NDM-1 in the Arctic / IACG seeks your views!

Dear All:

Apologies for inundating with updates … the last few days have been very data rich!

In case you missed it, McCann et al. (Env Internat, “Understanding drivers of antibiotic resistance genes in High Arctic soil ecosystems,” link) have found NDM-1, one of our more famous recent resistance genes, in the Arctic. As they state in their abstract, “The most plausible source … is bird and other wildlife guano… and … is concerning.” Deep sigh.

On the action side,IACG (the UN Interagency Coordination Group on Antimicrobial Resistance) has now released its draft recommendations (link) with comments due by 19 Feb 2019 (and see below for discussion of an opportunity to comment in person in London on 7 Feb). The full text of the IACG announcement is below my signature but I’ll summarize for you by saying that at the very highest level the recommendations are:

1. Accelerate progress in countries
2. Innovate to secure the future
3. Collaborate for more effective action
4. Invest for a sustainable response
5. Strengthen accountability and global governance

These are all good themes and there’s a lot of important detail to be found in the primary paper. Of particular interest is the long-term strategy in point 5 of creating a One Health Global Leadership Group for Antimicrobial Resistance that would be “composed of a small group of current and former Heads of State, Ministers of Agriculture, Health and Environment, Heads of the Tripartite agencies, other UN and international agencies, Heads of Regional Banks and other prominent global leaders and eminent persons representing human, animal and plant health, as well as food production and the environment.” Global cooperation is so important and this is a great concept! This feels like it might the AMR-focused equivalent of the The Intergovernmental Panel on Climate Change (IPCC), the United Nations body for assessing the science related to climate change.

As to incentives for work on AMR, there’s a lot of call in points #2 and #4 for various types of investment: “The IACG calls upon public, private and philanthropic donors and other funders to increase investment and innovation in new antimicrobials – particularly antibiotics, diagnostics, vaccines, waste management tools, and safe and effective alternatives to antimicrobials – for human, terrestrial and aquatic animal and plant health.”

Most of the explanatory text focuses on push incentives which are of course welcome and making an outstanding difference (e.g., the > 30 companies in the past and present CARB-X portfolio). The need for pull incentives (e.g., as discussed at Davos 2018 or in the UK’s recent commitment to delinked antibiotics) is implied in some of the comments and I hope that discussion expands over time. As all of you know, we don’t get to have antibiotics in the pharmacy if we won’t reimburse them! For more, please read here (Ardal 2017), here (OHE 2017), here (DRIVE-AB 2017), and here (Davos 2018). I think the need for pull incentives is redoubled by stories such as Allergan’s recent write-off of “$3.5 billion of total goodwill, including $622 million allocated to anti-infectives.” Ouch!

Comments are due to IACG by 19 Feb 2019. And if you’d like to comment in person, there was a tweet yesterday that said: “On Thursday 7th February, the @uniacgamr Secrétariat in collaboration with @wellcometrust will be hosting a discussion with the private sector on the draft recommendations in London. To attend this event, please contact iacg-secretariat@who.int.” 

Get to it! All best wishes, –jr

John H. Rex, MD | Chief Medical Officer, F2G Ltd. | Expert-in-Residence, Wellcome Trust. Follow me on Twitter: @JohnRex_NewAbx. See past newsletters and subscribe for the future: https://13.43.35.2/blog/

Entire public announcement from IACG
Public discussion – Draft recommendations of the Ad hoc Interagency Coordination Group on Antimicrobial Resistance
The Ad hoc Interagency Coordination Group (IACG) on Antimicrobial Resistance was convened by the UN Secretary-General in March 2017 in consultation with the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE) and the World Health Organization (WHO) following a call for its creation in the 2016 Political Declaration of the High-level Meeting on Antimicrobial Resistance (Resolution A/RES/71/3). The IACG’s mandate is to provide practical guidance for approaches needed to ensure sustained effective global action to address antimicrobial resistance. The terms of reference for the IACG include to promote, plan and facilitate collaborative action, to align activities so gaps are closed, and resources are optimally utilized, to explore the feasibility of developing global goals and targets related to antimicrobial resistance, and to report back to the UN Secretary-General by the 73rd General Assembly in 2019. The IACG is composed of representatives from major United Nations and multi-sectoral agencies and a range of individuals with different areas of expertise. More information on the IACG is available here.

The IACG has analysed critical issues in the response to antimicrobial resistance with the aim of informing its report and recommendations. In 2018, it developed discussion papers for public consultation in six thematic areas: 1) public awareness, behaviour change, and communication; 2) National Action Plans on Antimicrobial Resistance; 3) optimizing use of antimicrobials; 4) innovation, research, development, and access; 5) surveillance and monitoring and 6) global governance and alignment with the Sustainable Development Goals (SDGs). To guide its activities, the IACG developed a workplan and an IACG Framework for Action on Antimicrobial Resistance that describes key content areas and relevant levers to address them, building on the political declaration, the Global Action Plan and the SDGs. Feedback obtained from a public consultation process between June and August 2018 and other stakeholder engagement activities including consultation with Member States have informed the development of the draft IACG recommendations in this document.

