Director-General's Office

WHO Director-General addresses ministerial conference on antimicrobial resistance

Dr Margaret Chan
Director-General of the World Health Organization

Opening remarks at the European Union Ministerial Conference on Antimicrobial Resistance
Amsterdam, Netherlands

10 February 2016

Distinguished Commissioner, honourable ministers of health and agriculture, ladies and gentlemen,

I thank the government of the Netherlands, during its EU presidency and in cooperation with the European Commission, for organizing this ministerial conference on antimicrobial resistance.

The focus is on the development of national action plans that fully engage the agricultural sector, as called for in the global action plan adopted at last year’s World Health Assembly. It is a great pleasure indeed to see so many ministers of agriculture here today.

Netherlands is a most appropriate venue for this event. The Dutch system of food production made this small country an agricultural powerhouse. Much has been written about the country’s success in reducing antimicrobial use, first in medical care and later in food-producing animals.

For more than a decade, the European Union has been a world leader in the struggle to combat AMR. This is readily apparent in the number of policies, directives, technical reports, strategies, and regulatory decisions designed to reduce antibiotic consumption, in humans and animals, ensure the prudent use of these fragile medicines, and protect specific agents that are critically important for human medicine.

You have moved forward in remarkable ways, as reflected in several EU-wide networks for surveillance of both resistance and consumption, and for susceptibility testing.

Significantly, the EU-wide ban on the use of antibiotics as growth promoters in animal feed has not weakened the region’s leading position in global food production.

Compelling evidence shows that resistance is driven by the total volume of antibiotics used, also in food production. Worldwide, antibiotic use in humans, animals, and agriculture is still increasing, despite effective reductions in some countries.

In several large emerging economies, studies have consistently documented a rise in the demand for meat as household incomes improve. This growing demand, especially when met by intensive farming practices, contributes to the massive use of antibiotics in livestock production.

Worldwide, we need to insist that risks to human health guide the prudent use of antibiotics in food production. The WHO list of critically important antimicrobials for human medicine provides a tool for doing so.

The world certainly needs to feed its nearly 7.4 billion people, but not in ways that cause our mainstay antimicrobials to fail. Combatting antimicrobial resistance, in line with the global action plan, is a matter of the utmost urgency.

The health sector, acting alone, cannot possibly contain a threat of this magnitude. We need to work together with partners. Conferences like this one can move a broad agenda forward as a model for the rest of the world.

Ladies and gentlemen,

We face a crisis. We are hearing one alarm bell after another. Minister Schippers mentioned Zika and Ebola, two cross-border epidemics that are currently ongoing. We are meeting here today to discuss AMR, another cross-border slow moving tsunami. Early warnings have been issued on AMR and its impact. We must act.

I urge you to agree on the strongest possible action plans. I urge you to establish an aggressive model for the rest of the world to follow. I urge you to make the kind of noise that signals the need for action on a scale appropriate to the magnitude of this crisis.

Let me focus on one of the most recent of these alarm bells relevant to AMR. The detection last year by Chinese scientists of a new resistance mechanism, the mcr-1 gene, sent shockwaves through the medical and scientific communities.

The gene is located on a mobile loop of DNA that transfers easily from one bacterial strain to others. This is a horizontal transfer of resistance, and it is frightening.

In the Chinese study, the mcr-1 gene conferred resistance to colistin, the last-resort antibiotic used to treat several life-threatening infections caused by Gram-negative bacteria. Resistance to colistin was detected in samples from animals and humans and in food.

Colistin is a 50-year-old antibiotic that was shelved in the 1970s because of its toxic effects on the kidneys. It was brought back into clinical use when all newer antibiotics began to fail.

As colistin had not been widely used, it was still effective. It was also cheap, which encouraged its massive use as a growth promoter in food production in several countries, including China.

The Chinese findings, which have been replicated in several other countries, solidify the links between the agricultural use of antibiotics, resistance in slaughtered animals, resistance in food, and resistance in humans. All of the dots are connected.

If we lose colistin, as several experts are predicting, we lose our last medicine for fighting a number of serious infections.

This is a crisis, and it is global. Resistant pathogens travel well internationally in people, animals, and food. They can also spread directly from one person to another.

In some countries, as many as 35% of newly detected tuberculosis cases are infected with multi-drug resistant strains right at the start, indicating direct person-to-person transmission, not faulty treatment.

Ladies and gentlemen,

We need to take heed of the repeated warnings. I have been asked by my colleague, Monique Eliot, to convey to you the deep engagement of the World Organisation for Animal Health, or OIE, which she heads. I am pleased to do so.

OIE and FAO played a major role in shaping last year’s global action plan. As part of this tripartite effort, under the “one health” banner, the governing bodies of both agencies adopted resolutions supporting the action plan last year.

Together, we have produced a manual and checklist to support the implementation of national action plans. We all share the view that the use of antimicrobials should be supervised by medical and veterinary professionals.

Relevant OIE standards promote the responsible and prudent use of antibiotics in animals to preserve their efficacy and prolong their use in both veterinary and human medicine.

The 3 agencies collaborate very well through formal mechanisms, such as the Advisory group on the integrated surveillance of antimicrobial resistance. The group keeps close watch over the use of antibiotics in the food chain and issues the WHO list of critically important antimicrobials.

The news from this surveillance is not good. We face huge gaps in our ability to monitor the situation in many countries. As this is a global crisis, we need to close these gaps.

We need new diagnostics as well as replacement antimicrobials and more vaccines.

We need to find the business models and incentives to stimulate the relevant R&D.

We need to do more to prevent infections in the first place.

I am confident that this ministerial conference will move the agenda forward on these issues as well.

Thank you.

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