World Health Organization, Antimicrobial Resistance rev sea hlm 413
The World Health Assembly and the WHO Regional Committee for SouthEast Asia have endorsed several resolutions on antimicrobial resistance
(AMR). These resolutions reflect the commitment of all Member States and
also provide a roadmap for combating AMR. The resolutions contained in
this compilation provide guidance for initiating activities to prevent and
contain AMR.
Antibiotics save lives
Take antibiotics as prescribed for the full duration
Vaccinate children against preventable diseases
Follow a healthy lifestyle and reduce the need for antibiotics
Throw away old medicines and never self-medicate
Antimicrobial resistance
Resolutions of the
World Health Assembly and
WHO Regional Committee for South-East Asia
Combat antimicrobial resistance—
No action today, no cure tomorrow
Antibiotics are
a precious resource
Take antibiotics only as prescribed
Help prevent the emergence of
resistance
World Health House
Indraprastha Estate,
Mahatma Gandhi Marg,
New Delhi-110002, India
Email: cds@searo.who.int
www.searo.who.int
USE ANTIBIOTICS RATIONALLY
Antimicrobial Resistance
SEA-HLM-413
SEA-HLM-413
Antimicrobial resistance
Resolutions of the
World Health Assembly and
WHO Regional Committee for South-East Asia
© World Health Organization 2011
Reprinted in 2014
All rights reserved. Requests for publications, or for permission to reproduce
or translate WHO publications, whether for sale or for noncommercial
distribution, can be obtained from Publishing and Sales, World Health
Organization, Regional Ofice for South-East Asia, Indraprastha Estate,
Mahatma Gandhi Marg, New Delhi-110 002, India (fax: +91-11-23370197;
e-mail: publications@ searo.who.int).
The designations employed and the presentation of the material in this
publication do not imply the expression of any opinion whatsoever on
the part of the World Health Organization concerning the legal status of
any country, territory, city or area or of its authorities, or concerning the
delimitation of its frontiers or boundaries. Dotted lines on maps represent
approximate border lines for which there may not yet be full agreement.
The mention of speciic companies or of certain manufacturers’ products
does not imply that they are endorsed or recommended by the World
Health Organization in preference to others of a similar nature that are
not mentioned. Errors and omissions excepted, the names of proprietary
products are distinguished by initial capital letters.
All reasonable precautions have been taken by the World Health Organization
to verify the information contained in this publication. However, the published
material is being distributed without warranty of any kind, either expressed
or implied. The responsibility for the interpretation and use of the material
lies with the reader. In no event shall the World Health Organization be
liable for damages arising from its use.
This publication contains the collective views of an international group of
experts and does not necessarily represent the decisions or the stated
policy of the World Health Organization.
Printed in India
Contents
1.
Antimicrobial resistance
WHA67.25 .................................................................... 1
2.
Prevention and containment of antimicrobial resistance
SEA/RC63/R4 ................................................................ 6
3.
Progress in the rational use of medicines
WHA60.16 .................................................................... 9
4.
Improving the containment of antimicrobial resistance
WHA58.27 ...................................................................13
5.
Global health security: epidemic alert and response
WHA54.14 ...................................................................16
6.
Emerging and other communicable diseases:
antimicrobial resistance
WHA51.17 ...................................................................18
Antimicrobial resistance
iii
Antimicrobial resistance
WHA67.25
The Sixty-seventh World Health Assembly,
Having considered the report on antimicrobial drug resistance;1
Recognizing WHO’s leadership role in the containment of
antimicrobial resistance;
Recalling resolutions WHA39.27 and WHA47.13 on the rational
use of drugs, WHA51.17 on emerging and other communicable
diseases: antimicrobial resistance, WHA54.14 on global health
security, WHA58.27 on improving the containment of antimicrobial
resistance, WHA60.16 on progress in the rational use of medicines
and WHA66.22 on follow up of the report of the Consultative
Expert Working Group on Research and Development: Financing
and Coordination;
Aware that access to effective antimicrobial agents constitutes
a prerequisite for most of modern medicine, that hard-won gains in
health and development, in particular those brought about through
the health-related Millennium Development Goals, are at risk due
to increasing resistance to antimicrobials, and that antimicrobial
resistance threatens the sustainability of the public health response
to many communicable diseases, including tuberculosis, malaria
and HIV/AIDS;
Aware that the health and economic consequences of
antimicrobial resistance constitute a heavy and growing burden on
high-, middle- and low-income countries, requiring urgent action
at national, regional and global levels, particularly in view of the
limited development of new antimicrobial agents;
1
Document A67/39.
Antimicrobial resistance
1
Recognizing that the main impact of antimicrobial resistance
is on human health, but that the contributing factors and
consequences, including economic and others, go beyond health
and therefore there is a need for a coherent, comprehensive and
integrated approach at global, regional and national levels, in
a “One Health” approach and beyond, involving different actors
and sectors such as human and veterinary medicine, agriculture,
environment and consumers;
Noting that awareness of the broad scope and urgency of the
threat posed has been limited and that previous resolutions of
the Health Assembly and WHO’s strategies for the containment of
antimicrobial resistance have not yet been widely implemented;
Recognizing that antimicrobial resistance involves a wide range
of pathogens including bacteria, viruses and parasites but that the
development of resistance among some pathogens, particularly
antibiotic-resistant bacteria, is of particular urgency and most in
need of immediate attention;
Welcoming the establishment of the WHO Global Task Force on
Antimicrobial Resistance and the tripartite collaboration between
FAO, OIE and WHO,
1.
1
2
URGES Member States:1
(1)
to increase political awareness, engagement and
leadership in order to accelerate efforts to secure access
to effective antimicrobials and to use them responsibly;
(2)
to take urgent action at national, regional and local
levels to strengthen infection prevention and control,
by means that include application of basic hygiene
measures;
(3)
to develop or strengthen national plans and strategies
and international collaboration for the containment of
antimicrobial resistance;
And, where appropriate, regional economic integration organizations.
Antimicrobial resistance
(4)
to mobilize human and inancial resources in order
to implement plans and strategies to strengthen the
containment of antimicrobial resistance;
(5)
to strengthen overall pharmaceutical management
systems, including regulatory systems and supply
chain mechanisms, and, where appropriate, laboratory
infrastructure, with a view to ensuring access to and
availability of effective antimicrobial agents, taking
into account inancial and other incentives that might
have a negative impact on policies for prescribing and
dispensing;
(6)
to monitor the extent of antimicrobial resistance
including regular monitoring of the use of antibiotics
in all relevant sectors, in particular health and
agriculture, including animal husbandry, and to share
such information so that national, regional and global
trends can be detected and monitored;
(7)
to improve, among all relevant care providers, the public
and other sectors and stakeholders, awareness of (i) the
threat posed by antimicrobial resistance, (ii) the need
for responsible use of antibiotics and (iii) the importance
of infection prevention and control measures;
(8)
to encourage and support research and development,
including by academia and through new collaborative
and inancial models, to combat antimicrobial resistance
and promote responsible use of antimicrobial medicines,
develop practical and feasible approaches for extending
the lifespan of antimicrobial medicines and encourage
the development of novel diagnostics and antimicrobial
medicines;
(9)
to collaborate with the Secretariat in developing and
implementing a draft global action plan to combat
antimicrobial resistance, including antibiotic resistance,
which is based on all available evidence and best
practices;
Antimicrobial resistance
3
(10) to develop antimicrobial resistance surveillance systems
in three separate sectors: (i) inpatients in hospitals;
(ii) outpatients in all other health care settings and the
community; and (iii) animals and non-human usage of
antimicrobials;
2.
