The Minister for Health, Simon Harris TD and the Minister for Agriculture, Food and the Marine, Michael Creed TD, today (Wednesday) launched iNAP, Ireland’s first ‘One Health’ National Action Plan on Antimicrobial Resistance 2017-2020.
The launch of the plan represents the next big step in Ireland’s fight against the growing threat of AMR and follows on from the establishment of a National Interdepartmental Antimicrobial Resistance Consultative Committee in 2014.
Commenting on the launch of iNAP, Minister Harris said “we know that the emergence of AMR worldwide is a real and growing public health crisis, which must be tackled. Dealing with AMR requires a united approach, that involves action right across the human health, animal health and environmental sectors. Given that AMR is recognised as a global health issue, it is clear that sectors on their own cannot properly address this concern and a co-ordinated response is required. Both Minister Creed and I are very pleased that Ireland now has a comprehensive national action plan to tackle this growing global challenge.”
Minister Harris added: "We have a stark and on-going reminder of the consequences of AMR when we consider the increasing number of outbreaks of an infection, called CPE, a so called superbug, in the Irish healthcare system. The limited treatment options available for this infection are a reality on the ground for our healthcare providers and patients. The response to CPE and AMR is time sensitive. We are likely to be approaching a tipping point if antibiotic resistance continues unchecked and I am taking particular actions today to address the specific issue of CPE which I view as a public health emergency".
Minister Creed said, "AMR is everyone’s problem and one that cannot be solved unless we all work together to find solutions. In the area of agriculture, solutions need to focus on optimizing animal health, thereby reducing the need to use antibiotics in the first place and ensuring that when antibiotics are used, that they are used in accordance with prudent use guidelines. Good progress has already been made in certain areas but further work needs to be done if we are to combat the growing threat of AMR. Both Minister Harris and I believe that iNAP will give overarching support and direction to all the good work that is already in train across the different sectors at national level.”
Both Ministers thanked all those involved in the development of this joint action plan acknowledging the efforts and commitment of staff in both Departments, who have been working steadily to produce this joint document. Both Ministers thanked all the stakeholders, both public and private, who had made valuable contributions, and the members of the National Interdepartmental Antimicrobial Resistance Consultative Committee for their advice and guidance in relation to the development of the plan.
Both Ministers agreed that “the production of this action plan is another important milestone on the path to combating AMR. That said the real work starts today as together we set about implementing this ambitious plan for our future, for our children’s future and for all of global society.”
iNAP was developed following the WHO Global Action Plan on Antimicrobial Resistance. The plan contains a range of strategic interventions and activities across the human health, animal health and environmental sectors grouped under five strategic objectives aimed at:
1. Improving awareness and knowledge of AMR;
2. Enhancing surveillance of antibiotic resistance and antibiotic use;
3. Reducing the spread of infection and disease;
4. Optimizing the use of antibiotics in human and animal health; and
5. Promoting research and sustainable investment in new medicines, diagnostic tools, vaccines and other interventions
By adopting a ‘One Health’ approach iNAP builds on the structures already in place across the different sectors in a collaborative way. This holistic approach recognises that cross-sectoral cooperation at all levels is the best mechanism to effectively tackle this global challenge, and keep antibiotics working for future generations.
NOTE FOR EDITORS
What is AMR?
Antimicrobial resistance (AMR) is resistance of a microorganism to a drug that was originally effective for treatment of infections caused by that microorganism. Resistant microorganisms (including bacteria, fungi, viruses and parasites) are able to withstand attack by antimicrobial drugs, such as antibacterial drugs (e.g., antibiotics), antifungals, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist, increasing the risk of spread to others.
The evolution of resistant strains is a natural phenomenon that occurs when microorganisms replicate themselves erroneously or when resistant traits are exchanged between them. The use and misuse of antimicrobial drugs accelerates the emergence of drug-resistant strains. Poor infection control practices, inadequate sanitary conditions and inappropriate food handling encourage the further spread of AMR.
What is the effect of AMR?
A European Centre for Disease Control/European Medicines Agency (ECDC/EMEA) 2009 Report estimated that in 2007 drug-resistant bacteria were responsible for about 25,000 human deaths per annum in the EU alone, with associated healthcare costs and productivity losses of €1.5bn. The Report also stated that approx. 4 million patients are estimated to acquire a healthcare associated infection in the EU every year. (ECDC JOINT TECHNICAL REPORT 'The Bacterial Challenge: time to react' (2009)).
What is CPE?
CPE are bugs that live in the bowel and that cannot be treated by certain antibiotics, known as carbapenem antibiotics. CPE is the newest in a long line of ‘superbugs’ or bacteria that are hard to kill with antibiotics
Why is CPE a patient safety concern?
