The Strategic Research
Agenda of the Joint
Programming Initiative
on Antimicrobial
Resistance –
Why is it necessary?
Name of speaker:
Date:
Place:
Outline
1. The antimicrobial resistance (AMR) problem
2. Collaborating to find a solution
3. The priority topics
1. The antimicrobial resistance (AMR)
problem
History
In his 1945 nobel prize lecture, Fleming warned of the
dangers of antimicrobial resistance:
“The time may come when penicillin can be bought
by anyone in the shops. Then there is the danger
that the ignorant man may easily underdose
himself and by exposing his microbes to non-lethal
quantities of the drug make them resistant.”
Modern medicine depends on access to
effective antibiotics
Antibiotics revolutionized medicine!
• The introduction of penicillin in the 1950’s
increased the chance of survival for pneumonia
patients from 25% to 80%
Antibiotic Resistance threatens to return us to the
pre-antibiotic era
•In Tanzania, Antibiotic Resistance has decreased the rate of survival
from neonatal gram-negative infections from 70% to 20%
In the EU, more than 25 000 patients die from multidrug
resistant bacteria annually (EMA/ECDC report)
Extra health-care costs and productivity losses of at least
1,5 billion EURO per year
What is AMR?
Antimicrobial resistance (AMR) is the ability of
microorganisms that cause disease to withstand
attack by antimicrobial medicines.
In some parts of the world, once powerful
medicines against malaria and tuberculosis have
now become virtually useless.
AMR is rapidly becoming a major public health
risk and is threatening to undo decades of
advances in treating disease.
Source: WHO
What has led to resistance?






Increased use of antibiotics
Prescriptions taken incorrectly
Sold without medical supervision
Prophylactic use before surgery
Antibiotics used for viral infection
Spread of resistant microbes in hospitals due to
lack of hygiene
 Patients who do not complete course
 Antibiotics in animal feeds
“The more we use them, the more we lose them…”
By courtesy of Dr. Liselotte Diaz Högberg
Facts/context
Few new drugs
being developed
Excessive use
of antibiotics
Increasing number of
resistant strains
Great societal costs
Global problem:
a societal challenge
A Joint Programming Initiative is needed!
The AMR complexity……
…..leads to a problem which cannot be tackled
by one scientific domain or even by research
alone but that needs a collaborative approach
2. Collaborating to find a solution
A global problem!
Worldwide spread of the 23F clone of
penicillin-resistant pneumococci:
U. K
France
Korea
USA
Thailand
Mexico
Taiwan
Singapore
Colombia
Argentina
Japan
Brazil
S. Africa
By courtesy of Dr. Liselotte Diaz Högberg
AMR research facts
– National research on AMR is dispersed
– No common goals
– So far no success in reducing the risk of AMR
The spread of AMR continues
The Strategic Research Agenda (SRA):
uniting under one strategy
 To bring together all players in the field for a multidimensional approach
 To provide a platform for partners to collaborate in a tailormade fashion on specific topics
 To harmonise joint actions and create greater impact
 To reduce research overlaps
 To create awareness and knowledge
 To stand a chance of actually finding a solution to the AMR
problem
What can be achieved by working together?
(1)
 New preventative and therapeutic approaches
 AMR relevant research elements more
embedded in health service and care
infrastructure
 A reduction of inappropriate
consumption of antibiotics in
humans and animals
What can be achieved by working together?
(2)
 A positive impact on treatment, care and quality
of life
 Increased visibility of the burden of AMR and the
benefits of research
 A catalytic effect on the development on national
and international strategies
What exactly is the Strategic Research Agenda?
 The first step to drafting
future research
programmes
 A framework to begin
joint actions
 A framework for creating
an extensive transEuropean work
programme on AMR
3. The priority topics
SRA’s priority topics
 Will form a comprehensive approach for studies
into strategies to reduce the use of antibiotics
 Will minimise the emergence and spread of
antibiotic resistant genes and bacteria
 Will aim to reduce the burden of AMR by 2040
Six priority topics
Therapeutics
• Development of novel antibiotics and alternatives for antibiotics – from
basic research to the market.
Diagnostics
• Design strategies to improve treatment and prevention of infections by
developing new diagnostics.
Surveillance
• Standardisation and extension of surveillance systems to establish a
global surveillance programme on antibiotic resistance and antibiotic use.
Transmission
• Transmission dynamics
Environment
• The role of the environment as a source for the selection and spread.
Interventions
• Designing and testing interventions to prevent acquisition, transmission
and infection caused by AMR.
Therapeutics: what’s the story?
 The discovery of new antibiotics has slowed in
the last 40 years
 Even the few recently developed classes of
antibiotics report resistance already
 Large pharma withdraw because of huge
development costs
 Antibiotics are undervalued and underpriced
Therapeutics: what the SRA aims to do
 Find new targets for
antibiotics
 Develop new
antibiotics
 Improve
pharmakinetics and
pharmacodynamics of
neglected antibiotics
What the SRA aims to do (cont’d)
 Develop treatment protocols based on
combination therapy using existing and new
antibiotics
 Develop alternatives for antibiotics (vaccines)
 Develop and study effect of policy measures and
economic stimuli to minimise barriers for the
development and introduction of new antibiotics
Diagnostics: what’s the story?