4
REQUESTS the Director-General:
(1)
to ensure that all relevant parts of the Organization,
at headquarters, regional and country levels, are
actively engaged and coordinated in promoting work
on containing antimicrobial resistance, including
through the tracking of resource lows for research and
development on antimicrobial resistance in the new
global health research and development observatory;
(2)
to set aside adequate resources for the work in the
Secretariat, in line with the Programme budget 2014–
2015 and the Twelfth General Programme of Work,
2014–2019;
(3)
to strengthen the tripartite collaboration between FAO,
OIE and WHO for combating antimicrobial resistance in
the spirit of the “One Health” approach;
(4)
to explore with the United Nations Secretary-General
options for a high-level initiative, including a high-level
meeting, to increase political awareness, engagement
and leadership on antimicrobial resistance;
(5)
to develop a draft global action plan to combat
antimicrobial resistance, including antibiotic resistance,
which addresses the need to ensure that all countries,
especially low- and middle-income countries, have
the capacity to combat antimicrobial resistance and
which takes into account existing action plans and all
available evidence and best practice as well as the
recommendations of WHO’s Strategic Technical Advisory
Group on antimicrobial resistance and the WHO policy
package to combat antimicrobial resistance, which asks
Member States:
Antimicrobial resistance
(a)
to co mmit to a co mp r eh ens iv e, finan ced
national plan with accountability and civil society
engagement;
(b)
to strengthen surveillance and laboratory
capacity;
(c)
to ensure uninterrupted access to essential
medicines of assured quality;
(d)
to regulate and promote rational use of
medicines, including in animal husbandry, and
ensure proper patient care;
(e)
to enhance infection prevention and control;
(f)
to foster innovation and research and
development for new tools;
(6)
to apply a multisectoral approach to inform the drafting
of the global action plan, by consulting Member States1
as well as other relevant stakeholders, especially other
multilateral stakeholders, such as FAO and OIE, taking
into account the need to manage potential conlicts of
interest;
(7)
to submit to the Sixty-eighth World Health Assembly,
through the Executive Board at its
(8)
136th session, a draft global action plan to combat
antimicrobial resistance, including antibiotic resistance,
together with a summary report on progress made in
implementing the other aspects of this resolution.
(Ninth plenary meeting, 24 May 2014
A67/VR/9)
1
And, where appropriate, regional economic integration organizations.
Antimicrobial resistance
5
Prevention and containment of
antimicrobial resistance
SEA/RC63/R4
The Regional Committee,
Recalling World Health Assembly resolutions (WHA37.33,
WHA51.17, WHA54.11 and WHA58.27) on rational use of drugs
and prevention of antimicrobial resistance,
Concerned at the emergence and rapid spread of resistance in
several microorganisms to the available antimicrobial agents across
the South-East Asia Region, the unregulated and unauthorized
availability of antimicrobial agents, irrational use of antimicrobials
in medical practice and in the community, and the extensive use of
antimicrobial agents for non-therapeutic purposes in the veterinary
and ishery sectors, thus creating avoidable selection pressure to
emergence of resistance,
Noting that antimicrobial resistance is increasingly hampering
treatment of infectious diseases as a result either of totally
ineffective currently available antimicrobials or of the high cost
and toxic effects of newer drugs,
Aware that there is a lack of investment in the development of
new antimicrobials, and that the eficacy of existing antimicrobials
must therefore be preserved,
Recognizing that antimicrobial resistance in tuberculosis, malaria
and human immunodeiciency virus will impede the achievement
of health-related Millennium Development Goals (MDGs),
Noting the impact of resistant organisms in the eficient utilization
of modern technological and scientiic advances in improving human
health through complex surgeries and transplantation procedures,
6
Antimicrobial resistance
and the inadequacy of rational prescription and administration of
antimicrobial agents,
Further noting the tendency of communities to use antimicrobial
agents as a panacea for all illnesses and the poor adherence to
the recommended regimen,
Aware of the international implications of the problem of
resistant organisms crossing national boundaries through travel,
trade and foodchains, and
Recognizing the growing public health importance of antimicrobial
resistance and its increasing impact on health systems,
1.
URGES Member States:
(1)
to encourage the development of coordination mechanisms against antimicrobial resistance and establishment of appropriate governance mechanisms to combat
antimicrobial resistance;
(2)
to establish national surveillance systems for monitoring
of antimicrobial resistance, use of antimicrobial agents
in humans and animals and their impact on human
health and economy;
(3)
to effectively enforce the legislation and regulations
that counteract the manufacture, sale and distribution
of substandard antimicrobial agents and prohibit the
unauthorized sale of antimicrobial agents;
(4)
to work with relevant government departments in
discouraging the non-therapeutic use of antimicrobial
agents in the veterinary and ishery sectors;
(5)
to emphasize educational programmes for health and
veterinary students and professionals to comply with
the rational use of antimicrobial agents, to improve
practices to prevent the spread of resistant pathogens,
and to promote appropriate antimicrobial use in healthcare facilities, in the community, and in animal feed
production;
Antimicrobial resistance
7
2.
8
(6)
to strengthen infection control programmes to control
infectious diseases, especially in hospital settings, in
order to contain hospital-acquired infections;
(7)
to support operational research on behavioural aspects
and interventions to contain the irrational use of
antimicrobials, and laboratory and clinical research to
understand the technical dimension of antimicrobial
resistance;
(8)
to initiate community-awareness campaigns to solicit
people’s active cooperation in the rational use of
antimicrobial agents; and
REQUESTS the Regional Director:
(1)
to assist in the development of coordination mechanisms
to establish and implement sustainable national policies
and strategic frameworks for rational antimicrobial use
in the health and veterinary sectors;
(2)
to support development of national surveillance networks, especially laboratory capacity, for monitoring
antimicrobial resistance and use of antimicrobials;
(3)
to facilitate sharing of knowledge and information
between countries and regions, and to document best
practices in combating antimicrobial resistance;
(4)
to develop generic technical and educational material
that can be adapted by countries in monitoring resistance
and educating health professionals and communities;
(5)
to collaborate with nongovernmental organizations that
are engaged in containing antimicrobial resistance and
bring about a synergy in their actions for the beneit
of the Region;
(6)
to support capacity building in research on prevention
and containment of antimicrobial resistance; and
(7)
to compile and share evidence with Member States
on the use of antimicrobial agents in animals and its
impact on the emergence of antimicrobial resistance
and on human health.
Antimicrobial resistance
Progress in the rational
use of medicines
WHA60.16
The Sixtieth World Health Assembly,
Having considered the report on rational use of medicines:
progress in implementing the WHO medicines strategy;1
Recalling the report on rational use of medicines by prescribers
and patients discussed at the Fifty-eighth World Health Assembly
and followed by adoption of resolution WHA58.27 on antimicrobial
resistance;
Recalling resolutions WHA39.27, WHA41.16 and WHA47.13 on
the rational use of drugs, WHA41.17, WHA45.30 and WHA47.16
on ethical criteria for medicinal drug promotion, WHA43.20 and
WHA45.27 on the WHO Action Programme on Essential Drugs,
WHA47.12 on the role of the pharmacist, WHA49.14 and WHA52.19
on the revised drug strategy, WHA51.9 on cross-border advertising,
promotion and sale of medical products using the Internet, and
WHA54.11 on the WHO medicines strategy;
Recognizing the efforts of WHO, in collaboration with
governments, universities, the private sector and nongovernmental
organizations, in areas related to health-care delivery systems
and health-insurance programmes in order to improve the use of
medicines by prescribers, dispensers and patients;
Aware of the core components of WHO’s strategy for promoting
the rational use of medicines;2
1
2
Document A60/24.
