WHO Director-General addresses an expert advisory group on antimicrobial resistance

Dr Margaret Chan
Director-General of the World Health Organization

Welcoming remarks at the Strategic and Technical Advisory Group: Global strategy for tackling antimicrobial resistance
Geneva, Switzerland

19 September 2013

It is my pleasure to welcome this distinguished group of experts to Geneva. Thank you for giving us your expertise, and your time.

We need your guidance. Member States are deeply concerned about the rise of antimicrobial resistance. I heard this concern, time and time again, during the May World Health Assembly.

They are right to be concerned. The trends are ominous. Mainstay medicines are failing in unprecedented numbers. Second-line agents are nearly always more toxic, much more costly, and much less effective.

Some microorganisms are resistant to nearly everything we can offer to save the lives of infected patients. Few new antimicrobials are in the R&D pipeline. Medicines lost because of microbial resistance are not being replaced.

On current trends, we are moving towards a post-antibiotic era where common infections will once again kill.

The problem is getting worse. For example, we are rapidly running out of treatment options for gonorrhoea, returning this disease to the status of a major public health problem. Worldwide, an estimated 630 000 people are ill with multidrug-resistant tuberculosis.

Even more alarming is the fact that many of these infections are resistant to multiple drugs right at the start. This tells us that highly-resistant strains are passing directly from person to person.

Just six years ago, extensively drug-resistant TB was confined to a handful of countries. Today, cases of XDR-TB have been reported from more than 80 countries. Equally alarming are signs that the malaria parasite is developing resistance to artemisinin, our last class of effective medicines.

Hospital-acquired infections are another concern. More and more, hospitals are becoming hotbeds for super-pathogens. These infections are dangerous, often deadly, extremely costly, and increasingly difficult to manage.

For patients and their families, hospital-acquired infections are almost unforgiveable. Hospitals should heal, not harm.

The use of massive amounts of antimicrobials, usually at sub-therapeutic doses, in animal husbandry is another problem, as are the lobbies that fight against regulatory action.

Turning these trends around requires solidarity behind a worldwide, multi-pronged, and inclusive strategy. Among other things, this strategy must show awareness of some big challenges that perpetuate the irrational use of these medicines.

Many developing countries do not have a national drug policy. Many have no mechanisms or regulatory agencies in place to promote rational prescribing practices. In some cases, antimicrobial medicines can be bought, without prescription, on the open market.

Weak publicly-funded health services prompt patients to seek care from private providers, who usually have strong financial incentives to over-prescribe. In parts of Asia, the pharmaceutical industry is the principal source of prescribing information for doctors, which further drives over-prescribing.

We need a strong and far-reaching strategic plan, with clear roles for WHO and the many others who can help reverse these alarming trends. If we lose our most effective antimicrobials, we lose modern medicine as we know it.

Member States look to WHO to take this problem in hand. With your guidance, I am sure we will meet their expectations.

Thank you.