WHO Director-General addresses ministerial conference on antimicrobial resistance

Dr Margaret Chan
Director-General of the World Health Organization

Opening remarks at the Ministerial Conference on Antimicrobial Resistance: Joining forces for future health
The Hague, Netherlands

25 June 2014

Honourable ministers, the Directors-General of FAO and OIE, the European Commissioner, ladies and gentlemen,

I thank the government of the Netherlands, and in particular Ministers Schippers and Dijksma, for co-hosting this event with WHO. The world has much to learn from this country.

Since 2009, the Netherlands has reduced the use of antimicrobials in animal husbandry by more than half. In human medicine, the Scandinavian countries and the Netherlands have the strictest policies governing the prescribing of antimicrobials. And they have the lowest rates of drug resistance.

We need these encouraging success stories. I am sure that the European Commissioner will have some more good trends to report. WHO has been warning the world about the threat from antimicrobial resistance for more than two decades.

Already in 1994, scientists convened by WHO described the rise of antimicrobial resistance as an alarming crisis calling for urgent measures.

A typical pattern has emerged. A report is issued. The media respond with sensational coverage. Politicians give speeches and offer quotes that further underscore the high level of alarm. But then nothing much happens worldwide. Dangerous practices continue. The consequences spread. And the problem gets worse.

These reports have documented trends, explained contributing factors, and issued detailed policy advice targeted at multiple audiences, from consumers, prescribers, and medical schools, to regulatory authorities, veterinary services, and pharmaceutical companies. This has not been enough to provoke real worldwide change.

Our most recent report, issued this past April, was the most alarming yet. Drugs that were once lifesavers are now worthless. Hospitals have become hotbeds for the transmission of highly resistant superbugs, increasing the risk that hospitals kill rather than heal. For a growing number of serious infections, doctors are empty-handed. The rise of resistance has vastly outpaced the development of replacement drugs.

Antimicrobial resistance is not a future threat looming on the horizon. It is here, right now, and the consequences are devastating.

Here is the central question. How bad will things have to get before the recommendations we have been making for decades are finally acted upon? How much more evidence do we need?

In the midst of deeply alarming trends, I see some positive signs.

The May World Health Assembly adopted a resolution asking WHO to develop a draft global action plan to combat antimicrobial resistance. The resolution specifically asked WHO to collaborate with FAO and OIE in a multisectoral approach that brings together human health, animal health, and agriculture.

This meeting is being held to give WHO expert guidance as we develop this dimension of the draft action plan. Tripartite collaboration between FAO, OIE, and WHO is well-established, productive, and innovative, offering a solid foundation for joint work on the action plan.

Two ominous trends provide additional incentives to take urgent and sweeping action.

First, as incomes rise in the developing world, the use of antibiotics soars, fuelled by unregulated sales and ready access on open markets.

Second, as incomes rise, the demand for meat likewise soars. According to FAO data, per capita consumption of meat in developing countries has more than tripled since 1960. Over the same period, meat production in East and South-East Asia increased more than 100-fold.

In other words, economic progress, the very goal of so many development initiatives, means increased demand for meat, increased farming of animals, and an increased potential for the misuse of antimicrobials.

Some analysts have compared the threat of antimicrobial resistance with the threat from climate change. Both are already here. Both are caused by human activities. And both are global threats that demand global solutions, including solutions to problems that are caused by entrenched industry practices.

Ladies and gentlemen,

As in human medicine, veterinary services depend on safe and effective antibiotics to treat sick animals. The focus of concern is the routine use of antibiotics in food-producing animals in very large quantities, especially for growth promotion and for prophylaxis when animals are crowded together under unsanitary conditions.

This concern was formally recognized in 2003 by a scientific assessment jointly convened by FAO, OIE, and WHO. The assessment found “clear evidence” of adverse consequences for human health, including the transmission of resistant bacteria to humans through food.

The consequences were judged particularly severe when pathogens in animals developed resistance to medicines that are critically important for human health.

One outcome was the first WHO list of Critically important antimicrobials for use in human medicine, issued in 2005. These lists are regularly revised to guide the development of risk management strategies for the use of antibiotics in food-producing animals.

The list is now complemented by an OIE list of antimicrobial agents of veterinary importance, which recommends the restricted use of certain agents.

The challenge now is to move from recommended measures and instruments like these lists to implementation, to real and urgent action at global as well as national level.

To stop or reverse some extremely dangerous trends, difficult policy issues need to be addressed.

Our three agencies face similar challenges, including poor surveillance in the health and animal sectors, weak laboratory support and, above all, the almost total absence of regulatory capacity in many countries.

Financial and other incentives undermine the responsible and prudent use of antimicrobials. These agents can be purchased over the Internet, adding to the challenges. In many developing countries, doctors look to pharmaceutical companies as their principal source of prescribing information.

The intensely competitive meat industry is driven to produce ever higher quantities at ever lower prices. Hospitals, even in the richest countries, fail to follow good practices for infection control, including things so basic as hand hygiene.

These are some of the issues that need to be addressed as we jointly develop the global action plan to combat antimicrobial resistance.

Thank you.