Document WHO/EDM/2004.5.
Antimicrobial resistance
9
Wishing to promote evidence-based rational use of medicines
by providers and consumers and better access to essential
medicines;
Aware that irrational use of medicines continues to be an urgent
and widespread problem in the public and private health sector in
developed and developing countries, with serious consequences in
terms of poor patient outcome, adverse drug reactions, increasing
antimicrobial resistance and wasted resources;
Acknowledging that successful implementation of previous
resolutions on antimicrobial resistance cannot be achieved without
addressing the global problem of irrational use of medicines;
Recognizing that many countries do not have a stringent
drug-regulatory authority nor a full national programme or body
to promote rational use of medicines;
Emphasizing that global initiatives to increase access to
essential medicines should adhere to the principle of rational use
of medicines, and include adherence by patients;
Concerned that insuficient attention and resources are being
directed towards tackling the problem of irrational use of medicines
by prescribers, dispensers and consumers;
Emphasizing the need for a comprehensive, sustainable,
national and sector-wide approach to promote the rational use of
medicines;
Recognizing that financing of medicines and methods of
arrangements for provider payments can have a major impact on
rational use, and that appropriate policies on inancing health care
are required;
Recognizing that there may be incentives for the irrational use
of medicines throughout the health system, for example, in some
circumstances which give rise to conlict of interest;
Concerned that direct-to-consumer or Internet sales may give
rise to irrational use of medicines;
10
Antimicrobial resistance
Convinced that it is time for governments, the health professions,
civil society, the private sector and the international community
to pledge their commitment, including adequate resources, to
promoting the rational use of medicines,
1.
3
URGES Member States:3
(1)
to invest suficiently in human resources and provide
adequate financing for strengthening institutional
capacity in order to ensure more appropriate use of
medicines in both the public and private sectors;
(2)
to consider establishing and/or strengthening, as
appropriate, a national drug regulatory authority and a
full national programme and/or multidisciplinary body,
involving civil society and professional bodies, to monitor
and promote the rational use of medicine;
(3)
to consider developing, strengthening and implementing,
where appropriate, the application of an essential
medicines list into the beneit package of the existing
or new insurance funds;
(4)
to develop and strengthen existing training programmes
on rational use of medicines, to ensure that they
are taken into account in the curricula for all health
professionals and medical students, including their
continuing education, where appropriate, and to
promote programmes of public education in rational
use of medicines;
(5)
to enact new, or enforce existing, legislation to ban
inaccurate, misleading or unethical promotion of
medicines, to monitor promotion of medicines, and to
develop and implement programmes that will provide
independent, nonpromotional information about
medicines;
(6)
to develop and implement national policies and
programmes for improving use of medicines, including
clinical guidelines and essential medicines lists,
And regional economic integration organizations, where appropriate.
Antimicrobial resistance
11
as appropriate, with an emphasis on multifaceted
interventions targeting both the public and private health
sectors, and involving providers and consumers;
2.
(7)
to consider developing, and strengthening where
appropriate, the capacity of hospital drug and
therapeutic committees to promote the rational use of
medicines;
(8)
to expand to national level sustainable interventions
successfully implemented at local level;
REQUESTS the Director-General:
(1)
to strengthen the leadership and evidence-based
advocacy role of WHO in promoting rational use of
medicines;
(2)
in collaboration with governments and civil society,
to strengthen WHO’s technical support to Member
States in their efforts to establish or strengthen,
where appropriate, multidisciplinary national bodies for
monitoring use of medicines, and implementing national
programmes for the rational use of medicines;
(3)
to strengthen the coordination of international inancial
and technical support for rational use of medicines;
(4)
to promote research, particularly on development of
sustainable interventions for rational use of medicines
at all levels of the health sector, both public and
private;
(5)
to promote discussion among health authorities,
professionals and patients on the rational use of
medicines;
(6)
to report to the Sixty-second World Health Assembly,
and subsequently biennially, on progress achieved,
problems encountered and further actions proposed in
the implementation of WHO’s programmes to promote
rational use of medicines.
(Eleventh plenary meeting, 23 May 2007 –
Committee B, second report)
12
Antimicrobial resistance
Improving the containment of
antimicrobial resistance
WHA58.27
The Fifty-eighth World Health Assembly,
Having considered the report on rational use of medicines by
prescribers and patients;1
Acknowledging that the containment of antimicrobial resistance
is a prerequisite for attaining several of the internationally agreed
health-related goals contained in the United Nations Millennium
Declaration;
Recalling the recommendations of the Second International
Conference on Improving Use of Medicines (Chiang Mai, Thailand,
2004);
Recalling also the indings of relevant WHO reports, including
“Priority medicines for Europe and the world”,2 and the Copenhagen
Recommendation from the European Union conference on “The
Microbial Threat” (Copenhagen, 1998);
Aware that the spread of antimicrobial resistance recognizes
no national boundaries and has reached proportions that require
urgent action at national, regional and global levels, especially in
view of the decreasing development of new antimicrobial agents;
Recalling previous resolutions WHA39.27 and WHA47.13 on
the rational use of drugs, WHA51.17 on antimicrobial resistance,
and WHA54.14 on global health security;
Recognizing the efforts of WHO, in collaboration with
governments, universities, the private sector and nongovernmental
1
2
Document A58/14.
Document WHO/EDM/PAR/2004.7.
Antimicrobial resistance
13
organizations, to contain antimicrobial resistance, thereby
contributing to prevention of the spread of infectious diseases;
Noting that, despite some progress, the strategy for containment
of antimicrobial resistance has not been widely implemented;3
Wishing to intensify efforts to contain antimicrobial resistance
and to promote rational use of antimicrobial agents by providers
and consumers in order to improve global health security;
Re-emphasizing the need for a coherent, comprehensive and
integrated national approach to promoting the containment of
antimicrobial resistance;
Convinced that it is time for governments, the health professions,
civil society, the private sector and the international community to
reafirm their commitment to ensuring that suficient investment
is made to contain antimicrobial resistance,
1.
3
14
URGES Member States:
(1)
to ensure the development of a coherent, comprehensive
and integrated national approach to implementing the
strategy for containment of antimicrobial resistance
taking account, where appropriate, of inancial and
other incentives that might have a harmful impact on
policies for prescribing and dispensing;
(2)
to enhance rational use of antimicrobial agents, including
through development and enforcement of national
standard-practice guidelines for common infections, in
public and private health sectors;
(3)
to strengthen, as appropriate, their legislation on
availability of medicines in general and of antimicrobial
agents in particular;
(4)
to mobilize human and inancial resources in order to
minimize the development and spread of antimicrobial
resistance, in particular by promotion of the rational use
of antimicrobial agents by providers and consumers;
(5)
to monitor effectively and to control nosocomial
infections;
Document WHO/CDS/CSR/DRS/2001.2.
Antimicrobial resistance
2.
