Report to Sida on ReAct activities
January - December 2012
List of abbreviations
ABR
Antibiotic resistance
AMR
Antimicrobial resistance
ASU
Antibiotic Smart Use program
CSO
Civil Society Organization
EFPIA
European Federation of Pharmaceutical Industries and Associations
EU
European Union
ICIUM
International Conference for Improving the Use of Medicines
IMI
Innovative Medicines Initiative
LMICs
Low and Middle Income Countries
MDGs
Millennium Development Goals
MoH
Ministry of Health
MSF
Médecins sans Frontières
OHE
Office of Health Economics
PAHO
WHO/Pan-American Health Organization
PHC
Public Health Care Centers
RLA
ReAct Latin America
RU
Rational use
SEARO
WHO South East Asian Regional Office
TATFAR
Trans-Atlantic Task Force on Antimicrobial Resistance
WEF
World Economic Forum
WHO
World Health Organization
WPRO
West Pacific Regional Office
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Table of contents
1.
EXECUTIVE SUMMARY..................................................................................................................... 3
2. ACHIEVEMENTS IN RELATION TO THEMES 2012................................................................................. 5
2.1 THEME 1: INCREASING THE VISIBILITY OF ANTIBIOTIC RESISTANCE IN THE GLOBAL HEALTH
DIALOGUE ............................................................................................................................................ 5
2.1.1 Support to WHO ..................................................................................................................... 5
2.1.2 International meetings ........................................................................................................... 8
2.1.3 Other communication activities ........................................................................................... 10
2.1.4 Supporting the development and implementation of regional and national processes for
the management of antibiotic resistance ..................................................................................... 11
2.2 THEME 2: EVIDENCE GENERATION.............................................................................................. 16
2.3 THEME 3: PROMOTING INNOVATION AND THE DEVELOPMENT OF HEALTH TECHNOLOGIES TO
MEET GLOBAL NEEDS TO MANAGE ANTIBIOTIC RESISTANCE .......................................................... 19
2.3.1 The global need for new effective antibiotics ...................................................................... 19
2.3.2 Controlled distribution and use of new antibiotics .............................................................. 20
2.4 THEME 4: PROMOTING RATIONAL USE OF ANTIBIOTICS ............................................................ 22
2.4.1 Latin America ........................................................................................................................ 22
2.4.2 South East Asia ..................................................................................................................... 22
2.4.3 Africa..................................................................................................................................... 24
2.5 OVERALL COORDINATION ........................................................................................................... 24
2.5.1 Networking coordination ..................................................................................................... 27
2.6 TARGET FULFILMENT AND PERCEIVED IMPACT .......................................................................... 28
3. CSO PROJECT ENGAGING CIVIL SOCIETY ORGANIZATIONS FOR SOCIAL MOBILIZATION, HEALTH
EDUCATION AND COMMUNICATION .................................................................................................... 36
4. CHALLENGES AND FUTURE PROSPECTS ............................................................................................ 41
Annex 1 - ReAct publications 2012 ................................................................................................ 43
Annex 2 - Meetings and events 2012 ............................................................................................ 44
Annex 3 - ReAct in the Media 2012 .............................................................................................. 47
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1. EXECUTIVE SUMMARY
During 2012 ReAct continued playing the role of a convening organization and a catalyst, facilitating
important international and national processes. ReAct worked to deepen the understanding of the
knowledge and perceptions of infections among different groups in order to create long-term
behavioural changes in relation to the use of antibiotics. ReAct also further strengthened its work
towards WHO and continued with activities within the policy development and debate on controlled
distribution and use of new antibiotics.
International advocacy and collaboration
Throughout 2012, the issue of antibiotic resistance (ABR) became more widely recognized and ReAct
supported and catalyzed many of the important global activities that took place. ReAct made
significant contributions to The World Economic Forum (WEF) for the recognition of the seriousness
of ABR. The WEF identified ABR as one of the ‘greatest risks to global health’ in their Global Risks
report published in January 2013.
ReAct actively supported WHO in the process of forming a coordinating group and a task force on
AMR which includes members from all WHO Regions.
ReAct contributed to the development of the call for “New Drugs for Bad Bugs” program intended to
speed the development of new antibiotics. The program is within the Innovative Medicine's Initiative
(IMI) - a 2 billion Euro PPP between the European Commission and the European pharmaceutical
industry.
ReAct participated as an expert in the consultation work for the Joint Programming Initiative on
Antimicrobial Resistance (JPIAMR), a EU undertaking of 18 member countries.
ReAct continued to push forward a process started in 2011 to explore innovative ways to preserve
new effective antibiotics through several initiatives. One is the Treatment for Tomorrow (T4T)
project, run by Duke university, which explores the realignment of incentives to balance affordable
access with rational use of antibiotics. A stakeholder meeting was also hosted by Duke university in
December 2012.
The ReAct Resource Centre, a publically accessible web-based database with currently over 500 highquality reports, documents, tools, etc. concerning ABR and antibiotic use was launched in 2012. The
main target groups are policy makers, health professionals and community-based organizations in
low-income countries. The intention is to help these groups to take informed action on ABR.
3
Extending the ReAct network
Sida provided an additional grant for the period 2012-2014 aimed at mobilizing Civil Society
Organizations (CSOs) to address antibiotic resistance as part of their regular work. This CSO project
was launched in connection with a planning-meeting in Penang, Malaysia, in February 2012. The
CSOs participating are from Latin America, Ghana and South-East Asia. Most of them work in the
areas of child and maternal health, women's issues, education and environment.
An ABR policy development process was initiated in Ghana under the leadership and coordination by
the Ministry of Health in Ghana. They have initiated programs and stakeholder meetings at the
policy/health-systems level and have included the community level through the CSO-project.
The ReAct South East Asia network of professionals and organizations working on ABR in the
community, at hospital and on policy-level expanded during 2012. ReAct successfully facilitated the
placing of AMR as a priority issue within the implementation of national medicines policies, with a
strategy for action at the Asia Pacific Conference on National Medicines Policies in May 2012.
ReAct Latin America (RLA), based at the University of Cuenca, represented a strong force in educating
healthcare workers and the community on ABR. RLA successfully combined research with advocacy
in a study on ESBL in neonatals which was successfully used as a policy tool to advocate for improved
infection control in hospitals.
RLA worked on new innovative solutions for communicating ABR and developed the novel concept
envisaged in the FotoResisistencia project, where primary health care workers are trained in ABR and
take photographs visualizing the causes and consequences of ABR.
.
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2. ACHIEVEMENTS IN RELATION TO THEMES 2012
2.1 THEME 1: INCREASING THE VISIBILITY OF ANTIBIOTIC RESISTANCE IN
THE GLOBAL HEALTH DIALOGUE
2.1.1 Support to WHO
ReAct has for many years been advocating for the need for WHO to increase its work and global
leadership on antibiotic resistance, and has been instrumental in several processes to support WHO
on both central and regional levels. ReAct played an important role in supporting the resolution
improving the Containment of Antimicrobial Resistance (WHA 58.27) that was adopted in 2005 and
the preparatory work to support the passing of the Rational Use of Medicines resolution (WHA
60:16) at the World Health Assembly 2007.
In 2008 ReAct hosted several activities at the 61st World Health Assembly, among them a session at
the Third World Network NGO Briefing meeting and a ReAct reception attended by WHO, WHPA, FIP
and 35 other well-renowned global organisations. At the 62th World Health Assembly in 2009 ReAct
contributed to the campaign Fight AMR – Save medicines for our children was launched in a
partnership between ReAct and the Ecumenical Pharmaceutical Network (EPN).
In 2011 ReAct played an important role in supporting the activities of the World Alliance for Patient
Safety and the WHO interest in the issue and chaired two out of the five expert working groups
contributing to the WHO monograph on “The Evolving Threat of Antimicrobial Resistance: Options
for Action” 1 launched in March 2012. ReAct facilitated the participation of groups in SEA, Latin
America, Africa, and Europe in the World Health Day (WHD) 2011 campaign focused on ABR.
Innovative communication materials were produced for this particular event, such as the information
campaign “Save the pill for the really ill”.
Following the renewed commitment by WHO to antimicrobial resistance, the WHO Headquarter has
formed a small AMR secretarial team, placed within the Health Security and Environment (HSE)
Cluster. This new structure was officially announced on Dec 1, 2011 and has been very active in
creating an internal network on AMR within the HQ as well as forming a task force on AMR together
with the regional offices. ReAct has been closely involved in the process as an expert advisor.
