Dear Elisabeth, Apologies for the delay in my reply.

Elisabeth: "Could you clarify what they meant with this what I have highlighted in bold?: "Significant WASH improvements and effective strategies to change practices are essential, combined with the application of biosecurity measures"?"

I understand this to refer to Infection Prevention and Control.

More here from the WHO AMR website:
www.who.int/antimicrobial-resistance/glo...evention-control/en/

Best wishes, Neil

Dear Neil,

Thanks for posting this. I hope some of our SuSanA partners involve themselves in this public consultation process (www.who.int/antimicrobial-resistance/int...iscussion-papers/en/). This topic is something that could affect all of us in the future, not just at a professional level but also at a private level (next time when you or your children need antibiotics to fight off a disease and the antibiotics no longer work...)

Could you clarify what they meant with this what I have highlighted in bold?: "Significant WASH improvements and effective strategies to change practices are essential, combined with the application of biosecurity measures"?

Wikipedia explains biosecurity as follows: "Biosecurity has multiple meanings and is defined differently according to various disciplines. The original definition of biosecurity started out as a set of preventive measures designed to reduce the risk of transmission of infectious diseases in crops and livestock, quarantined pests, invasive alien species, and living modified organisms ."

And I copy a section from their report which sounds promising (www.who.int/antimicrobial-resistance/int...ials_120718.pdf?ua=1):

In addition, the spread of pathogens through unsafe water results in a high burden of
gastrointestinal disease, increasing even further the need for antibiotic treatment.

It is important to highlight that the link between AMR and WASH must be better acknowledged and
communicated.
Current response: A WHO expert meeting in 2017 on the link between AMR and WASH concluded
that:
 Existing WASH interventions in health facilities and communities offer significant co-benefits
for combatting AMR, and investment should be increased, including through national
action plans on AMR;
 Manufacturers of antimicrobials need to improve wastewater treatment to reduce the
release of residues into the environment; and
 Additional research is needed on the relative impact of inadequate WASH on AMR
infections, and on effective management strategies.

Regards,
Elisabeth

Dear SuSanA colleagues,

I am forwarding the message below from the HIFA forum (www.hifa.org)

Note especially:

"4. Infection prevention and control measures, supported by adequate water and sanitation infrastructure, will make a difference: Significant WASH improvements and effective strategies to change practices are essential, combined with the application of biosecurity measures."

Best wishes, Neil

++++++++++++++

From: "Neil Pakenham-Walsh" <This email address is being protected from spambots. You need JavaScript enabled to view it.>
To: "HIFA - Healthcare Information For All" <This email address is being protected from spambots. You need JavaScript enabled to view it.>

WHO has opened a public consultation on a Discussion Paper: 'Reduce unintentional exposure and the need for antimicrobials, and optimize their use'

This will help inform the Interagency Coordination Group (IACG) on AMR to 'provide practical guidance for approaches needed to ensure sustained effective global action to address AMR; and to report back to the UN Secretary-General in 2019. AMR is a global and multisectoral problem requiring a coherent response that bridges human, animal, plant and environmental health'.

Key messages and questions below. Full text here:
www.who.int/antimicrobial-resistance/int...ials_120718.pdf?ua=1

KEY MESSAGES:

1. Good guidance is available: There is a wealth of good, relevant guidance that, if put into practice, would lead to a significant, rapid reduction in the inappropriate use of antimicrobials in humans, animals and plants.

2. AMR in the environment is a challenge: There is a need to better understand resistance in the environment, the root causes and the means to prevent and mitigate the spread of resistance in the environment.

3. Implementation is key: Ways must be found to increase the implementation of existing guidelines and facilitate good practices, with a focus on solutions and strategies suitable for settings with limited resources.

4. Infection prevention and control measures, supported by adequate water and sanitation infrastructure, will make a difference: Significant WASH improvements and effective strategies to change practices are essential, combined with the application of biosecurity measures.

5. Balancing increased and sustainable food production will be a challenge: Measures that address the need to phase out the inappropriate use of antimicrobials in food production must take into account the need to sustainably increase safe food production in accordance with the Sustainable Development Goals.

6. Effective measures to reduce the burden of food- and waterborne infections will also reduce the need for antimicrobial therapy and prevent the spread of AMR.

7. Harmonized approaches to regulation are essential: To ensure effective, science-based regulation on AMR, and to avoid trade friction elicited by different regulatory approaches to AMR, countries must be encouraged to take a harmonized approach based on international standards.

QUESTIONS FOR STAKEHOLDERS

1. What kind of support (other than financial) is needed to translate the existing guidance into implementable actions?

2. How can policy makers be assisted to further develop and implement infection prevention and control in human and animal health and plants and be convinced to invest now to mitigate the escalating and future costs and obtain benefits far beyond preventing AMR?

3. What incentives or initiatives are needed for behaviour change towards responsible use in the health sector (hospitals, community health centres) and in the food and animal production sectors (animal and plant health professionals, food producers and manufacturers, consumers).

4. What is needed to generate evidence-based data that link the misuse of antimicrobials and the development and spread of AMR via the environment? How can we use the available data to develop effective policy solutions influence policy makers?

5. What approaches are needed to ensure the industry and investors manufacture and market antimicrobials responsibly, and not stimulate overuse or contribute to environmental pollution?

6. Changing practices needs the support of the industry - how can we balance the availability of a public good such as effective antimicrobials, with a private industry perspective?

7. What are the mechanisms to enhance the availability and utility of global resources for the end user (communities and individuals) to optimize or reduce the need for the use of antimicrobials and mitigate the unintentional exposure to the environment?

I would like to encourage all HIFA members to share any thoughts directly with the AMR Secretariat (deadline 31 August) and/or to This email address is being protected from spambots. You need JavaScript enabled to view it.

Further information about the consultation process (which also looks at several Discussion Papers on other aspects of AMR) is here: www.who.int/antimicrobial-resistance/int...iscussion-papers/en/

Best wishes, Neil