(6)
to monitor regularly the use of antimicrobial agents
and the level of antimicrobial resistance in all relevant
sectors;
(7)
to share actively knowledge and experience on best
practices in promoting the rational use of antimicrobial
agents;
REQUESTS the Director-General:
(1)
to strengthen the leadership role of WHO in containing
antimicrobial resistance;
(2)
to accelerate the implementation of resolutions WHA51.17
and WHA54.14 concerning the containment of antimicrobial resistance by expanding and strengthening the
provision of technical support to Member States, at
their request;
(3)
to collaborate with other relevant programmes and
partners in order to promote the appropriate use of
antimicrobial agents in the context of the rational use
of medicines, by scaling up interventions proven to
be effective, and to provide support for the sharing
of knowledge and experience among stakeholders on
best practice;
(4)
to provide support for the generation of up-to-date
information on antimicrobial resistance at regional and
subregional levels and to make this available to Member
States and other parties;
(5)
to provide support for gathering and sharing of
evidence on cost-effective interventions for prevention
and control of antimicrobial resistance at national and
local levels;
(6)
to report to the Sixtieth World Health Assembly, and
subsequently on a regular basis, on progress achieved,
problems encountered and further actions proposed in
implementing this resolution.
(Ninth plenary meeting, 25 May 2005 –
Committee A, seventh report)
Antimicrobial resistance
15
Global health security: epidemic
alert and response
WHA54.14
The Fifty-fourth World Health Assembly,
Recalling resolutions WHA48.7 on the International Health
Regulations, WHA48.13 on new,emerging and re-emerging
infectious diseases, and WHA51.17 on antimicrobial resistance;
Recalling that public health is a priority for development and
that combating communicable diseases, which are a major burden
in terms of human mortality and morbidity, provides important and
immediate opportunities for progress;
Mindful of the globalization of trade and of the movement of
people, animals, goods and food products, as well as the speed
with which these take place;
Recognizing that, as a result, any upsurge in cases of infectious
disease in a given country is potentially of concern for the
international community,
1.
16
EXPRESSES its support for:
(1)
ongoing work on the revision of the International Health
Regulations, including criteria to deine what constitutes
a health emergency of international concern;
(2)
development of a global strategy for containment
and, where possible, prevention of antimicrobial drug
resistance;
(3)
collaboration between WHO and all potential technical
partners in the area of epidemic alert and response,
including relevant public sectors, intergovernmental
organizations, nongovernmental organizations and the
private sector;
Antimicrobial resistance
2.
3.
URGES Member States:
(1)
to participate actively in the veriication and validation
of surveillance data and information concerning health
emergencies of international concern, together with
WHO and other technical partners;
(2)
to develop and update national preparation and response
plans;
(3)
to develop training for the staff involved and the exchange of good practice between specialists in response
to alerts;
(4)
to update regularly information on the resources
available for the surveillance and control of infectious
diseases;
(5)
to designate a focal point for the International Health
Regulations;
REQUESTS the Director-General:
(1)
to devise relevant international tools, and to provide
technical support to Member States for developing or
strengthening preparedness and response activities
against risks posed by biological agents, as an integral
part of their emergency management programmes;
(2)
to provide technical support to Member States for developing intervention programmes that prevent epidemics and respond to communicable disease threats and
emergencies, particularly with regard to epidemiological
investigations, laboratory diagnoses and community and
clinical management of cases;
(3)
to make appropriate arrangements for the development
of regional preparedness and response plans;
(4)
to provide support to Member States for strengthening
their capacity to detect and respond rapidly to communicable disease threats and emergencies, especially by
developing the laboratory skills needed for diagnosis and
providing training in epidemiological methods for use in
the ield, particularly in the most exposed countries;
(5)
to make available relevant information on public health
risks to Member States, relevant intergovernmental
organizations and technical partners;
(6)
to provide technical support to Member States in the
implementation of national efforts to contain and
prevent resistance to antimicrobials.
(Ninth plenary meeting, 21 May 2001 – A54/VR/9)
Antimicrobial resistance
17
Emerging and other
communicable diseases:
antimicrobial resistance
WHA51.17
The Fifty-irst World Health Assembly,
Having considered the report of the Director-General on emerging
and other communicable diseases: antimicrobial resistance;
Concerned about the rapid emergence and spread of human
pathogens resistant to available antibiotics;
Aware that antimicrobial resistance is increasingly hampering
treatment of infectious diseases as a result either of totally
ineffective antibiotics currently available or of the high cost of
“new generation” agents;
Concerned about the extensive use of antibiotics in food
production, which may further accelerate the development of such
resistance,
1.
18
URGES Member States:
(1)
to encourage the development of sustainable systems
to detect antimicrobial-resistant pathogens, thereby
increasing awareness of antimicrobial resistance, and
to monitor volumes and patterns of use of antimicrobial
agents and the impact of control measures;
(2)
to develop educational programmes for professional staff
and the general public to encourage the appropriate and
cost-effective use of antimicrobial agents;
(3)
to improve practices to prevent the spread of infection
and thereby the spread of resistant pathogens, and
to promote appropriate antibiotic use in health care
facilities and in the community;
Antimicrobial resistance
2.
(4)
to develop measures to protect health workers from
the hazards of resistant pathogens;
(5)
to develop measures to prohibit the dispensing of
antimicrobials without the prescription of a qualiied
health-care professional;
(6)
to strengthen legislation to prevent the manufacture,
sale and distribution of counterfeit antimicrobial agents
and the sale of antibiotics on the informal market;
(7)
to take measures to encourage the reduced use of
antimicrobials in food-animal production;
REQUESTS the Director-General:
(1)
to support countries in their efforts to control
antimicrobial resistance through the strengthening
of laboratory capacity for the detection of resistant
pathogens;
(2)
to collaborate in developing sustainable national policies
for rational antimicrobial use, not only in human
medicine, but also in food-animal production;
(3)
to collaborate with the public health sector, the
pharmaceutical industry, universities and institutions
concerned with research, laboratory testing, marketing,
prescription and consumption of antimicrobial agents,
in order to encourage the sharing of knowledge and
resources to combat antimicrobial resistance;
(4)
to devise means for the gathering and sharing of
information by countries and regions concerning
resistance in certain pathogens and to promote
international cooperation among Member States;
(5)
to develop programmes of information and education
for prescribers and users of antimicrobial agents;
(6)
to encourage promotion of research and development
of new antimicrobial agents.
(Tenth plenary meeting, 16 May 1998 – A51/VR/10)
Antimicrobial resistance
19
The World Health Assembly and the WHO Regional Committee for SouthEast Asia have endorsed several resolutions on antimicrobial resistance
(AMR). These resolutions reflect the commitment of all Member States and
also provide a roadmap for combating AMR. The resolutions contained in
this compilation provide guidance for initiating activities to prevent and
contain AMR.
Antibiotics save lives
Take antibiotics as prescribed for the full duration
Vaccinate children against preventable diseases
Follow a healthy lifestyle and reduce the need for antibiotics
Throw away old medicines and never self-medicate
Antimicrobial resistance
Resolutions of the
World Health Assembly and
WHO Regional Committee for South-East Asia
Combat antimicrobial resistance—
No action today, no cure tomorrow
Antibiotics are
a precious resource
Take antibiotics only as prescribed
Help prevent the emergence of
resistance
World Health House
Indraprastha Estate,
Mahatma Gandhi Marg,
New Delhi-110002, India
Email: cds@searo.who.int
www.searo.who.int
USE ANTIBIOTICS RATIONALLY
Antimicrobial Resistance
SEA-HLM-413
(AMR). These resolutions reflect the commitment of all Member States and
also provide a roadmap for combating AMR. The resolutions contained in
this compilation provide guidance for initiating activities to prevent and
contain AMR.