1
http://www.who.int/patientsafety/implementation/amr/en/index.html
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Activities and accomplishments 2012
WHO Headquarters
ABR Stakeholder analysis
WHO initiated the development a global roadmap for action on antimicrobial resistance (AMR),
specifically addressing antibiotic resistance (ABR) to lay the ground for engaging stakeholders to work
together. Whilst stakeholder analyses were available in the fields of malaria, TB and HIV/AIDS, there
was a gap in the field of ABR.
ReAct conducted the analysis of stakeholders in the field of ABR for and with WHO, identifying key
stakeholders of international relevance. The framework for the analysis included the 6-point policy
package developed by WHO for the World Health Day 2011, and a broader set of issues related to
engagement of new actors in ABR.
The main output of the analysis was a database of over 200 stakeholders. These stakeholders include
for example governments, civil society organisations, surveillance networks, pharmaceutical trade
associations, academic research and training organisations, health professional organisations,
funding organisations and the key organisations working at global level to promote the issue of ABR
in one aspect or another. In addition to those stakeholders working specifically in the area of ABR,
important organisations working in relevant areas such as rational use of medicines, access, infection
control etc. were included.
Additional outputs included a 15-page report describing the rationale behind the analysis and 5
additional annexes. In particular, one annex contained a shortlist of a selection of stakeholders
categorised according to relevance.
Global surveillance of antibiotic resistance
The AMR taskforce created at WHO HQ in Geneva in 2011 prioritized the creation of a global
surveillance system on antibiotic resistance and appointed an AMR surveillance sub-working group.
The taskforce asked ReAct to help draft a roadmap for development of a global ABR surveillance
system. To this end, ReAct applied and received funding from the Swedish Ministry of Health and
Social Affairs to enlist an expert in surveillance systems, (professor Hajo Grundmann) with whom
ReAct has previously worked. As a follow up of this process, ReAct was invited to two expert
consultations at WHO, the first one in July to discuss the roadmap. The outcomes of this meeting
formed the basis of a strategy for Global antimicrobial drug resistance surveillance. The second
meeting, in which ReAct also participated, was held at WHO HQ 18-19 December. This meeting was a
wider consultation that brought international experts in surveillance together to take the first steps
in creating a global surveillance system for ABR.
ReAct in a seminar on ABR at the World Health Assembly
On May 22 2012, in conjunction with the 65th World Health Assembly in Geneva, Ghana and Sweden
co-hosted a high-level ministerial seminar to share national experiences of combating antibiotic
resistance. The seminar "Saving lives through cost-effective measures against antimicrobial
6
resistance" addressed the growing health challenges the world is now facing due to the rapidly
declining effectiveness of antibiotics.
From the left: Dr Phusit Prakongsai, Thailand, Dr Otto Cars, ReAct, Mrs Martha Gyansa-Lutterodt, Ghana Ministry of Health, Dr Keiji Fukuda,
WHO, Dr Danilo Lo Fo Wong, WHO and Mr Göran Hägglund, Minister for Health and Social Affairs, Sweden.
The seminar was introduced by Mr Alban S.K. Bagbin, Minister of Health, Ghana and Mr. Göran
Hägglund, Minister for Health and Social Affairs, Sweden. Prof. Otto Cars from ReAct and Dr Keiji
Fukuda from the WHO gave introductory keynote presentations. Panelists from Ghana, Thailand, and
the Republic of Korea shared valuable experiences in combating antibiotic resistance. The meeting
was well attended by WHA delegates from many countries that also participated in the ensuing
discussions.
WHO monograph on “The Evolving Threat of Antimicrobial Resistance: Options for Action”
The book, "The evolving threat of antimicrobial resistance - Options for action" 2, launched by WHO
on March 8 2012, was the result of a collaboration between WHO and more than 50 international
experts in the field of antimicrobial resistance. Members of ReAct chaired two of the working groups
with international experts and were main authors of two of the chapters.
The book showcases examples of actions taken to slow down drug resistance and preserve the ability
of medicine to effectively treat many infectious diseases, building on the recommendations in the
2001 WHO Global Strategy for Containment of Antimicrobial Resistance. ReAct participated in the
launch event in Geneva on March 8 with a video presentation 3.
WHO Regional Offices
ReAct South East Asia (SEA), with co-funding from WHO-WPRO, developed a research proposal to
study the costs of ABR. The study “South East Asia Antibiotic Resistance Costs in Hospitals” involves
hospitals in Thailand, the Philippines, Malaysia, Indonesia, Singapore, Brunei and Vietnam. ReAct SEA
2
The evolving threat of antimicrobial resistance - Options for action
http://whqlibdoc.who.int/publications/2012/9789241503181_eng.pdf
3
http://www.who.int/patientsafety/implementation/amr/en/
7
also contributed to the WHO-WPRO Informal Consultative Meeting on Antimicrobial Resistance
(AMR) Prevention and Control in Emergencies/Disasters
ReAct participated in the Scientific Planning Committee for the Asia Pacific Conference on National
Medicines Policies co-hosted by WHO WPRO and SEARO and the Australian Government and hosted
an AMR workshop which established AMR as a priority within the implementation strategy for
National Medicines Policies. This also established a wider Asia Pacific network on AMR and linked it
to the existing ReAct SEA network.
ReAct contributed to PAHO’s online policy forum on the WHO Consultative Expert Working Group on
R&D: Financing and Coordination (CEWG). The business model for new antibiotics put forward by
ReAct was included as part of the actions suggested by CEWG. ReAct Latin America contributed to
several key regional meetings of PAHO on AMR and continued its active collaboration with PAHO
Ecuador on edu-communication and training models in ABR.
Inspired by Ghana’s work towards developing a national ABR policy and by ReAct’s support to the
process, the WHO AFRO expressed interest in facilitating the sharing of Ghana’s national ABR policy
process as a model for other countries in the region. ReAct organized a satellite meeting at the
International Pharmaceutical Federation, FIP, meeting in October 2012 with representatives from
WHO AFRO and the Ghana ABR National Policy team. It was decided that Ghana would document the
process of the development of the ABR National Policy to facilitate its adoption, adaptation and
deployment in other African countries. WHO AFRO will streamline activities with ongoing activities
on the country level.
2.1.2 International meetings
Amsterdam ministerial summit
ReAct was represented at the Ministerial Summit on the responsible use of medicines hosted by the
Dutch Minister of Health in Amsterdam on October 2. ReAct´s director was invited to make an
intervention at the ministerial summit.
FIP stakeholder meeting
In conjunction with the ministerial summit, the International Pharmaceutical Federation (FIP)
arranged its annual congress 3-8 October 2012 in Amsterdam. ReAct was invited to and attended a
stakeholder roundtable with the main theme “improving health through responsible medicines use”.
World Economic Forum
World Economic Forum in Davos, Switzerland included an open discussion called ‘What if All Known
Antibiotics Lost Their Effectiveness?’ on the future of antibiotics at their annual event 27 January
2012. The WEF Forum Blog in September 2012 contained an interview with Otto Cars from ReAct
where the urgent need for research and development of new antibiotics was highlighted along with
the comment that any new antibiotics must be made “globally accessible and affordable”.
8
Otto Cars, ReAct, warns that the days of curing pneumonia and carrying out organ transplants will be over unless we tackle antibiotic
resistance. The interview is part of the Risk Response Network’s “What if?” series.
Euroscience Open Forum, ESOF
ESOF, held in Dublin July 11-15, is Europe´s largest forum for science and research. The ESOF
conference is open to academics, the public and the media. ReAct participated together with the
Swedish Research Council, the Swedish Council for Working Life and Social Research, the Swedish
Research Council Formas and the Swedish Governmental Agency for Innovation Systems at an
interactive exhibition on antibiotic resistance entitled "The Good. The Bad. The Ugly".
The aim of the exhibition was to increase awareness and knowledge of antibiotic resistance. In
conjunction with the exhibition a press meeting and a lunch seminar entitles “We are facing a world
without antibiotics — Who takes responsibility?” was held on July 12 where ReAct’s director was one
of the speakers.
Euroscience Open Forum, ESOF, held in Dublin July 11-15, is Europe´s largest forum for science and research.
9
In conjunction with the exhibition a press meeting and a lunch seminar was held: “We are facing a
world without antibiotics — Who takes responsibility?” on July 12 where professor Otto Cars from
ReAct was one of the speakers
2.1.3 Other communication activities
The ReAct website
ReAct’s present website www.reactgroup.org was launched in 2011. During the first year there were
915 visits/month with an increase of 25% to 1150 visits/month in 2012. The website hosts
information about the ReAct network and the various projects carried out in the regional nodes,
ReAct Latin America, ReAct South East Asia and ReAct Ghana. One of the major projects, the CSO
(Civil Society Organizations) Project also has a dedicated sub-site, http://cso.reactgroup.org/ that
showcases the work of CSO partners around the globe and provides regular updates on their
activities, achievements and future plans. The ReAct web site also provides regular news updates on
the antibiotic resistance situation globally together with reports on relevant meetings and events.
