Antibiotic ResistanceInterview with HELLE AARGAARD, Policy Advisor at ReAct – Action on Antibiotic Resistance

The Member State Consultation on the World Health Organization’s (WHO) proposed roadmap for the Global Development and Stewardship Framework to Combat Antimicrobial Resistance (AMR) was held on 9–10 November in Geneva. The first day was open for non-state actor participation. ReAct – Action on Antibiotic Resistance represented Health Action International (HAI) at the meeting. The second day of discussions between Member States were held behind closed doors.

In the following interview with HAI, ReAct’s policy advisor, Helle Aagaard, who attended the meeting, details the discussions, results and interesting controversy on new Guidelines for antibiotic use in animals.

Antibiotic Resistance
Facing a Global Threat – Antibiotic Resistance

What was the purpose of the meeting?
The meeting anchored the WHO AMR Secretariat’s ongoing work to address innovation, access and conservation of antimicrobials, and to validate the approach it takes with Member States.

This meeting also placed the discussion on R&D for new antibiotics, vaccines and diagnostics back with the WHO. In addition, it allowed a broader range of countries, rather than only those in the G7 and G20, to provide perspectives on a global framework on development and stewardship that’s compatible with the realities in low- and middle-income countries (LMICs).

What was discussed at the meeting?
On both days, the agenda was divided in two strands: A discussion on research and development, followed by a discussion on access and stewardship. HAI, through ReAct, delivered an intervention in each of these discussions.

 “The twin goals of access and conservation should not be seen as being at odds with one another”

Was there agreement on the Framework?
Overall, the draft roadmap prepared by the WHO Secretariat was well received by Member States; however, there is still disagreement between some countries on whether the Framework’s emphasis should predominantly address the lack of access to effective antibiotics, which concerns many LMICs, or on improving the stewardship of antibiotics.

In an intervention during the Access and Stewardship discussion, ReAct particularly emphasised that the twin goals of access and conservation should not be seen as being at odds with one another. Instead, they should be considered two integral parts of an effective response to ensure sustainable access to effective antibiotics.

What was the outcome of the meeting?
The meeting seemed to provide the WHO AMR Secretariat with a renewed mandate of support for their recent approach. This means progressing further on the technical work, where it has made important progress in recent years with the development of the priority pathogens list, the ‘access, watch, reserve’ categorisation (AWARE) of antibiotics included on the essential medicines list, and, most recently, the qualitative assessment of the clinical pipeline. The bigger—and perhaps more controversial—questions about the type of legal framework, and when to start political negotiations on such a framework, was parked for the time being.

“The main point of contention was, in fact, not even related to the proposed Roadmap”

The main point of contention was, in fact, not even related to the proposed Roadmap. In the days prior to the meeting, the WHO published a set of Guidelines on the use of antibiotics in animals, which tells farmers and the industry to “Stop using antibiotics routinely to promote growth and prevent disease in healthy animals.”

These Guidelines received considerable pushback during the meeting—particularly from the United States and United Kingdom. They criticised the process by which the Guidelines had been published, the lack of notification that countries received prior to publishing, and the lack of joint publication with the two other AMR tripartite organisations (the World Organisation for Animal Health and the Food and Agriculture Organization of the United Nations).

One country delegate noted that the lack of prior notification by the WHO may have been intentional. According to the delegate, when the WHO issued prior notification about the release of new sugar intake guidelines in 2015, a range of Member States and industry put pressure on the WHO to try to have them amended before publication.

It’s impossible to tell whether the WHO AMR Secretariat wished to avoid a similar situation. But given the considerable pushback and requests by some countries to not include the Guidelines as part of the Framework, it seems the Secretariat chose an approach that succeeded in keeping the recommendations ambitious.

ReAct made our support for the Guidelines clear during our interventions.