Antibiotics save lives
Take antibiotics as prescribed for the full duration
Vaccinate children against preventable diseases
Follow a healthy lifestyle and reduce the need for antibiotics
Throw away old medicines and never self-medicate
Antimicrobial resistance
Resolutions of the
World Health Assembly and
WHO Regional Committee for South-East Asia
Combat antimicrobial resistance—
No action today, no cure tomorrow
Antibiotics are
a precious resource
Take antibiotics only as prescribed
Help prevent the emergence of
resistance
World Health House
Indraprastha Estate,
Mahatma Gandhi Marg,
New Delhi-110002, India
Email: cds@searo.who.int
www.searo.who.int
USE ANTIBIOTICS RATIONALLY
Antimicrobial Resistance
SEA-HLM-413
SEA-HLM-413
Antimicrobial resistance
Resolutions of the
World Health Assembly and
WHO Regional Committee for South-East Asia
© World Health Organization 2011
Reprinted in 2014
All rights reserved. Requests for publications, or for permission to reproduce
or translate WHO publications, whether for sale or for noncommercial
distribution, can be obtained from Publishing and Sales, World Health
Organization, Regional Ofice for South-East Asia, Indraprastha Estate,
Mahatma Gandhi Marg, New Delhi-110 002, India (fax: +91-11-23370197;
e-mail: publications@ searo.who.int).
The designations employed and the presentation of the material in this
publication do not imply the expression of any opinion whatsoever on
the part of the World Health Organization concerning the legal status of
any country, territory, city or area or of its authorities, or concerning the
delimitation of its frontiers or boundaries. Dotted lines on maps represent
approximate border lines for which there may not yet be full agreement.
The mention of speciic companies or of certain manufacturers’ products
does not imply that they are endorsed or recommended by the World
Health Organization in preference to others of a similar nature that are
not mentioned. Errors and omissions excepted, the names of proprietary
products are distinguished by initial capital letters.
All reasonable precautions have been taken by the World Health Organization
to verify the information contained in this publication. However, the published
material is being distributed without warranty of any kind, either expressed
or implied. The responsibility for the interpretation and use of the material
lies with the reader. In no event shall the World Health Organization be
liable for damages arising from its use.
This publication contains the collective views of an international group of
experts and does not necessarily represent the decisions or the stated
policy of the World Health Organization.
Printed in India
Contents
1.
Antimicrobial resistance
WHA67.25 .................................................................... 1
2.
Prevention and containment of antimicrobial resistance
SEA/RC63/R4 ................................................................ 6
3.
Progress in the rational use of medicines
WHA60.16 .................................................................... 9
4.
Improving the containment of antimicrobial resistance
WHA58.27 ...................................................................13
5.
Global health security: epidemic alert and response
WHA54.14 ...................................................................16
6.
Emerging and other communicable diseases:
antimicrobial resistance
WHA51.17 ...................................................................18
Antimicrobial resistance
iii
Antimicrobial resistance
WHA67.25
The Sixty-seventh World Health Assembly,
Having considered the report on antimicrobial drug resistance;1
Recognizing WHO’s leadership role in the containment of
antimicrobial resistance;
Recalling resolutions WHA39.27 and WHA47.13 on the rational
use of drugs, WHA51.17 on emerging and other communicable
diseases: antimicrobial resistance, WHA54.14 on global health
security, WHA58.27 on improving the containment of antimicrobial
resistance, WHA60.16 on progress in the rational use of medicines
and WHA66.22 on follow up of the report of the Consultative
Expert Working Group on Research and Development: Financing
and Coordination;
Aware that access to effective antimicrobial agents constitutes
a prerequisite for most of modern medicine, that hard-won gains in
health and development, in particular those brought about through
the health-related Millennium Development Goals, are at risk due
to increasing resistance to antimicrobials, and that antimicrobial
resistance threatens the sustainability of the public health response
to many communicable diseases, including tuberculosis, malaria
and HIV/AIDS;
Aware that the health and economic consequences of
antimicrobial resistance constitute a heavy and growing burden on
high-, middle- and low-income countries, requiring urgent action
at national, regional and global levels, particularly in view of the
limited development of new antimicrobial agents;
1
Document A67/39.
Antimicrobial resistance
1
Recognizing that the main impact of antimicrobial resistance
is on human health, but that the contributing factors and
consequences, including economic and others, go beyond health
and therefore there is a need for a coherent, comprehensive and
integrated approach at global, regional and national levels, in
a “One Health” approach and beyond, involving different actors
and sectors such as human and veterinary medicine, agriculture,
environment and consumers;
Noting that awareness of the broad scope and urgency of the
threat posed has been limited and that previous resolutions of
the Health Assembly and WHO’s strategies for the containment of
antimicrobial resistance have not yet been widely implemented;
Recognizing that antimicrobial resistance involves a wide range
of pathogens including bacteria, viruses and parasites but that the
development of resistance among some pathogens, particularly
antibiotic-resistant bacteria, is of particular urgency and most in
need of immediate attention;
Welcoming the establishment of the WHO Global Task Force on
Antimicrobial Resistance and the tripartite collaboration between
FAO, OIE and WHO,
1.
1
2
URGES Member States:1
(1)
to increase political awareness, engagement and
leadership in order to accelerate efforts to secure access
to effective antimicrobials and to use them responsibly;
(2)
to take urgent action at national, regional and local
levels to strengthen infection prevention and control,
by means that include application of basic hygiene
measures;
(3)
to develop or strengthen national plans and strategies
and international collaboration for the containment of
antimicrobial resistance;
And, where appropriate, regional economic integration organizations.
Antimicrobial resistance
(4)
to mobilize human and inancial resources in order
to implement plans and strategies to strengthen the
containment of antimicrobial resistance;
(5)
to strengthen overall pharmaceutical management
systems, including regulatory systems and supply
chain mechanisms, and, where appropriate, laboratory
infrastructure, with a view to ensuring access to and
availability of effective antimicrobial agents, taking
into account inancial and other incentives that might
have a negative impact on policies for prescribing and
dispensing;
(6)
to monitor the extent of antimicrobial resistance
including regular monitoring of the use of antibiotics
in all relevant sectors, in particular health and
agriculture, including animal husbandry, and to share
such information so that national, regional and global
trends can be detected and monitored;
(7)
to improve, among all relevant care providers, the public
and other sectors and stakeholders, awareness of (i) the
threat posed by antimicrobial resistance, (ii) the need
for responsible use of antibiotics and (iii) the importance
of infection prevention and control measures;
(8)
to encourage and support research and development,
including by academia and through new collaborative
and inancial models, to combat antimicrobial resistance
and promote responsible use of antimicrobial medicines,
develop practical and feasible approaches for extending
the lifespan of antimicrobial medicines and encourage
the development of novel diagnostics and antimicrobial
medicines;
(9)
to collaborate with the Secretariat in developing and
implementing a draft global action plan to combat
antimicrobial resistance, including antibiotic resistance,
which is based on all available evidence and best
practices;
Antimicrobial resistance
3
(10) to develop antimicrobial resistance surveillance systems
in three separate sectors: (i) inpatients in hospitals;
(ii) outpatients in all other health care settings and the
community; and (iii) animals and non-human usage of
antimicrobials;
2.