The news section is complemented by “Resistance in the News” that is published once a week is a
selection of articles with relevance to antibiotic resistance and antibiotic use that have been
published in various internet media and on-line scientific journals.
There is also a possibility to sign up for regular newsletters with updates on the activities of ReAct
and other stakeholders working with public health and antibiotic resistance. The newsletter has
around 1200 subscribers at present.
The ReAct Resource Center
The ReAct Resource Center, http://www.reactgroup.org/rc.html, launched in 2012 and integrated
with the ReAct website, is a publically accessible web-based database with a wide range of highquality reports, policy documents, presentations, videos etcetera on antibiotic resistance and
antibiotic use. The main focus is to provide policy makers with tools to take action on ABR but also
students, CSOs, health professionals, journalists, community-based organizations and primary health
workers can benefit from the Resource Center within their areas of interest. The Resource Center is
10
also used as a source for background documents for courses on ABR. There are at present 500
different resources available.
In the next phase the Resource Center will be complemented with readymade “tool boxes” for more
specialized needs. To better assist countries and/or regions in developing and introducing policies to
manage ABR and to support other ongoing regional projects, the content in the “toolboxes” will not
only describe results but also processes. What has been successful within our own and other´s areas
of activities, highlighting success factors and benchmarks as well as critical points and but also critical
factors and pitfalls.
The Resource Center will also be developed in a new version with advanced search functions, better
navigation and resource presentation features together with better interactivity with the visitor.
Resistance in the News
Resistance in the News is a selection of articles with relevance to antibiotic resistance and antibiotic
use published in various internet media and on-line scientific journals, gathered by ReAct and sent to
around 125 health experts in co-operation with Swedish Institute for Communicable Disease Control,
(SMI) and also published on the ReAct website.
IFMSA (International Federation of Medical Students' Associations)
Cecilia Kållberg, active in the medical student network IFMSA, did her Master’s thesis at ReAct.
Cecilia has now set up the initiative “START” (Students Targeting Antibiotic Resistance) within IFSMA
and discussions are currently ongoing regarding possibilities to collaborate on preparing a web
platform with materials on ABR for students, including presentations and other tools.
2.1.4 Supporting the development and implementation of regional and
national processes for the management of antibiotic resistance 4
Establishing a national policy platform for work against ABR in Ghana
Much is known, primarily from European countries, about the necessary components required to
manage antibiotic resistance (ABR), and how successful interventions can be coordinated and
implemented. Although the basic components needed for a sustainable national process against ABR
are no different, managing antibiotic resistance in LMICs poses significant challenges. There are no
examples of coordinated national policies from the African region and Ghana is a country suitable for
piloting such a project. This project focuses on and seeks to steward this process to gain experience
on how countermeasures against ABR could be stepwise implemented in an African country. Through
the engagement and leadership of Martha Gyansa-Lutterodt, Director of Pharmaceutical Services
department at the Ghanaian Ministry of Health, a national policy platform for the work against ABR
has been established. This process is also linked to the Ghana part of the CSO project (see page 31)
and it could potentially be further linked to other networks and processes and countries in the
4
Some regional activities area los described under the themes 2, 4 and the CSO-project.
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region, as well as to activities by the WHO AFRO.
Activities and accomplishments 2012
Activities on the development of a national policy on antimicrobial resistance in Ghana are in the
advanced planning stages for roll out. In a recent meeting, a subcommittee led by the Director of
Clinical Care, MoH, was tasked to come out with a Terms of Reference and guidelines for the
development of the antimicrobial policy. The management team in collaboration with specific
individuals and members of the Technical Working Group on AMR have been tasked to deliver on
specific activities in order to achieve stated objectives.
Identification and mapping of major key stakeholders, an assessment of their interests and the ways
in which their interests will affect the processes and overall policy development and subsequent
implementation is another part of the process. These stakeholders are grouped to provide technical
expertise that pertains to their interest, to develop the policy documents.
A website hosted by the Ghana National Drugs programme has been developed 5 and will with time
be made more interactive and accessible to all partners involved in the project.
ReAct in South East Asia (SEA)
ReAct in SEA have been organising successful annual meetings since 2007 and the partnerships
developed are very promising. Since 2012, the Universiti Sains Malaysia is serving as the
administrative host for the ReAct SEA network. Following upon four years of networking carried out
by the ReAct coordinator, the achievement in 2011 was a visible and committed ReAct SEA network
comprising physicians, pharmacists, CSO representatives, activists, academicians, policy makers,
scientists and representatives of regional/global health-related networks and WHO regional bodies,
numbering more than 50 professionals from six of the 10 ASEAN countries.
With support from ReAct and through voluntary work, the network members have initiated ABRprevention interventions in their individual countries, including WHD 2011 campaigns; influenced
policy making processes, to various extents at national and regional levels (for example, the Jaipur
Declaration); come together to explore various ABR-related research; and facilitated cross-border
learning of local community-level intervention programmes (Antibiotic Smart Use Thailand) as well as
hospital level programmes (Antimicrobial Stewardship Program - Singapore). The process to roll
these out as SEA-regional programs has begun in Indonesia and Malaysia with local adaptation and
innovation.
During the course of ReAct activities over the past 3-4 years ReAct SEA has also seen the participation
and interest from national health promotion boards/foundations in Thailand, Malaysia, Indonesia
and Philippines. These are important stakeholders and also potential local funders.
5
http://ghndp.org/antimicrobialresistance/
12
Activities and accomplishments 2012
Malaysia
ReAct´s partner, the Discipline of Social and Administrative Pharmacy, School of Pharmaceutical
Sciences (DSAP), Universiti Sains Malaysia, participated in the launch of the national campaign to
curb AMR by the Health Ministry of Malaysia. The DSAP described the implementation of the ReAct
CSO project in Malaysia and called for the MoH AMR campaign to include community mobilisation
and empowerment as an important and necessary strategy to address the problem of AMR. 6
Asia Pacific Conference on National Medicines Policies, Sydney, Australia7
ReAct in SEA network partners participated in the planning and discussions of the workshop on
‘Antimicrobial resistance and rational use of antibiotics’, at the Asia Pacific Conference on National
Medicines Policies (NMP), held in Sydney, May 2012.
The ReAct-organised workshop saw participants from the small island nations, such as Kiribati, American Samoa, Samoa, Vanuatu, Tonga,
Cook Islands, Tuvalu, express keen interest to be part of the ReAct network in the region.
40 participants from Indonesia, Malaysia, Australia, India, Kiribati, American Samoa, Samoa, Vanuatu,
Tonga, Cook Islands, Tuvalu, India, Netherlands, Nepal, New Zealand, Philippines, Bangladesh, Korea,
China, Mongolia, Netherlands and WHO participated in the workshop, which aimed at identifying the
main challenges/barriers/gaps to developing and implementing effective strategies to contain AMR,
and integrate AMR into NMPs. A set of policy recommendations came out from the workshop
including: education, awareness raising, national policy platforms, and research.
A spin off from the NMP conference was an invitation by the Chief Editor of the journal - Southern
Med Review (SMR) – to ReAct to collaborate on a special issue of the journal, on antibiotic usage and
resistance, to be published in April 2013. ReAct in SEA partners have been involved in the planning
discussions in 2012.
Prince Mahidol Award Conference 2013
Planning towards the ReAct workshop on Controlling Antibiotic Resistance through the One Health
Approach, to be convened at the Prince Mahidol Award Conference 2013 has been going on since
June 2012.
6
7
http://thestar.com.my/news/story.asp?file=/2012/10/22/focus/12206549&sec=focus
http://www.apcnmp2012.com.au/
13
ReAct in Latin America
ReAct in Latin America is coordinated by the Medical Faculty of the University of Cuenca and the
Child to Child Centre. Since 2007 they have gradually built of a network of people, organizations and
institutions that act against bacterial resistance to antibiotics in the fields of education, research and
communication. Important items on the ReAct Latin American agenda have been the social
determinants of health including poverty, inequity, environmental change and the conditions of
indigenous peoples in the region.
Community based advocacy, knowledge, empowerment and practical initiatives have in parallel been
initiated in Ecuador and neighbouring countries.
Activities and accomplishments 2012
Fotoresistencia
The ReAct Latin America (RLA) so called edu-communication project, FotoResistencia (FR), a
photodocumentary project, was launched for professionals and the public, and exhibited in twelve
different places across Ecuador.
