing research resources and expertise will allow us to tackle AMR from a One Health approach. In addition, joining forces across national borders and under one strategic research agenda will allow focused actions in areas of unmet needs.

The JPIAMR is working hard to be successful. In this issue you can read about some of the calls and workshops we are organising. These are steps towards taking the fight against AMR from discussion to action.

Read the Newsletter

In a publication containing best practice examples on tackling antimicrobial resistance from G7 countries, JPIAMR is being highlighted. The publication presents some of the existing experience in combating antimicrobial resistance other countries might benefit from. At the World Health Assembly in May 2015 Member States of the WHO committed to develop national action plans on AMR within two years. This best practice brochure aims to contribute to the further development and implementation of the respective national action plans on antimicrobial resistance.

The Joint Efforts to Combat Antimicrobial Resistance (AMR) formulated in the annex of the Leadersʼ Declaration of the G7 Summit in June 2015 summarize the crucial steps to meet this challenge. Among them is the necessity to identify and share best practice examples, providing information on existing programs as well as most successful strategies to prevent avoidable infections and promote the responsible use of antibiotics.

The publication calls for all countries to increase their efforts: They must further develop their concepts and strategies, and expand their measures already in use.

Read the publication.

The European Commission has published  Guidelines aimed to prevent the overuse and misuse of antibiotics by sharing best-practices in Member States.  These guidelines are one of the key deliverables in the EU action plan on AMR. They provide Member States’ authorities, farmers and veterinarians with practical examples of what is being done in other EU countries to promote the prudent use of antimicrobials in veterinary medicine. Such measures can contribute to the control of AMR also in human medicine.

Read the guidelines.

 

The Nordic Council of Ministers have agreed to take a joint stance against antibiotic resistance through increased regional co-operation.

The declaration will establish a Nordic “One Health” strategic group of senior officials that can support exchange of best practice and ensure an efficient use of the Nordic resources in the areas of antimicrobial resistance and use of antimicrobials. The strategic group will further elaborate on ways to use the Nordic collaboration to support the global processes and in doing so stressing the importance of:

• National action plans which incorporate the “One Health” perspective.
•  The need for effective hygiene, sanitation and prevention guidelines.
• Support mechanisms that stimulate controlled and prudent use of antimicrobials.
• Identification and elimination of economic incentives in all sectors that encourage inappropriate use of antimicrobial agents, and introduction of incentives to optimize use.
• Improving awareness and understanding of antimicrobial resistance.
• Surveillance of antimicrobial resistance and the use of antimicrobials in humans and animals.
• The development of preventive measures and alternative means to the use of antimicrobials that may contribute to prudent use in humans and animals and reduction in antimicrobial resistance development.

Read the Declaration in English.