4
REQUESTS the Director-General:
(1)
to ensure that all relevant parts of the Organization,
at headquarters, regional and country levels, are
actively engaged and coordinated in promoting work
on containing antimicrobial resistance, including
through the tracking of resource lows for research and
development on antimicrobial resistance in the new
global health research and development observatory;
(2)
to set aside adequate resources for the work in the
Secretariat, in line with the Programme budget 2014–
2015 and the Twelfth General Programme of Work,
2014–2019;
(3)
to strengthen the tripartite collaboration between FAO,
OIE and WHO for combating antimicrobial resistance in
the spirit of the “One Health” approach;
(4)
to explore with the United Nations Secretary-General
options for a high-level initiative, including a high-level
meeting, to increase political awareness, engagement
and leadership on antimicrobial resistance;
(5)
to develop a draft global action plan to combat
antimicrobial resistance, including antibiotic resistance,
which addresses the need to ensure that all countries,
especially low- and middle-income countries, have
the capacity to combat antimicrobial resistance and
which takes into account existing action plans and all
available evidence and best practice as well as the
recommendations of WHO’s Strategic Technical Advisory
Group on antimicrobial resistance and the WHO policy
package to combat antimicrobial resistance, which asks
Member States:
Antimicrobial resistance
(a)
to co mmit to a co mp r eh ens iv e, finan ced
national plan with accountability and civil society
engagement;
(b)
to strengthen surveillance and laboratory
capacity;
(c)
to ensure uninterrupted access to essential
medicines of assured quality;
(d)
to regulate and promote rational use of
medicines, including in animal husbandry, and
ensure proper patient care;
(e)
to enhance infection prevention and control;
(f)
to foster innovation and research and
development for new tools;
(6)
to apply a multisectoral approach to inform the drafting
of the global action plan, by consulting Member States1
as well as other relevant stakeholders, especially other
multilateral stakeholders, such as FAO and OIE, taking
into account the need to manage potential conlicts of
interest;
(7)
to submit to the Sixty-eighth World Health Assembly,
through the Executive Board at its
(8)
136th session, a draft global action plan to combat
antimicrobial resistance, including antibiotic resistance,
together with a summary report on progress made in
implementing the other aspects of this resolution.
(Ninth plenary meeting, 24 May 2014
A67/VR/9)
1
And, where appropriate, regional economic integration organizations.
Antimicrobial resistance
5
Prevention and containment of
antimicrobial resistance
SEA/RC63/R4
The Regional Committee,
Recalling World Health Assembly resolutions (WHA37.33,
WHA51.17, WHA54.11 and WHA58.27) on rational use of drugs
and prevention of antimicrobial resistance,
Concerned at the emergence and rapid spread of resistance in
several microorganisms to the available antimicrobial agents across
the South-East Asia Region, the unregulated and unauthorized
availability of antimicrobial agents, irrational use of antimicrobials
in medical practice and in the community, and the extensive use of
antimicrobial agents for non-therapeutic purposes in the veterinary
and ishery sectors, thus creating avoidable selection pressure to
emergence of resistance,
Noting that antimicrobial resistance is increasingly hampering
treatment of infectious diseases as a result either of totally
ineffective currently available antimicrobials or of the high cost
and toxic effects of newer drugs,
Aware that there is a lack of investment in the development of
new antimicrobials, and that the eficacy of existing antimicrobials
must therefore be preserved,
Recognizing that antimicrobial resistance in tuberculosis, malaria
and human immunodeiciency virus will impede the achievement
of health-related Millennium Development Goals (MDGs),
Noting the impact of resistant organisms in the eficient utilization
of modern technological and scientiic advances in improving human
health through complex surgeries and transplantation procedures,
6
Antimicrobial resistance
and the inadequacy of rational prescription and administration of
antimicrobial agents,
Further noting the tendency of communities to use antimicrobial
agents as a panacea for all illnesses and the poor adherence to
the recommended regimen,
Aware of the international implications of the problem of
resistant organisms crossing national boundaries through travel,
trade and foodchains, and
Recognizing the growing public health importance of antimicrobial
resistance and its increasing impact on health systems,
1.
URGES Member States:
(1)
to encourage the development of coordination mechanisms against antimicrobial resistance and establishment of appropriate governance mechanisms to combat
antimicrobial resistance;
(2)
to establish national surveillance systems for monitoring
of antimicrobial resistance, use of antimicrobial agents
in humans and animals and their impact on human
health and economy;
(3)
to effectively enforce the legislation and regulations
that counteract the manufacture, sale and distribution
of substandard antimicrobial agents and prohibit the
unauthorized sale of antimicrobial agents;
(4)
to work with relevant government departments in
discouraging the non-therapeutic use of antimicrobial
agents in the veterinary and ishery sectors;
(5)
to emphasize educational programmes for health and
veterinary students and professionals to comply with
the rational use of antimicrobial agents, to improve
practices to prevent the spread of resistant pathogens,
and to promote appropriate antimicrobial use in healthcare facilities, in the community, and in animal feed
production;
Antimicrobial resistance
7
2.
8
(6)
to strengthen infection control programmes to control
infectious diseases, especially in hospital settings, in
order to contain hospital-acquired infections;
(7)
to support operational research on behavioural aspects
and interventions to contain the irrational use of
antimicrobials, and laboratory and clinical research to
understand the technical dimension of antimicrobial
resistance;
(8)
to initiate community-awareness campaigns to solicit
people’s active cooperation in the rational use of
antimicrobial agents; and
REQUESTS the Regional Director:
(1)
to assist in the development of coordination mechanisms
to establish and implement sustainable national policies
and strategic frameworks for rational antimicrobial use
in the health and veterinary sectors;
(2)
to support development of national surveillance networks, especially laboratory capacity, for monitoring
antimicrobial resistance and use of antimicrobials;
(3)
to facilitate sharing of knowledge and information
between countries and regions, and to document best
practices in combating antimicrobial resistance;
(4)
to develop generic technical and educational material
that can be adapted by countries in monitoring resistance
and educating health professionals and communities;
(5)
to collaborate with nongovernmental organizations that
are engaged in containing antimicrobial resistance and
bring about a synergy in their actions for the beneit
of the Region;
(6)
to support capacity building in research on prevention
and containment of antimicrobial resistance; and
(7)
to compile and share evidence with Member States
on the use of antimicrobial agents in animals and its
impact on the emergence of antimicrobial resistance
and on human health.
Antimicrobial resistance
Progress in the rational
use of medicines
WHA60.16
The Sixtieth World Health Assembly,
Having considered the report on rational use of medicines:
progress in implementing the WHO medicines strategy;1
Recalling the report on rational use of medicines by prescribers
and patients discussed at the Fifty-eighth World Health Assembly
and followed by adoption of resolution WHA58.27 on antimicrobial
resistance;
Recalling resolutions WHA39.27, WHA41.16 and WHA47.13 on
the rational use of drugs, WHA41.17, WHA45.30 and WHA47.16
on ethical criteria for medicinal drug promotion, WHA43.20 and
WHA45.27 on the WHO Action Programme on Essential Drugs,
WHA47.12 on the role of the pharmacist, WHA49.14 and WHA52.19
on the revised drug strategy, WHA51.9 on cross-border advertising,
promotion and sale of medical products using the Internet, and
WHA54.11 on the WHO medicines strategy;
Recognizing the efforts of WHO, in collaboration with
governments, universities, the private sector and nongovernmental
organizations, in areas related to health-care delivery systems
and health-insurance programmes in order to improve the use of
medicines by prescribers, dispensers and patients;
Aware of the core components of WHO’s strategy for promoting
the rational use of medicines;2
1
2
Document A60/24.