In the FR project, primary health care workers are trained in ABR and to take photographs visualizing
the causes and consequences of ABR. Every participant develops a photo-ethnographic story, and
later uses this material (photos and texts) to do edu-communicational activities in their communities,
with their colleagues, and more widely. These activities represent a starting point to change
knowledge and practices on the ABR and its underlying causes.
"FotoResistencia, Antibiotic Resistance in my Primary Health Center and my community". A ReAct Latin America documentation and educommunication project based on photography.
14
The project has been developed and implemented in four southern provinces of Ecuador with
partners that include the Faculty of Medical Sciences of the University of Cuenca, the Pan-American
Health Organization in Ecuador (PAHO), the Ministry of Public Health, the Ecuadorian Social Security
Institute, and the city of Cuenca Health Council.
The results of FR 2011 edition, i.e. the photos and the album, were disseminated during 2012
through an exhibition where the album was launched and, through various colloquia on ABR,
oriented to several targets: health sector workers, students, artists, journalists, and the community.
The Global Health Program of the University of British Columbia’s interest in the FR project led to a
collaboration initiated in Nov 2012 to look for arts based-methods to tackle the ABR issue from an
ecosystem perspective. Now, RLA, its partners and the UBC group are developing a project to
evaluate FR.
A conference organized by RLA on Antimicrobial Resistance included a presentation of the
“FotoResistencia” project in the Particular and Technical University of Loja, Ecuador, in June 2012.
Pedalling with consciousness
In the “Pedalling with consciousness, using antibiotics wisely” project supported by RLA, three
students of the Faculty of Medical Sciences of the University of Cuenca, travelled by bike along the
coast of Ecuador (700 km) during 15 days. They visited elementary and high schools to raise
consciousness on antibiotic resistance, the appropriate use of antibiotics and the use of bikes, in an
ecology framework. A booklet documenting the activity with texts and pictures was produced and is
available at the ReAct website. Moreover, there is a Facebook group of this project 8.
Arts & Microbes Project
An interdisciplinary cooperation between RLA and the Faculties of Medical Sciences and Arts of the
University of Cuenca has been exploring new ways to understand ABR by generating artistic educommunicational material and activities on the microbial world, the ABR and the use of antibiotics.
The idea behind the project was to promote interchanges and actions between medical sciences
students and arts students for better understanding of ABR. The outputs of this project were
released in November 14th, 2012 in the Caravan for Life and Bacteria. A video is available 9.
8 https://www.facebook.com/pedaleaconconciencia?fref=ts
9 http://www.youtube.com/watch?v=tKdFE4t3bnc&feature=youtu.be
15
The Caravan for Life was part of an educational and mobilization process conducted by the Faculty of Medical Sciences and the Faculty of
Arts of the University of Cuenca, ReAct Latin America and the Child to Child Foundation.
2.2 THEME 2: EVIDENCE GENERATION
Burden fact sheet
To better visualize both the health and economic burden of antibiotic resistance, ReAct produced a
fact sheet on this topic in the spring of 2012. Scientific literature on the topic was gathered and
translated into a more accessible format. The fact sheet was widely distributed at the
Swedish/Ghanaian side event at the WHA, the Asia Pacific Conference on National Medicines Policies
and at the Euroscience Open Forum. The fact sheet is available at the ReAct website together with
the other ReAct produced fact sheets (one of which was referred to at the World Economic Forum
blog in Jan 2012).
Master thesis on access, excess and ethics
ReAct in cooperation with the Institution for International Maternal and Child Health, IMCH, at
Uppsala University supervised a master student, Gabriel Heyman, to conduct a study in 2012 to
explore what properties a system of antibiotic distribution must possess to keep prescription and use
rational while achieving access in areas where the coverage and quality of healthcare are poor. The
MSc study “Access, excess and ethics-towards a model for rational use of new antibiotics” was
presented in March 2013.
Knowledge, Attitude, Behaviour and Practices survey on health professional of ABR in Ghana
A Knowledge, Attitude, Behaviour and Practices (KAP) survey on ABR targeted to health professionals
in Ghana helped collect data that will advice the training and building the capacity of core health care
providers in public health institutions. This training will contribute to health professionals being
better placed to influence and work with policy makers for more rational use of antibiotics in public
sector institutions. The research subgroup of the Technical Working Group initially developed a
protocol to carry out this activity within the demographic community at the four sentinel sites of the
Ghana Health Service research institutions across the country. Due to the current direction and
budgetary constraints this protocol is being redesigned to focus on health professionals within
selected public health facilities in the three geographical zones of Ghana.
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Baseline study in Ghana on the level of resistance of five key antibiotics and the establishment of
routine monitoring and surveillance of these antibiotics and resistance.
The baseline study in Ghana on the level of resistance of five key antibiotics is linked to the KAP study
and form part of the assessment on antibiotic resistance in some selected hospitals in the country.
These activities are directed towards providing additional evidence on resistance to commonly used
antibiotics and also to determine the capacity of laboratories and personnel to handle resistant
organisms.
A proposal to carry out needs assessment of the selected hospital laboratories and also determine
the capacity of these laboratories to undertake surveillance on resistance has been developed. This
proposal, “Monitoring Antibiotic Resistance in Hospital Laboratories” (Marhlab) is intended to be
applied in four selected hospitals with different levels of laboratory capacity and facilities. Marhlab
will achieve five objectives, which include a rapid assessment of the selected laboratories to
determine capacity gaps; determine the prevalence of resistance strains; and then carry out routine
monitoring and survey resistance pattern to five key antibiotics in the selected hospitals laboratories.
South East Asia Antibiotic Resistance Costs in Hospitals
The development of South East Asia Antibiotic Resistance Costs in Hospitals (SEARCH) proposal that
had been initiated in 2011 was completed in 2012. The study protocol is aimed at documenting and
analyzing the Costs and Consequences of Antibiotic Resistance in bacteraemic patients in South East
Asian Hospitals. Hospitals from seven countries in the region have shown interest in participating in
the research project and funds are being sought from regional organisations as well as from national
health promotion boards.
ESBL-carriers in a neonatal intensive care unit at a tertiary hospital in Ecuador
In 2011, ReAct Latin America in cooperation with Karolinska Institutet, Stockholm, Sweden, finished a
study on EBSL in neonates 10, which was presented in the ICIUM conference 11. The study showed that
55% of the admitted children were colonized by ESBL-producing isolates, and these data were used
in 2012 to raise awareness with the authorities. This study is a first step in demonstrating the need
for a national policy, the importance of national and regional programs as well as ongoing research
to increase infection control in Ecuadorean hospitals.
Antibiotic use in children in indigenous communities in Ecuador
A study entitled “An ecosystem approach to promoting appropriate use of antibiotics for children in
indigenous communities in Ecuador” was performed in 2012 and published in the Pan-American
Journal of Public health 12. The study was done in collaboration with University of British Colombia
and showed that environmental, social, and cultural factors must be addressed to prevent antibiotic
resistance in addition to training health personnel and that an ecosystem approach is well-suited to
achieve this goal.
10
http://f1000.com/posters/browse/summary/1089935
Third International Conference for Improving Use of Medicines, http://www.inrud.org/ICIUM/ICIUM-2011.cfm
12
http://www.ncbi.nlm.nih.gov/pubmed/22358404
11
17
Studies on the perception of infection and antibiotics by mothers and children in Ecuador.
In 2012, a study to analyze perceptions of ABR and use of antibiotics by 500 children, 10-12 years
of age, and more than 1000 mothers in communities in urban and rural areas in different social
strata was initiatied.
Evaluation of KAP of PHC doctors and community in the Amazonian region.
A new project to evaluate the knowledge, attitude and perception, (KAP) of public health center
doctors and the community they serve in relation to antibiotic use was started in a region with
30,000 inhabitants encompassing one second-level hospital and eight primary health care units.
Based on the results obtained, the goal is to develop a training program adapted to the identified
needs.
18
2.3 THEME 3: PROMOTING INNOVATION AND THE DEVELOPMENT OF
HEALTH TECHNOLOGIES TO MEET GLOBAL NEEDS TO MANAGE
ANTIBIOTIC RESISTANCE
2.3.1 The global need for new effective antibiotics
ReAct has since its inception in 2004 made strategic interventions to inform stakeholders about the
need for development of new antibiotics. To influence the process of innovation of health products
to manage ABR, ReAct has catalyzed and actively participated in processes to develop new funding
mechanisms, and re-engineer the R&D pipeline to create an enabling environment for novel, reliable,
and affordable antibiotics and diagnostics for all.