 Up to 70% of antibiotics are prescribed
incorrectly
– Physicians cannot make precise diagnosis
 Diagnostic strategies can help identify patients
and animals who really need antibiotics
 Reimbursements structures used by
governments and health insurers need to allow
for diagnostics
What’s the story (cont’d)
 Diagnostic technologies exist but are costly and
have not been developed with the current reality
of health care in mind
 Behaviour change to use diagnostic
technologies is needed:
– clinicians, veterinarians, farmers, patients
Diagnostics: what the SRA aims to do?
 Improve existing and develop new diagnostic
tools:
– that more effectively distinguish between viral and
bacterial infections
– that can promote the use of narrow spectrum
antibiotics
– for the identification of antibiotic resistance bacteria;
including their resistance profile
 Identify and remove current barriers that inhibit
the acceptance of rapid diagnostic tests
Surveillance: what’s the story?
 Human travel and migration and the transport of
food and animals enable greater spread of the
genetic elements responsible for AMR
 Crucial surveillance data is so far lacking
 Countries have different levels of surveillance
and many lack national reporting systems
What’s the story (cont’d)
 Current surveillance programmes do not meet
the needs of policy makers, professionals and
researchers
 No existing international surveillance reporting
system allowing for integration of data
 Lack of existing data on:
– Morbidity and mortality
– Economic costs
– Associations between the emergence of resistance in
humans and in animals
Surveillance: why do we need it?






To quantify the burden of resistance
To serve as a warning system
To guide policy makers
To track transmission routes
To detect and control localised outbreaks
To document impact of interventions and efforts
to reduce AMR
Surveillance: what the SRA aims to do
 Perform operational research on the
standardisation and extension of existing
surveillance systems
 Carry out a pilot study on the feasibility of a
global phenotypic and genotypic surveillance
programme for AMR
 Initiate a surveillance programme for antibiotic
use in people and animals
Transmission: what’s the story?
 Understanding the complexity of how resistance
is spread is crucial to be able to design
preventative measures
Transmission: what the SRA aims to do
 Determine by which mechanisms and how efficiently
AMR can spread among bacteria that populate the
human and animal intestinal tract
 Determine whether food is an important vector for
the spread of AMR
 Determine the effect of migration, tourism, different
health care systems and agricultural exposure of
humans to antibiotics and AMR
 Provide testable hypothesis for intervention studies
that are aimed at controlling the emergence and
spread of AMR
Environment: what’s the story?
 Environmental risk factors for the spread of
resistant bacteria have not been assessed
 Lack of systematic analysis of food
contamination, in particular in relation to
environmental contamination
 Unclear how current practices in food production
could contribute to the spread of AMR
 No systematic programme that addresses the
impact of sewage on resistance in the
environment, animals, food contamination and
potable water
Environment: what the SRA aims to do
 Perform risk assessment studies to estimate the
various transmission pathways from the
environment to humans
 Perform a meta-analysis of current national and
international activities that are aimed at reducing
the contamination of the environment by human
and animal waste and by human activity with
antibiotics and resistant bacteria
What the SRA aims to do (cont’d)
 Determine the exact role of various
environmental reservoirs (eg surface water,
soild, air) on the emergence and dissemination
of AMR
 Understand the basic biological process that
underlies these phenomena to develop
remediative and preventative measures
Interventions: what’s the story?
 Little biomedical research on resistance has
been translated into interventions to improve
health care
 Most interventions to control AMR to date have
been based on experience, empiricism and
common sense; rather than strong evidence
 Lack of evidence base also in veterinary science
 Controlled integrated studies in society, health
care and agricultural settings are urgently
needed
Interventions: what the SRA aims to do
 Initiate large-scale, international projects in
which interventions to prevent and control the
spread of AMR can be tested in different settings
 Compare and combine AMR prevention and
control practices in cost efficacy trials
 Perform research to optimise implementation
strategies of interventions aimed at reducing
AMR
JPIAMR anchors the priority topics
By
 establishing a biobank of clinical specimens and
strains
 establishing a database containing information on
on-going AMR research (including veterinary and
environmental samples)
 collaborating with stakeholders
 raising awareness of AMR
 putting focus on antibiotic resistance in bacteria that
cause life-threatening infection during hospitalisation
JPIAMR Participating countries (19)
Belgium
France
Netherlands
Sweden
Canada
Germany
Norway
Switzerland
Czech
Republic
Greece
Poland
Turkey
Denmark
Finland
Israel
Italy
Romania
Spain
United Kingdom
SRA launch conference
“Implementing a Global Research Agenda for AMR”
Brussels, 3rd April 2014
Conference Objectives:
 Recognition and awareness for the SRA
 Future collaboration between research funding
agencies in the field of AMR
 Participation of private funders
 Developing global funding opportunities
 Work towards a global Joint Programming
Initiative
Thank you
More information at:
www.jpiamr.eu