Document WHO/EDM/2004.5.
Antimicrobial resistance
9
Wishing to promote evidence-based rational use of medicines
by providers and consumers and better access to essential
medicines;
Aware that irrational use of medicines continues to be an urgent
and widespread problem in the public and private health sector in
developed and developing countries, with serious consequences in
terms of poor patient outcome, adverse drug reactions, increasing
antimicrobial resistance and wasted resources;
Acknowledging that successful implementation of previous
resolutions on antimicrobial resistance cannot be achieved without
addressing the global problem of irrational use of medicines;
Recognizing that many countries do not have a stringent
drug-regulatory authority nor a full national programme or body
to promote rational use of medicines;
Emphasizing that global initiatives to increase access to
essential medicines should adhere to the principle of rational use
of medicines, and include adherence by patients;
Concerned that insuficient attention and resources are being
directed towards tackling the problem of irrational use of medicines
by prescribers, dispensers and consumers;
Emphasizing the need for a comprehensive, sustainable,
national and sector-wide approach to promote the rational use of
medicines;
Recognizing that financing of medicines and methods of
arrangements for provider payments can have a major impact on
rational use, and that appropriate policies on inancing health care
are required;
Recognizing that there may be incentives for the irrational use
of medicines throughout the health system, for example, in some
circumstances which give rise to conlict of interest;
Concerned that direct-to-consumer or Internet sales may give
rise to irrational use of medicines;
10
Antimicrobial resistance
Convinced that it is time for governments, the health professions,
civil society, the private sector and the international community
to pledge their commitment, including adequate resources, to
promoting the rational use of medicines,
1.
3
URGES Member States:3
(1)
to invest suficiently in human resources and provide
adequate financing for strengthening institutional
capacity in order to ensure more appropriate use of
medicines in both the public and private sectors;
(2)
to consider establishing and/or strengthening, as
appropriate, a national drug regulatory authority and a
full national programme and/or multidisciplinary body,
involving civil society and professional bodies, to monitor
and promote the rational use of medicine;
(3)
to consider developing, strengthening and implementing,
where appropriate, the application of an essential
medicines list into the beneit package of the existing
or new insurance funds;
(4)
to develop and strengthen existing training programmes
on rational use of medicines, to ensure that they
are taken into account in the curricula for all health
professionals and medical students, including their
continuing education, where appropriate, and to
promote programmes of public education in rational
use of medicines;
(5)
to enact new, or enforce existing, legislation to ban
inaccurate, misleading or unethical promotion of
medicines, to monitor promotion of medicines, and to
develop and implement programmes that will provide
independent, nonpromotional information about
medicines;
(6)
to develop and implement national policies and
programmes for improving use of medicines, including
clinical guidelines and essential medicines lists,
And regional economic integration organizations, where appropriate.
Antimicrobial resistance
11
as appropriate, with an emphasis on multifaceted
interventions targeting both the public and private health
sectors, and involving providers and consumers;
2.
(7)
to consider developing, and strengthening where
appropriate, the capacity of hospital drug and
therapeutic committees to promote the rational use of
medicines;
(8)
to expand to national level sustainable interventions
successfully implemented at local level;
REQUESTS the Director-General:
(1)
to strengthen the leadership and evidence-based
advocacy role of WHO in promoting rational use of
medicines;
(2)
in collaboration with governments and civil society,
to strengthen WHO’s technical support to Member
States in their efforts to establish or strengthen,
where appropriate, multidisciplinary national bodies for
monitoring use of medicines, and implementing national
programmes for the rational use of medicines;
(3)
to strengthen the coordination of international inancial
and technical support for rational use of medicines;
(4)
to promote research, particularly on development of
sustainable interventions for rational use of medicines
at all levels of the health sector, both public and
private;
(5)
to promote discussion among health authorities,
professionals and patients on the rational use of
medicines;
(6)
to report to the Sixty-second World Health Assembly,
and subsequently biennially, on progress achieved,
problems encountered and further actions proposed in
the implementation of WHO’s programmes to promote
rational use of medicines.
(Eleventh plenary meeting, 23 May 2007 –
Committee B, second report)
12
Antimicrobial resistance
Improving the containment of
antimicrobial resistance
WHA58.27
The Fifty-eighth World Health Assembly,
Having considered the report on rational use of medicines by
prescribers and patients;1
Acknowledging that the containment of antimicrobial resistance
is a prerequisite for attaining several of the internationally agreed
health-related goals contained in the United Nations Millennium
Declaration;
Recalling the recommendations of the Second International
Conference on Improving Use of Medicines (Chiang Mai, Thailand,
2004);
Recalling also the indings of relevant WHO reports, including
“Priority medicines for Europe and the world”,2 and the Copenhagen
Recommendation from the European Union conference on “The
Microbial Threat” (Copenhagen, 1998);
Aware that the spread of antimicrobial resistance recognizes
no national boundaries and has reached proportions that require
urgent action at national, regional and global levels, especially in
view of the decreasing development of new antimicrobial agents;
Recalling previous resolutions WHA39.27 and WHA47.13 on
the rational use of drugs, WHA51.17 on antimicrobial resistance,
and WHA54.14 on global health security;
Recognizing the efforts of WHO, in collaboration with
governments, universities, the private sector and nongovernmental
1
2
Document A58/14.
Document WHO/EDM/PAR/2004.7.
Antimicrobial resistance
13
organizations, to contain antimicrobial resistance, thereby
contributing to prevention of the spread of infectious diseases;
Noting that, despite some progress, the strategy for containment
of antimicrobial resistance has not been widely implemented;3
Wishing to intensify efforts to contain antimicrobial resistance
and to promote rational use of antimicrobial agents by providers
and consumers in order to improve global health security;
Re-emphasizing the need for a coherent, comprehensive and
integrated national approach to promoting the containment of
antimicrobial resistance;
Convinced that it is time for governments, the health professions,
civil society, the private sector and the international community to
reafirm their commitment to ensuring that suficient investment
is made to contain antimicrobial resistance,
1.
3
14
URGES Member States:
(1)
to ensure the development of a coherent, comprehensive
and integrated national approach to implementing the
strategy for containment of antimicrobial resistance
taking account, where appropriate, of inancial and
other incentives that might have a harmful impact on
policies for prescribing and dispensing;
(2)
to enhance rational use of antimicrobial agents, including
through development and enforcement of national
standard-practice guidelines for common infections, in
public and private health sectors;
(3)
to strengthen, as appropriate, their legislation on
availability of medicines in general and of antimicrobial
agents in particular;
(4)
to mobilize human and inancial resources in order to
minimize the development and spread of antimicrobial
resistance, in particular by promotion of the rational use
of antimicrobial agents by providers and consumers;
(5)
to monitor effectively and to control nosocomial
infections;
Document WHO/CDS/CSR/DRS/2001.2.
Antimicrobial resistance
2.