*Collaboration for Innovation”, ReAct high-level meeting with the European Commission, The European Medicines Agency, the World Health
Organization, academia, the pharmaceutical industry as well as several civil society organizations
Activities and accomplishments 2012
Input to the process of the EU action plan against Antimicrobial Resistance
This plan was launched in November 2011 and included research to speed the development of new
antibiotics within the PPP between the European Commission and the European pharmaceutical
industry -The Innovative Medicine's Initiative (IMI). ReAct was asked by IMI to suggest research areas
to be considered and to write a background document on the topic “Controlled Distribution and Use
of New Antibiotics”.
Lectures at meetings and conferences
ReAct actively participated at several meetings including a meeting on ABR organized by the Joint
Programming Initiative on Antimicrobial Resistance (JPIAMR), a session at Drug Information
Association 24th Annual Euro Meeting 2012 (DIA 2012) in Copenhagen regarding the scientific and
political challenges in antibiotic development (together with speakers from EFPIA and the EU
19
Commission , DG Research) and a “meet the expert session“ on the urgent need for novel antibiotics
at the International Conference on Antimicrobial Agents and Chemotherapy.
High level meetings on a new business model for R&D of new antibiotics
On 20 April 2012 a meeting took place between ReAct and the Assistant Director General for the EU
Commission Directorate on Health and Consumers. On November 26, a second meeting with WHO
Assistant Director Keiji Fukuda and several representatives from WHO and the Director of EFPIA to
discuss new business models for the development of new effective antibiotics took place.
Leadership training in International health including policy innovation and access to medicines
In November 2012, the ReAct strategic Policy unit at Duke University hosted a leadership training, coorganized with the American Medical Student Association, on several key issues for U.S. and
international health including policy innovation and access to medicines, tackling antibiotic
resistance, and ensuring open access to knowledge. Thirty students, selected from ninety applicants,
came together for an intensive, two-and-a-half day training. The conference included three breakout
session tracks, of which one focused on antibiotic resistance.
Treatment for Tomorrow (T4T): Finding Breakthrough Innovations for Tackling Antibiotic Resistance.
The ReAct Strategic Policy Unit at Duke University explored the design of a co-opetition - that is, a
prize competition with collaborative elements integrated into the event’s timeline - entitled,
“Treatment for Tomorrow (T4T): Realigning Incentives to Balance Affordable Access with Rational
Use of Antibiotics.” This ideation challenge was intended to call for innovative ideas on how to
change the incentives throughout the value chain of antibiotics—from pharmaceutical company to
consumer - in order to improve the use of antibiotics. In December 2012, a diverse group of global
health stakeholders and topical experts were brought together to help develop a process by which
breakthrough innovations to tackling the challenge of ABR in the healthcare delivery system might be
supported within four related ABR challenges:
•
•
•
•
Infection Control and Prevention
Metrics, Maps and Media (3M)
Delivery/Distribution Systems for Medicines
Incentives for Rational Use
The highly productive discussions generated many potential follow-up leads, but depending on
funding and resources, ReAct will have to be strategic in selecting which to pursue.
2.3.2 Controlled distribution and use of new antibiotics
As a logical step following the several ongoing EU and global initiatives to address the need for
innovative R&D for new antibiotics and to push forward the process started in 2011 concerning the
use of any future new antibiotics, ReAct initiated in the autumn 2012 a process to address and stir
debate on how to ensure rational use of any future new antibiotics while securing the equitable
access and affordability. To this end, ReAct procured the services of a consultant and appointed an
20
academic team to write a debate paper to lay down exploratory ways to preserve new effective
antibiotics.
3Rs for innovating novel antibiotics: sharing resources, risks, and rewards. Anthony So, ReAct Strategic Policy & Advocacy.
ReAct participated in the QUAMED (Quality Medicines for all) partner meeting held in December at
the Institute of Tropical Medicine, in Antwerp, Belgium. The meeting gathered not only the 21
QUAMED partners but also organizations involved in the access to quality medicines in and towards
developing countries. ReAct shared its views on controlled distribution and use of new antibiotics
and what can be learned from other initiatives like those working to evaluate and control resistance
to antimalarials
Addressing the importance of de-linkage of R&D investments for new antibiotics from marketing
activities
The ReAct strategic policy unit at Duke University worked to publicly address the importance of delinkage R&D investments for new antibiotics from marketing activities in the United States. The
activities relate to and address the passage of the Generating Antibiotic Incentives Now (GAIN) Act, a
piece of U.S. legislation aimed to incentivize R&D of new antibiotics. The group at Duke debated and
questioned the content of the GAIN Act that extends company monopoly rights to its new drug’s
market. In light of the increased need to educate the public and policymakers on delinkage, ReAct
worked with the head of Public Citizen, a major U.S. consumer rights group, to write a Huffington
Post editorial against the use of data exclusivity as an incentive for antibiotic development. The
article informed that there is little evidence that increased market monopoly rights address the
scientific and business model challenges facing the antibiotic R&D space. Moreover, monopoly
protections like exclusivity fail to delink R&D cost recuperation from high-volume sales of antibiotics a contributing factor to the over-marketing and overuse of antibiotics, factors contributing to the
public health threat of antibiotic resistance.
21
2.4 THEME 4: PROMOTING RATIONAL USE OF ANTIBIOTICS
2.4.1 Latin America
Courses and Training activities
A seminar on the appropriate use of antibiotics in human health was organized in June 2012 and
targeted 40 health workers of the Ecuadorian Ministry of Health, Morona Santiago province.
ReAct in Latin America (RLA) participated in a conference about the global view of antibiotic
resistance, appropriate use of antibiotics, water and healthy environments in a workshop for health
promoters hosted by the Faculty of Medical Science of the University of Cuenca in April 2012 and
have provided short training on rational use of antibiotics to community leaders (150 who are now
“champions” in local communities).
In collaboration with academics from Brazil, Venezuela, Cuba and Ecuador React Latin America is
developing a guideline for appropriate use of antibiotics aimed at Primary Health Care workers
Dr. Cristian Pacheco (research team) LCDA. Soledad Ortega (research team), Dr. Romulo Lima (medical director), DRA. Georgina Munöz
(research team).
2.4.2 South East Asia
Baseline surveys and training of trainer’s workshops.
During 2012, ReAct partners in Indonesia, Malaysia and Thailand implemented activities related to
the ReAct project - Engaging Civil Society Organizations as stakeholders in national/regional
platforms to manage ABR. Baseline surveys and training of trainers workshops were held in project
sites in the three countries since the launch of the project in 2012. The activities aimed at extending
community-based health promotion and education networks to reach parents, children and youth to
22
foster positive health behaviour including the themes of ABR management. The project will also
engage relevant regional CSOs as active stakeholders in national/regional platforms to manage
antibiotic resistance.
The CSOs participating in the new project are based in Latin America, West Africa and South-East Asia. Most of them are working in the
areas of child and maternal health, women's issues, education and environment.
Antibiotics Smart Use: a workable model for promoting the rational use of medicines in Thailand.
Several ReAct partners in SEA are part of the Antibiotics Smart Use (ASU) program 1 introduced in
Thailand as a model to promote the rational use of medicines, starting with antibiotics. The programs
first phase consisted of assessing interventions intended to change prescribing practices; the second
phase examined the feasibility of program scale-up.
Currently the programme is in its third phase, which centers on sustainability. To change antibiotic
prescription practices, multifaceted interventions at the individual and organizational levels were
implemented; to maintain behaviour change and scale up the program, interventions at the network
and policy levels were used.
The National Health Security Office has adopted ASU as a pay-for-performance criterion, a major
achievement that has led to the program’s expansion nationwide. Despite limited resources,
program scale-up and sustainability have been facilitated by the promotion of local ownership and
mutual recognition, which has generated pride and commitment. ASU is clearly a workable entry
point for efforts to rationalize the use of medicines in Thailand. Its long-term sustainability will
require continued local commitment and political support, effective auditing and integration of ASU
into routine systems with appropriate financial incentives.
23
2.4.3 Africa
EPN Forum "Access to quality medicines: priority needs, priority actions for today and tomorrow".
ReAct actively participated in the 2012 EPN (Ecumenical Pharmaceutical Network) Forum and
General Meeting held in Addis Ababa, Ethiopia in March that had the theme "Access to quality
medicines: priority needs, priority actions for today and tomorrow".
EPN identified AMR as one of several priority issues it needs to address and expressed the desire to
work with ReAct on this. Access to quality antibiotics, extending awareness of AMR in the community
and development of tools to enable these were identified as issues.
The Forum brought together 62 representatives from member and non-member institutions.
About 20 high level speakers connected general approaches in fields of procurement, supply chain,
quality of medicines, and non-communicable disease with practical results and successes within the
network.