The World Health Organization (WHO), Centre for Disease Control and the European Centre for Disease Prevention and Control (ECDC) all identify that infections with CPE are a serious threat to patient safety due to their resistance to multiple antimicrobials, meaning that there are very few therapeutic options which to treat infected patients.
They are associated with poorer patient outcomes, increase morbidity, mortality and higher hospital costs. Infections with CPE are associated with mortality rates exceeding 40-50%. Outbreaks can result in bed closures and operations being postponed. CPE is not confined to hospitals and can cross all health sectors including the community.
What does ‘One Health’ mean?
The 'One Health' concept is a worldwide strategy for expanding interdisciplinary collaborations and communications in all aspects of health care for humans, animals and the environment. Recognising that human health, animal health and ecosystem health are inextricably linked, ‘One Health’ seeks to promote, improve and defend the health and well-being of all species by enhancing cooperation and collaboration between physicians, veterinarians, other scientific health and environmental professionals and by promoting strengths in leadership and management to achieve these goals.
There is international consensus through the ‘One Health’ Initiative to which the WHO (World Health Organisation), FAO (Food and Agriculture Organisation) and the OIE (World Health Organisation for Animal Health) are signatories, that tackling the global public health threat of AMR requires action across human and animal health sectors, agriculture and the wider environment.
The multi-sector harmonisation of strategies and measures to address the challenge of AMR are necessary at a global, regional, and national level. There has been global intersectoral collaboration since 2010, with the World Organisation for Animal Health (OIE), the World Health Organisation (WHO) and the Food and Agriculture Organisation of the United Nations (FAO) establishing tripartite actions to coordinate strategies to ensure antimicrobials maintain their efficacy, and are used responsibly. These agencies are signatories to a ‘One Health’ worldwide initiative.
The European Commission has also promoted a holistic and multi-sectoral approach involving many groups such as the public health, food safety, animal health and welfare, research and innovation, bio-safety and environment sectors. The EU at both Council and Parliament levels has developed its Community Strategy against AMR having regard to the ‘One Health’ concept.
At a national level the Chief Medical Officer (CMO) and the Chief Veterinary Officer (CVO) of the Department of Health and the Department of Agriculture, Food and the Marine, respectively, established the National Interdepartmental Antimicrobial Resistance Consultative Committee in 2014 as part of the ‘One Health‘ initiative, and to advance a holistic national approach in working together to ensure that effective antibiotics remain available into the future. The Committee is co-chaired by the CMO and CVO and has a clear role and mandate across the human and animal health sectors. Committee membership consists of representatives of both Departments, relevant HSE agencies, EPA, HPRA, FSAI and other key stakeholder groupings in the human and animal health sectors.
What is the World Health Organisation (WHO) Global Action Plan 2015?
In May 2015, delegates at the World Health Assembly endorsed a global action plan to tackle antimicrobial resistance - including antibiotic resistance, the most urgent drug resistance trend.
The plan sets out 5 Strategic Objectives:
1. Improve awareness and understanding of antimicrobial resistance;
2. Strengthen surveillance and research;
3. Reduce the incidence of infection;
4. Optimize the use of antimicrobial medicines;
5. Ensure sustainable investment in countering antimicrobial resistance.
The WHO called on member countries to develop their own national action plans on antimicrobial resistance in line with the Global Action Plan.
What are the other developments at the international level in relation to AMR?
In June 2016, the European Council adopted a set of conclusions in relation to AMR entitled ‘The next steps under a ‘One Health’ approach to combat antimicrobial resistance’. The Council called on Member States to develop national action plans in line with the WHO Action Plan
In September 2016, the UN General Assembly adopted a Political Declaration on Antimicrobial Resistance which reaffirmed that the blueprint for tackling AMR is the WHO Global Action Plan on AMR and its five overarching strategic objectives. The General Assembly reaffirmed countries commitments to produce national action plans based on the five strategic objectives in the WHO Action Plan.
In June 2017 the European Commission published its second AMR action plan entitled 'A European One Health Action Plan against Antimicrobial Resistance (AMR)'. This second action plan builds on the political commitment and actions achieved by the first EU action plan (2011-2016). The overarching goal of the new plan is to preserve the efficacy of antimicrobials so that they remain effective disease treatment options for humans and animals into the future. The plan outlines a range of activities under three strategic headings as follows
(1) Making the EU a best practice region
(2) Boosting research, development and innovation in order to better control the spread of AMR
(3) Strengthening the role of the EU on the global stage to drive actions to address AMR in the context of the ‘One Health’ approach
The Plan provides a 'framework for continued, coherent and more extensive action to tackle AMR'.
iNAP is Ireland's response to international calls to produce a multisectoral action plan to tackle AMR. Ireland is fully committed to and engaged in addressing resolution of the problem of AMR. We will continue to collaborate at international, EU and national levels to this end.