(6)
to monitor regularly the use of antimicrobial agents
and the level of antimicrobial resistance in all relevant
sectors;
(7)
to share actively knowledge and experience on best
practices in promoting the rational use of antimicrobial
agents;
REQUESTS the Director-General:
(1)
to strengthen the leadership role of WHO in containing
antimicrobial resistance;
(2)
to accelerate the implementation of resolutions WHA51.17
and WHA54.14 concerning the containment of antimicrobial resistance by expanding and strengthening the
provision of technical support to Member States, at
their request;
(3)
to collaborate with other relevant programmes and
partners in order to promote the appropriate use of
antimicrobial agents in the context of the rational use
of medicines, by scaling up interventions proven to
be effective, and to provide support for the sharing
of knowledge and experience among stakeholders on
best practice;
(4)
to provide support for the generation of up-to-date
information on antimicrobial resistance at regional and
subregional levels and to make this available to Member
States and other parties;
(5)
to provide support for gathering and sharing of
evidence on cost-effective interventions for prevention
and control of antimicrobial resistance at national and
local levels;
(6)
to report to the Sixtieth World Health Assembly, and
subsequently on a regular basis, on progress achieved,
problems encountered and further actions proposed in
implementing this resolution.
(Ninth plenary meeting, 25 May 2005 –
Committee A, seventh report)
Antimicrobial resistance
15
Global health security: epidemic
alert and response
WHA54.14
The Fifty-fourth World Health Assembly,
Recalling resolutions WHA48.7 on the International Health
Regulations, WHA48.13 on new,emerging and re-emerging
infectious diseases, and WHA51.17 on antimicrobial resistance;
Recalling that public health is a priority for development and
that combating communicable diseases, which are a major burden
in terms of human mortality and morbidity, provides important and
immediate opportunities for progress;
Mindful of the globalization of trade and of the movement of
people, animals, goods and food products, as well as the speed
with which these take place;
Recognizing that, as a result, any upsurge in cases of infectious
disease in a given country is potentially of concern for the
international community,
1.
16
EXPRESSES its support for:
(1)
ongoing work on the revision of the International Health
Regulations, including criteria to deine what constitutes
a health emergency of international concern;
(2)
development of a global strategy for containment
and, where possible, prevention of antimicrobial drug
resistance;
(3)
collaboration between WHO and all potential technical
partners in the area of epidemic alert and response,
including relevant public sectors, intergovernmental
organizations, nongovernmental organizations and the
private sector;
Antimicrobial resistance
2.
3.
URGES Member States:
(1)
to participate actively in the veriication and validation
of surveillance data and information concerning health
emergencies of international concern, together with
WHO and other technical partners;
(2)
to develop and update national preparation and response
plans;
(3)
to develop training for the staff involved and the exchange of good practice between specialists in response
to alerts;
(4)
to update regularly information on the resources
available for the surveillance and control of infectious
diseases;
(5)
to designate a focal point for the International Health
Regulations;
REQUESTS the Director-General:
(1)
to devise relevant international tools, and to provide
technical support to Member States for developing or
strengthening preparedness and response activities
against risks posed by biological agents, as an integral
part of their emergency management programmes;
(2)
to provide technical support to Member States for developing intervention programmes that prevent epidemics and respond to communicable disease threats and
emergencies, particularly with regard to epidemiological
investigations, laboratory diagnoses and community and
clinical management of cases;
(3)
to make appropriate arrangements for the development
of regional preparedness and response plans;
(4)
to provide support to Member States for strengthening
their capacity to detect and respond rapidly to communicable disease threats and emergencies, especially by
developing the laboratory skills needed for diagnosis and
providing training in epidemiological methods for use in
the ield, particularly in the most exposed countries;
(5)
to make available relevant information on public health
risks to Member States, relevant intergovernmental
organizations and technical partners;
(6)
to provide technical support to Member States in the
implementation of national efforts to contain and
prevent resistance to antimicrobials.
(Ninth plenary meeting, 21 May 2001 – A54/VR/9)
Antimicrobial resistance
17
Emerging and other
communicable diseases:
antimicrobial resistance
WHA51.17
The Fifty-irst World Health Assembly,
Having considered the report of the Director-General on emerging
and other communicable diseases: antimicrobial resistance;
Concerned about the rapid emergence and spread of human
pathogens resistant to available antibiotics;
Aware that antimicrobial resistance is increasingly hampering
treatment of infectious diseases as a result either of totally
ineffective antibiotics currently available or of the high cost of
“new generation” agents;
Concerned about the extensive use of antibiotics in food
production, which may further accelerate the development of such
resistance,
1.
18
URGES Member States:
(1)
to encourage the development of sustainable systems
to detect antimicrobial-resistant pathogens, thereby
increasing awareness of antimicrobial resistance, and
to monitor volumes and patterns of use of antimicrobial
agents and the impact of control measures;
(2)
to develop educational programmes for professional staff
and the general public to encourage the appropriate and
cost-effective use of antimicrobial agents;
(3)
to improve practices to prevent the spread of infection
and thereby the spread of resistant pathogens, and
to promote appropriate antibiotic use in health care
facilities and in the community;
Antimicrobial resistance
2.
(4)
to develop measures to protect health workers from
the hazards of resistant pathogens;
(5)
to develop measures to prohibit the dispensing of
antimicrobials without the prescription of a qualiied
health-care professional;
(6)
to strengthen legislation to prevent the manufacture,
sale and distribution of counterfeit antimicrobial agents
and the sale of antibiotics on the informal market;
(7)
to take measures to encourage the reduced use of
antimicrobials in food-animal production;
REQUESTS the Director-General:
(1)
to support countries in their efforts to control
antimicrobial resistance through the strengthening
of laboratory capacity for the detection of resistant
pathogens;
(2)
to collaborate in developing sustainable national policies
for rational antimicrobial use, not only in human
medicine, but also in food-animal production;
(3)
to collaborate with the public health sector, the
pharmaceutical industry, universities and institutions
concerned with research, laboratory testing, marketing,
prescription and consumption of antimicrobial agents,
in order to encourage the sharing of knowledge and
resources to combat antimicrobial resistance;
(4)
to devise means for the gathering and sharing of
information by countries and regions concerning
resistance in certain pathogens and to promote
international cooperation among Member States;
(5)
to develop programmes of information and education
for prescribers and users of antimicrobial agents;
(6)
to encourage promotion of research and development
of new antimicrobial agents.
(Tenth plenary meeting, 16 May 1998 – A51/VR/10)
Antimicrobial resistance
19
The World Health Assembly and the WHO Regional Committee for SouthEast Asia have endorsed several resolutions on antimicrobial resistance
(AMR). These resolutions reflect the commitment of all Member States and
also provide a roadmap for combating AMR. The resolutions contained in
this compilation provide guidance for initiating activities to prevent and
contain AMR.
Antibiotics save lives
Take antibiotics as prescribed for the full duration
Vaccinate children against preventable diseases
Follow a healthy lifestyle and reduce the need for antibiotics
Throw away old medicines and never self-medicate
Antimicrobial resistance
Resolutions of the
World Health Assembly and
WHO Regional Committee for South-East Asia
Combat antimicrobial resistance—
No action today, no cure tomorrow
Antibiotics are
a precious resource
Take antibiotics only as prescribed
Help prevent the emergence of
resistance
World Health House
Indraprastha Estate,
Mahatma Gandhi Marg,
New Delhi-110002, India
Email: cds@searo.who.int
www.searo.who.int
USE ANTIBIOTICS RATIONALLY
Antimicrobial Resistance
SEA-HLM-413