2.5 OVERALL COORDINATION
The overall coordinating functions of ReAct are managed by its office based at Uppsala University
and its network coordinator. The tasks of the staff at the Uppsala office in the overall project
management included:
-planning and following up the progress of the projects including problem-solving and other decisionmaking in dialogue with ReAct staff, consultants and partners
-providing infrastructure for documents, projects (platforms), teleconferences and meetings
-contracting of partners, consultants and employees
-financial management and reporting to funders
24
-external communication with stakeholders through informal contacts and by representing ReAct at
meetings and conferences
-providing scientific knowledge and credibility
-providing an updated website including the ReAct Resource Center
The staffing of the office in Uppsala 2012 is described in the table below:
Name
Role
ReAct 2012 %
Sida funded %
Elisabeth
Lindström
Project coord.
& economy et. al
Website & comm.
coord. et al.
Director
1
1
1
1
0,4
0
Ass. Director
researcher
Proj. manager
CDU, Africa et.al.
Proj manager,
strat. Policy
Proj. manager
researcher
Director
1
0,17
0,5
0
1
0,75
0,08
0,08
0,16
0
Scientific advisor
0,14
0,14
5,28
3,14
Christel
Törnros
Otto Cars
Anna Zorzet
Maria-Teresa
Bejarano
Anna Hedin
Liselotte
Högberg-Diaz
Andreas
Heddini
Ingrid Trolin
TOTAL:
Comment
Director from
2012-03-01
100% 1 aug-31
dec
Left ReAct 201212-31
Left ReAct 201201-31
Left ReAct 201202-28
Left ReAct 201206-30
Employees in the network and consultants:
Name
Role
ReAct 2012%
Sida funded%
Comment
Eva Ombaka
Göran Tomson
Michael Chai
Mary Murray
Satya
Sivaraman
Senior advisor
Senior advisor
SEA coordinator
Network coord.
Communication
coordinator
Scientific advisor
0,05
0,05
0,8
0,6
0,4
0,05
0,05
0,8
0,6
0,4
Tanzania
0,15
0,15
2012-03-01 -
Lars Blad
Malaysia
Australia/Uppsala
India
25
Ken Phillips
Yong Kwok
Hajo
Grundmann
TOTAL:
Organisation
consultant
Consultant CDU
project
Consultant
Surveillance
0,07
0,07
0,12
0
0,16
0
2,4
2,12
2012-12-31
2012-09-19 2012-12-31
2012-10-01 2012-12-31
2012-09-01 2012-12-31
Apart from the above listed personnel there are several people employed or working as volunteers
through the funding provided as grants to the regions, see the presentation below.
Snapshot of the staffing situation of ReAct (total all funds) in March 2013
One major focus for the coordinating function 2012 has been the organization of a Strategic Planning
Workshop for ReAct staff and external advisory key stakeholders in Noordwijk, the Netherlands
March 2013. Working closely with an organizational consultant, background material was prepared
26
during 2012 and a number of activities to facilitate organization and analysis of material to help
ReAct to plan and make decisions on four inter-related areas:
• Resource mobilization and financial sustainability
• Strategic and operational planning
• Organization culture, development and change management
• Team, management and leadership development
In 2012 ReAct has seen an increased level of engagement and coordination across themes and
regional affiliation that has created good synergy and strength when managing the cross-cutting
activities within controlled distribution and use and innovation of new antibiotics and the planning of
a course concept.
2.5.1 Networking coordination
The work of the Global Network Coordinator has been important in 2012 as a major contribution to
the active unification of ReAct’s work under themes and between themes, the integration of ReAct’s
previous work, links and network relationships into the conceptualising and development of new
projects such as CDU; supporting and mentoring every person in the ReAct organization through
2012 - a period of challenge in ReAct’s growth and reorganization thereby keeping the ReAct spirit
alive.
One of the main efforts was to actively facilitate understanding and collaboration between the
regions, themes, projects and people that as a whole make up ReAct as a catalyst organization. The
global network coordinator was actively involved in the preparations for the abovementioned
Strategic Planning Workshop together with an external consultant. A major task in 2012 was
initiating the first step of a harvesting process which involved interviewing each member of the ReAct
international secretariat and drafting a paper on the experiences and influence of the ReAct network.
This work contributed significantly to developing links and inducting new people and organisations
into the issue of ABR and ReAct’s approach to it.
27
2.6 TARGET FULFILMENT AND PERCEIVED IMPACT
Target- fulfilment of ReAct Log frame for 2012
Fulfilment of LFA
Activities
Achieved results
Indicators
Increased visibility of antibiotic resistance in the global health dialogue
1.To work with national
and regional partners to
promote the establishment
of national platforms on
antibiotic resistance;
Regional and/or national
policies on ABR established
in one or several countries
where ReAct is active;
1.1Management of ABR
featured in national health
plans;
Measures to manage ABR being
featured in national health
plans
(Chapter 2.1.4)
1.1.1 In Ghana an AMR policy
is ready for roll out.
1.1.2 In South East Asia the
policy network has expanded
as seen by the MoH Malaysia
AMR campaign and Asia
13
Pacific conference
1.1.3 In Latin America mainly
the “bottom-up” approach is
used ex. ESBL-study lifted to
policy makers to improve
14
infection control
1.1.4 Pre-policy paper
developed and signed by
University of Cuenca, MoH
Ecuador, Social Security,
Municipality of Cuenca, PAHO,
and ReAct
2. To engage communities,
health professionals,
international organisations
and academic centres in
antibiotic resistance and its
management;
Antibiotic resistance being
recognised as a major
problem by organisations
and networks working with
health, access to medicines
and drug quality in LMICs;
2.1 ReAct’s work being brought
up in meetings, media and
publications
15
2.1.1-2.2.1 RLA campaigns to
engage different groups:
- Expansion of the
Fotoresistencia campaign;
8
- Pedalling with conscience .
9
- Arts & microbes project ,
see also launch of the CSOproject (chapt. 3)
2.1.2 ReAct’s work being
brought up in publications,
meetings and media (annexes
1, 2 and 3)
http://thestar.com.my/news/story.asp?file=/2012/10/22/focus/12206549&sec=focus
http://www.apcnmp2012.com.au/
14
http://f1000.com/posters/browse/summary/1089935
15
http://ia600606.us.archive.org/34/items/EsTiempoDeSensibilizarnosAnteLaResistenciaALosAntibioticos/Declaracion_dia
MundialDeLaSalud_7abril2011.pdf
13
13
28
Additional network
partners in SSA.
2.2 New organisations taking
on antibiotic resistance as a
result of ReAct collaboration
esp in SSA;
2.2.1 ReAct SEA have been
organising successful annual
meetings and the partnerships
developed are promising.
Network members have
initiated ABR-prevention
interventions locally
(chapt.2.1.4)
2.2.2 Collaboration with WHOAMR-team (chapt 2.1.1) and
regional offices such as WHOAFRO and other actors.
2.3 Relevant information on the
root causes of poor access, its
consequences and options to
improve access to antibiotics in
different contexts published by
React and/or partners (no. of
publications);
3. To publish articles,
newsletters and other
communication materials
2.3.1 Publication of root
causes to access not complied
to sufficiently but is an
element in most ReAct
communication, see annex
1,2,3
3.1.1 Well updated ReAct
website www.reactgroup.org
3.1.2 Publication of articles,
newsletters and other
communication-material, see
annex 1
Evidence on antibiotic resistance, its causes and consequences
generated
1. To work with
organisations, NGOs,
networks and other actors
to increase the generation
of data on antibiotic
resistance and use;
First steps towards a global
network for surveillance of
antibiotic use and
resistance taken where
ReAct has contributed by
catalysing action with
multiple regional partners;
Data is being used to
underpin new policies and
guides decision making.
1.1 Continuous surveillance
being carried out in resource
constrained settings;
1.1.1 This is a huge task but as
a first step a ReAct roadmap
on global ABR surveillance has
been developed and fed to
WHO (chapt 2.1). The next
step is ongoing; WHO is
mapping what data that exist
globally.
1.1.2 Studies on ESBL, MRSA
etc conducted by ReAct Latin
America in cooperation with
other Universities and fed to
stakeholders in different ways
(chapt. 2.2)
1.1.3 Baseline study on the
level of resistance of 5 key
antibiotics and establishment
of surveillance of these
29
antibiotics initiated in Ghana
by the Ghana MoH.
2. To promote better
assessment of the social
and economic burden of
antibiotic resistance.
Data is being used to
underpin new policies and
guides decision making.
1.2 Funding leveraged for work
on surveillance
1.2.1 Catalysation and uptake
of ABR on the INDEPTH
agenda including a funding
proposal to Wellcome Trust.