The IACG report and recommendations will be submitted to the UN Secretary-General by April 2019. In February 2019, prior to finalization of the report, IACG Members and the Secretariat are engaging with partners, including Member States, United Nations organizations, non-governmental and civil society organizations, private sector entities, philanthropic foundations, academic institutions and interested individuals, through web-based discussions and other events, to obtain stakeholder input on the draft recommendations and help ensure that they address key needs in the response to antimicrobial resistance.

All stakeholders are now invited to provide written feedback on the draft IACG recommendations, which may be accessed here:

• https://www.who.int/antimicrobial-resistance/interagency-coordination-group/Draft_IACG_recommendations_for_public_discussion_290119.pdf?ua=1

All feedback should be sent to iacg-secretariat@who.int as soon as possible, and not later than 19 February 2019. Please note the following guidelines when providing feedback:

1. Include the full name, title and affiliation of the respondent (e.g. representing a Member State, organization, or individual) in the email.
2. Feedback should be submitted either directly in the body of the email or as an email attachment (Word document or PDF). Track changes or comments in the original document will not be considered.
3. Feedback should be high level, action-orientated, precise and feasible, bearing in mind that the audience for the IACG recommendations is primarily Member States, political leaders and policy -makers, and that the recommendations aim to address urgent priorities in the global response to antimicrobial resistance and the implementation of the 2016 Political Declaration of the High-level Meeting on Antimicrobial Resistance.
4. The draft recommendations form part of the IACG’s final report, which will include additional background materials and key messages when submitted to the Secretary-General.

As it finalizes its report and recommendations, the IACG will give all due consideration to the comments received but will not respond to individual comments directly.

Upcoming meetings of interest to the AMR community:

• 4-5 Feb 2019 (London): Hamied Foundation UK-India Antimicrobial Resistance Meeting 2019. This is a 2-day meeting focused on building research links between the UK and India with the specific aim of jointly addressing the challenge of AMR. Register here.
• [NEW] 7 Feb 2019 (London): Opportunity to comment in person on the IACG draft recommendations. See this tweet for more details.
• [NEW] 5-6 Mar 2019 (Washington): NIAID-sponsored workshop: Vaccine strategies for endemic fungal pathogens. Register here.
• 14-15 Mar 2019 (Berlin): BEAM-, CARB-X-, Novo REPAIR-, DZIF-, ND4BB-ENABLE-sponsored (among a long list!) Berlin Conference on Novel Antimicrobials and AMR Diagnostics. Details here. Poster submissions are being accepted through 9 Jan (details here).
• [NEW] 18 Mar 2019 (everywhere): Deadline for responding to the WHO call for data on preclinical antibiotic programs. Details here.
• 21-22 Mar 2019 (Birmingham, UK): BSAC Spring Conference.
• 26 Mar 2019 (London, UK): Sponsored by The Economist, a 1-day symposium entitled “Antimicrobial Resistance: Preventing an antibiotic apocalypse.” Register here.
• 28 Mar 2019 (REVIVE webinar, 4-5.30p GMT): “Clinical development for non-developers Part 3: Antibacterial Drug Enhancer Combinations and Non-traditional Products.” Register here.
• [NEW] 11-12 Apr 2019 (Amsterdam): ESGAP–SWAB (European Study Group for Antibiotic Policies – Stichting Werkgroep Antibioticabeleid)Technical Workshop on measuring quantity and quality of antimicrobial use. Register here. 
• 13-16 Apr 2019 (Amsterdam): Annual ECCMID meeting
• 16-18 Apr 2019 (Utrecht): ICOHAR, International Conference on One Health Antimicrobial Resistance. Organized by the ESCMID Study Group for Veterinary Microbiology (ESGVM).
• 24-26 Apr 2019 (Boston): Annual SHEA (Soc. for Hospital Epidemiology of America) Spring meeting
• 6-11 May 2019 (Ljubljana, Slovenia): 37th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID). Details here.
• 3-6 Jun 2019 (Philadelphia): Annual BIO meeting
• 10-11 June 2019 (Research Triangle Park, NC): AMR Action Summit on R&D and Commercialization. Sponsors include the British-American Business Council, the UK Gov’t, CARB-X, the NC Biotechnology Center, and others. Details here.
• 20-24 June 2019 (San Francisco): Annual ASM Microbe meeting.
• [Mark your calendar now!] 3-6 Sep 2019 (Boston). Annual ASM-ESCMID Conference on Antibiotic Development. The Bootcamp series will continue on 3 Sep with the main meeting on 4-6 Sep. Mark your calendar now and check back here for details.
• 6-8 Sep 2019 (Bilbao, Spain): 5th ESCMID conference on Vaccines. Check back here for details.
• 2-6 Oct 2019 (Washington, DC): IDSA’s annual IDWeek meeting.
• 19-27 Oct 2019 (Annecy, France): International Course on Antibiotics and Resistance (ICARe) – A soup-to-nuts intensive residential training program on all things AMR, especially R&D for new antibiotics. See this link for details.