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Combining the fight against Antimicrobial Resistance with access to medicines: The Case of the African Region

Professor Smail Mesbah, Director General of Prevention and Promotion of Health, Ministry of Health, Algeria Today, two billion men, women and children, mostly from developing countries and the African region in particular, suffer from lack of access to essential medicines. Today, the growing threat of developing antimicrobial resistance (AMR) in the areas of human, animal health and agriculture no longer spares developing countries, including those in the African region. These are two major issues, also ones of  human rights and dignity, that particularly affect developing countries, including Africa. These are also complex issues of multiple dimensions, linked in particular in our countries to intellectual property laws, lack of financial resources, weak health systems and inequalities which are aggravating factors. These issues, which provide so many challenges for the international community, call, more than ever before, for an urgent and concerted response at the local, national, regional and international levels. First of all, this response requires that access to medicines is a fundamental obligation based on the primacy of human rights in relation to international trade. Therefore, medicines must be economically affordable, acceptable, accessible, good quality and made available without discrimination. In this regard, any pressure to prevent the use of TRIPS flexibilities or to impose TRIPS-plus provisions in trade agreements should be seen as an infringement of human rights. This response also requires measuring the threat of antimicrobial resistance (AMR)...

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Antibiotic Resistance In Lebanon

Professor Pascale Salameh, Professor of Epidemiology, Faculty of Pharmacy and Faculty of Medicine, Lebanese University, Hadath, Lebanon; Dr Hala Sacre, Director, Drug Information Center, Lebanese Order of Pharmacists, Beirut, Lebanon; Dr Souheil Hallit, Director of The Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon and Assistant Professor Aline Hajj, Laboratory of Pharmacology, Clinical Pharmacy and Quality Control of Drugs, Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon Over the last 50 years, antibiotics have contributed to one of the greatest advances in medicine. Today, however, the emergence of pathogenic bacteria that have become resistant to antibiotics and their spread in the human population is a public health concern (1). The often inappropriate exposure of the population, to antibiotics and the inter-individual transmission of resistant strains are the major determinants of the emergence and increase of bacterial resistance to antibiotics. Thus, overuse and misuse of antibiotics in the veterinary, livestock, agriculture and medical (hospital and community) sectors have led to increasing levels of antimicrobial resistance. This problem is even more important since the numerous factors leading to the emergence and spread of multi-resistant strains remain uncontrollable today, such as the inappropriate use of antibiotics (exaggerated global use, incomplete or incorrect therapeutic strategies, availability of antibiotics without prescription, etc.), the failure of infection control policies in hospitals and the widespread use of antibiotics in agriculture (2-4). This problem is not...

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A National Action Plan to Contain Antimicrobial Resistance in China: Contents, Actions and Expectations

Professor Yonghong Xiao, Vice-Director, State Key Laboratory For Diagnosis & Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China In response to the call of the World Health Organization, the Chinese government issued its national action plan to contain antimicrobial resistance (AMR) in August 2016.  The ambitious five-year plan contains detailed strategies and clear targets. The major targets include new drugs and the development of new techniques, implementation of antibiotics sale only with a prescription, optimization of surveillance, rational use of antibiotics in both the human and animal sectors, and professional education and publicity for AMR control. Antimicrobial resistance (AMR) is a serious public health threat of international concern. Containment of AMR is a very urgent priority throughout the world and was one of many issues discussed at various high-level international political conferences. The G7 has already reached a consensus on AMR control (1); the G20 discussed AMR control and issued a communique on this in 2016 (2); and there was a special debate on AMR at the United Nations General Assembly in September 2016 (3). In 2014, the World Health Organization (WHO) adopted a resolution to develop a global action plan for AMR containment. This was issued in 2015 and required all member states to develop their own action plan by 2017 (4). The week before the G20 summit in Hangzhou, the...

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Governance against Antimicrobial Resistance in Africa: Confronting AMR when resources are limited – The example of Senegal

Professor Awa Marie Coll-Seck Minister of Health and Social Action, Republic of Senegal; Professor Ibrahima Seck , Technical Adviser to the Minister of Health and Social Action, Republic of Senegal; Professor Ahmad Iyane Sow , Director of Laboratories, Ministry of Health And Social Action, Republic Of Senegal; Professor Babacar Ndoye, Former Coordinator of Pronalin; Dr Mamadou Ngom, Pharmacist, WHO/Senegal Focal Point For Laboratories and Medicines; and Dr Pape Amadou Diack , Director General of Health, Ministry of Health and Social Action, Republic of Senegal The Global Action Plan on AMR (GAPAMR), voted by the World Health Assembly in 2015, recommended establishing national plans of action – a difficult undertaking on the African continent – and the World Health Organization’s (WHO) intermediary report in May 2016 deplored the delays. However, Senegal shows real progress in comparison with the vast majority of African countries, and, in addition to campaigns promoting the rational use of antimicrobials for animals and humans, Senegal is fast moving forward thanks to two structures: – The National Program for the Control of Nosocomial Infections (PRONALIN), launched in 2004, which has been effective in reducing infections and the transmission of multi-drug resistant bacteria associated with hospital care. – The Directorate of Laboratories which set up a national system for monitoring antibiotic resistance through laboratories. Senegal has thus grasped the complexity of AMR control and has been at the forefront...

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Drug-Resistant Tuberculosis: What Is The Situation, What Are The Needs To Roll It Back?

Dr Karin Weyer, Coordinator, Laboratories, Diagnostics and Drug Resistance; Dr Dennis Falzon, Medical Officer; Dr Ernesto Jaramillo, Team Leader, Drug-Resistant TB Policies; Dr Matteo Zignol, Team Lead, Global Project on Anti-Tuberculosis Drug Resistance Surveillance; Dr Fuad Mirzayev and Professor Mario Raviglione, Director, Global TB Programme, World Health Organization, Geneva, Switzerland Tuberculosis (TB) strains with rifampicin- or multidrug-resistance (defined as, at least, combined rifampicin and isoniazid resistance) – MDR/RR-TB – require more complex, costly management than drug-susceptible TB. The global response to MDR/RR-TB will determine if the targets set in the context of the new End TB Strategy of the World Health Organization (WHO) are achieved. In 2015, WHO estimated that 580,000 incident MDR/RR-TB cases and 250,000 MDR/RR-TB deaths occurred globally. However, country reports to WHO show that only 30% of TB patients notified worldwide are tested for MDR/RR-TB, 22% of those eligible start MDR-TB treatment and just over one half of them complete treatment successfully. Strong political commitment and increased funding for research and universal diagnosis and effective treatment for MDR/RR-TB are direly needed. Antimicrobial resistance (AMR) has become one of the dominating, and most pressing, global concerns in public health (1). Yet a silent epidemic at the core of AMR often goes largely unnoticed and neglected – tuberculosis (TB), the world’s number one infectious disease killer (2). Multidrug-resistant TB (MDR-TB, defined as resistance to, at least, rifampicin and isoniazid)...

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