2.1 Increase in the number of
organizations involved in this
area
2.1.1 ABR costing study
developed by ReAct South
East Asia, this proposal was
funded by SEARO (chapt. 2.2)
2.2 Reports and publications on
burden where ReAct has
contributed (no. of
publications);
2.2.1 Fact-sheet about health
and economic burden of ABR
produced and widely
disseminated,(chapt.2.2)
2.2.2 Publication of articles,
newsletters and other
communication-material
(annex 1)
3. To increase the visibility
and knowledge of
restricted access to
effective antibiotics and its
consequences in global,
regional and local
dialogues on health and
related areas;
3. To make data available
through dissemination and
communication;
3. To promote the uptake
and use of growing
evidence base.
Data is being used to
underpin new policies and
guides decision making.
2.3 Policy statements and
documented decision
processes of governments and
position papers of relevant
health organisations (no. of
publications).
2.3.1 Policy-documents exists,
but it is difficult to quantify.
3.1 Increase in the number of
organizations involved in this
area
3.1.1 Restricted access lifted
in multiple local, regional and
global dialogues.
3.1.2 Master-thesis conducted
on access, excess and ethics
(chapt.2.2)
3.1.3 KAP survey initiated by
MoH Ghana to influence
health professionals and
policymakers on rational use.
(chapt.2.2)
3.1.4 Study on antibiotic use
for children in indigenious
communities in Ecuador
published.
(chapt.2.2)
3.1.5 Study on perception of
antibiotic use targeted to
mother and children initiated
30
in Ecuador.
(chapt.2.2)
3.1.6 KAP study of PHC
personnel in Amazonas
initiated.
(chapt.2.2)
3.1.7 Publication of articles,
newsletters and other
communication-material,
(annex 1)
Innovation and development of health technologies to meet global
needs to manage antibiotic resistance
1. To engage in and drive a
process to stimulate the
development of new
antibiotics;
2. To link innovation to
global access to
forthcoming products;
A new initiative for the
development of new
antibiotics and associated
health technologies
established.
1.1 No. of policy convenings
and international meetings;
1.1.1 ReAct has contributed to
the outcome of several
conferences: JPIAMR, DIA,
ICAAC and high level meetings
with EU and WHO (annex 2)
1.2 New efforts arising from
this process, e.g. the
establishment of PDPs, funding
of basic research etc;
1.2.1 Mainly delivered 2011.
Actions now taken by
boundary partners eg. IMIprocess (chapt. 2.3.1)
1.3 Other actions taken by
boundary partners;
1.3.1 Antibiotic Action, British
initiative to stimulate
development of new
antibiotics and EU AMR
strategy, see outcomemapping table.
1.4 Amount of funding that
goes into this area
1.4.1 In May 2012, IMI
launched The ‘New Drugs for
Bad Bugs’ programme
(ND4BB) with the first topics
having a budget of EUR 224
million. The next call, in
December 2012, included
projects with a budget of EUR
137 million.
2.1 No. of policy convenings
and international meetings;
2.1.1 Organisation of
international leadership
training in health for students
including access issue see
chapt. 2.3.1. Active
participation at the QUAMEDmeeting in Antwerpen,
December (chapt. 2.3.2 and
annex 2)
31
2.2.3 Master thesis conducted
on access vs, excess
problematic on antibiotic
distribution (chapt. 2.3)
3. To stimulate reengineering of the value
chain of R&D to make
drugs, vaccines and
diagnostics affordable;
3.1 No. of policy convenings
and international meetings;
3.1.1 Treatment for Tomorrow
(T4T) meeting in December
that generated many potential
follow up leads, see also
annex 2.
3.2 Framework for prioritizing
amongst health technologies
developed;
3.2.1 The T4T process may
deliver results here during
2013 and 2014.
3.2.2 Importance of delinking
R&D investments from sales
has been addressed, e.g. by
debating the GAIN-act (chapt.
2.3.2)
Promoting rational use of antibiotics
1. To work with other
networks and
organisations to promote
rational use of antibiotics;
1.1 No. of processes where
ReAct is involved to promote
rational use of antibiotics
1.1.1 ReAct has been involved
to promote rational use of
antibiotics in:
-partnership with ASUprogram in SEA
-WHO consultations
-community initiatives
-public awareness raising
through websites and social
media (chapt 2.1)
- education of PHC workers in
Latin America and SEA (chapt.
2.4)
- conferences and workshops
for various audiences about
rational use (chapt 2.1 & 2.4)
1.1.2 Process initiated to
debate a new system for CDU
of antibiotics (chapt. 2.3)
1.1.3 Debate article under
production, will be published
2013.
2.To develop more
powerful tools and
processes for training of
New participatory actionoriented education model
for primary health care
2.1 Established training course
on the management of ABR in
primary health care established
2.1.1. In SEA baseline surveys
and train the trainer
workshops has been arranged
32
health workers and
engaging the community;
workers developed, tested
and implemented in several
countries in South America;
in at least one Latin American
country
in Indonesia, Malaysia,
Thailand in synergy with the
CSO project see chapt.3.
Training of health workers and
community done in
partnership with ASU-program
in SEA (chapt. 2.4.2)
2.1.2 Education of PHC
workers in Latin America e.g.:
seminar on appropriate use of
antibiotics for health workers
of the Ecuadorian ministry of
health and training of rational
use of abs to community
leaders (chapt. 2.4.1)
2.1.3 In a collaboration with
Brazil, Venezuela and Cuba
RLA is developing guidelines
for appropriate use of
antibiotics aimed at PHC
workers.
3. To stimulate
interdisciplinary work to
re-conceptualise ABR
issues to uncover new
aspects of the humanmicrobe-ecology relation.
Broader understanding of
ABR as a complex
phenomenon beyond the
health care sector.
3.1 Broader understanding of
ABR as a complex phenomenon
beyond the health care sector
3.1.1 Interdisciplinary work to
re-conceptualise ABR:
pedalling with consciousness
& art projects in Latin America
(chapt. 2.1)
3.2 No. references to paradigm
shift or need for holistic
approach to ABR in scientific
literature;
3.2.1 References made about
the need for a holistic
approach; example 16
3.3 No. of messages with
changed image of ABR as
expressed by language, images,
etc
3.3.1 Messages with changed
image of ABR,
example 17 18 19
3.3.2 ReAct’s work being
brought up in meetings, media
and publications, see annexes
1,2 and 3 (applies to all
activities in this theme)
http://www.onehealthglobal.net/?page_id=1132
http://www.economist.com/node/21560523
18
http://www.spiegel.de/wissenschaft/medizin/mikrobiom-ueber-10-000-bakterien-am-menschen-gezaehlt-a-838739.htm
19
http://www.newyorker.com/reporting/2012/10/22/121022fa_fact_specter#ixzz2HUd6j4Wt
16
17
33
Overall coordination
1. Optimise synergies
between the ReAct
components to harness the
collective potential of
ReAct;
Improve internal and
external communication;
2. Develop a method for
prioritising amongst
projects;
Focus on a limited number
of larger projects;
3. Global surveillance of
news and activities relating
to antibiotic resistance;
ReAct continues to grow
and consolidate its role as a
catalyst that can leverage
action to manage antibiotic
resistance. ReAct engages
in and leads several
different international
projects and processes
1.1 Network coordination and
management as assessed by
ReAct core members
(qualitative);
1.1.1. Process initiated for:
-Strategic and operational
planning,
-Organization culture,
development and change
management and
-Team, management and
leadership development
1.2 Overall funding level;
No. of funders;
1.2.1 Process initiated for:
-Resource mobilization and
financial sustainability
-Funders contacted (chapt. 4)
ReAct continues to grow
and consolidate its role as a
catalyst that can leverage
action to manage antibiotic
resistance. ReAct engages
in and leads several
different international
projects and processes
2.1.1. Process initiated for:
-Improved strategic and
operational planning
3.1 Quality and contents of
website (external reviews);
No. of visitors to website;
3.1.1 Regularly updated high
quality website,
www.reactgroup.org with
1150 visits/month 2012
(chapt. 2.1.3)
3.1.2 Launch of the ReAct
resource center with over 500
documents available
(chapt.2.1.3)
3.1.3 Global surveillance of
news relating to antibiotic
resistance, compiled into the
“resistance in the news”
collection that is distributed
weekly by email & published
at the ReAct website
(chapt.2.1.3)
3.2 No. of media briefs;
No. of media interviews and
publications.
No. of media interviews and
publications.
3.2.1 ReAct’s work being
brought up in meetings, media
and publications (annexes 1,2
and 3)
34
Elements of outcome-mapping
During 2012 contacts and collaborations have been established with an increasing number of
actors/organisations, some of which are described in the table below. We wish in this way to
capture changes in behaviour in actors with whom we do not have direct contact with but where
ReAct has influenced or given impetus to change processes.
Organization
Type of contact/relation
with ReAct
Outcome
Antibiotic Smart Use (ASU)
programme, Thailand
Part of the extended ReAct
network, joint meetings, ad-hoc
contacts. ReAct facilitated crosscountry study visits to introduce
champions for ABR to the ASU
project.
Since 2006, ASU has evolved from
a small pilot project to a national
programme to improve rational
use of antibiotics, which is now
much appreciated internationally.
Organisations in Indonesia and
Malaysia have adapted ASU and
implemented it in pilot locations.
Australian working group on ABR
Personal contacts through one of
ReAct’s Sec members,
participation in meeting
National programme on ABR
launched in Australia
Antibiotic Action
A British initiative aiming to
stimulate the development of
new antibiotics launched autumn
2011
Part of the extended ReAct
network, joint meetings, jointdebate articles, ad-hoc contacts
Increased global awareness raised
through debate articles and
workshops
EU
Meetings and workshops for EU
representatives 2009-2011
EU AMR strategy to contain AMR
launched 2011
IMI initiative launched 211
IFMSA (International Federation
of Medical Students Associations)
Master thesis student from
IFMSA.
Initiation of START (Students
targeting antibiotic resistance)
project
IMI
Engagement in a process
stemming from meetings in
Sweden in 2009, 2010 and 2011
and involvement in call process
2012
New initiatives to stimulate
development of new antibiotics
INDEPTH
International Network for the
Demographic Evaluation of
Populations and Their Health.
INDEPTH currently consists of 37
demographic surveillance field
One ReAct member was previously
chair of INDEPTH and managed to
catalyse an uptake of ABR on their
agenda and initiate a funding
proposal to Wellcome Trust
Improved surveillance of ABR
through INDEPTH sites
35
sites (DSS) in 19 developing
countries
KI /ICHAR
Part of the extended ReAct
network, joint meetings, joint
courses and research projects, adhoc contacts
Increased knowledge of the root
causes of ABR and methods for
managing ABR better among
international health students &
authorities in Latin America
Numerous partners in SEA and
RLA extended network
Interactions through the ReAct
SEA group and RLA group through
WHO regional offices,
governments, CSO organisations,
workshops, training, meetings,
joint publications..
ABR included on other actors
agendas locally, nationally and
regionally
(Jaipur declaration, Chennai
declaration, Malaysian campaign
to curb ABR, …)
WHO
Long standing advocacy contacts.
Frequent participation in WHO
meetings and WHO projects.
Preparation of a number of
reports for WHO. Support to the
Swedish governments WHO
delegation
Initiation of global coordination of
ABR through the WHO AMR group
3. CSO PROJECT ENGAGING CIVIL SOCIETY ORGANIZATIONS
FOR SOCIAL MOBILIZATION, HEALTH EDUCATION AND
COMMUNICATION
Background information
2012 saw the start of ReAct’s CSO Project: Towards national/regional policy platforms to manage
antibiotic resistance - engaging civil society organizations for social mobilization, health education
and communication. The project was launched at a meeting in Penang, Malaysia, on 17-18 February
2012. The CSOs participating in the project based in Latin America (Ecuador and Nicaragua), West
Africa (Ghana) and South-East Asia (Indonesia, Malaysia and Thailand) and work in, among other
things, the areas of child and maternal health, women's issues, education and environment.
In Latin America, the lead CSOs involved are the Child to Child Foundation, Ecuador (CCF), and
Information Center & Advisory Services in Health, Nicaragua (CISAS). In West Africa (Ghana), the lead
CSOs involved are Centre for Science and Health Communication, Alert Foundation, and LAPAG- Lady
Pharmacist association of Ghana. In Southeast Asia, the lead CSOs involved are Yayasan Orangtua
Peduli (Foundation of Concerned Parents) (YOP) (Indonesia); Yayasan Bina Ilmu Foundation for
Building Knowledge) (YBI) and Discipline of Social and Administrative Pharmacy, USM (DSAP)
(Malaysia); and Family Network Foundation (FNF), AIDS Access Foundation (AAF) and Drugs System
Monitoring Development, Chulalongkorn University (DMD) (Thailand).
36
The administration of project funds are managed by CCF (Latin America); Ministry of Health (Ghana);
and USAINS Holdings (Southeast Asia).
The General Manager of the global project is Michael Chai (ReAct Southeast Asia), who also manages
the SEA component of the project. The Regional Managers of the Latin America and West Africa
component of the project are Klever Calle (Ecuador) and Martha Gyansa-Lutterodt (Ghana)
respectively.
ReAct Uppsala coordinates the overall CSO global project and funds administration. Professor Otto
Cars, the PI of the global project also managers the global component of the CSO project, which is
aimed at linking international CSOs in the work of this project.
Project results
Year One saw a slow start, to implementation of project activities, in most countries, due to planning
processes, capacity of partners, local challenges and paperwork related to contracts, LoAs and
disbursements of funds. In SEA, Indonesia began their activities the earliest, in March 2012, using
their own funds first. Malaysia began activities in mid-June 2012, Thailand in August. In Latin
America, Ecuador began project activities in March, Nicaragua in April. In Ghana, project activities
began in August 2012.
The first main activity of all project partners was a baseline survey (knowledge, attitudes, behaviour
and practice - KABP), to indicate the KABP of the CSOs, and when possible the KABPs of the
communities they worked in, vis-à-vis use of antibiotics and understanding of ABR. All countries
completed their baseline surveys in 2012, with the exception of Ghana.
The results of the project site surveys were mixed. Against the completed baseline surveys, KABPs
indicate that the CSO members are generally familiar with the basics of AB use and ABR. The
community knowledge, however, varies from a significant lack to mis-informed knowledge about AB
use and ABR. Examples include use of AB without prescription, use of others’ AB, use of AB for viral
infections, lack of awareness of ABR, not completing the AB course, and expecting AB prescription in
visits to physicians, despite the nature of the ailments.
Results achieved against outputs and outcomes planned
As Ghana was the latest among the country project partners to implement the activities, having
started the KABP survey in November 2012, there were no outcomes of note to report. The outputs
of 2012 consisted of several preparatory meetings and preparations of the KABP survey, the results
of which is expected to be reported in 2013.
As for the other country partners, the Training of Trainers (ToT) workshops, aimed at equiping the
project CSOs with, knowledge, skills and tools for health promotion including AB use and ABR, proved
successful. From reports of the ToT workshops, the participants indicated an improved knowledge
and understanding of the issues and challenges related to AB use and ABR, and ways to communicate
these messages to the communities they worked with. The development of materials for use in the
37
information-communication-education activities were, additionally, innovative, context-relevant and
effective. Examples include the use of the Fotoresistencia materials, exhibitions, visuals, etc.in
Ecuador and Nicaragua; drama, art and music in Thailand; brochures, posters and easy-to-use
manuals in Malaysia; social media formats (twitter, facebook, mobile messaging etc) in Indonesia.
Participants of the ToT workshops also indicated a greater commitment and cooperation towards
addressing the challenges of ABR in their health promotion work. Examples include the time, effort
and voluntarism given to communicating the ABR messages to the communities. CSOs in Ecuador,
Thailand, Malaysia and Indonesia also used their own organisational funds and human resources to
co-fund the CSO project activities.
Of particular note is the ‘Life in Plenitude and Health’ approach taken by the Ecuador project
partners in learning and communicating the ABR problem. The ‘Life in Plenitude and Health’
approach is a holistic one, considering and linking health to ecology as well as cultural, social and
economic drivers and contexts.
Another event of note, in Ecuador, was the Creando conciencia sobre la resistencia… en bicicleta.
Students of the Faculty of Medical Sciences, University of Cuenca, carried out a bicycle tour to
promote the smart use of antibiotics among students. The Sun Route is a coastal road which crosses
three provinces of Ecuador. During 14 days, along 700 kilometters, the group visited elementary
schools and high schools in each town they reached. They sent periodically messages on the travel
and the educational activities via their Facebook page, texts and images. The aim was to disseminate
project messages among the schools teachers who are participating in the CSO training program. The
teachers and schools showed great interest in the creative campaign.
The CSO in Ecuador have also entered into an agreement with PAHO to support the development of
materials for the CSO project.
In Thailand, CSOs not involved in the ReAct project have expressed interest in participating. The lead
CSO - DMD - has used its own funds to include the new CSOs in the project activities.
In Indonesia, YOP has received air time with two national television stations to broadcast their work
in the project.
Changes in workplan
There were changes in the workplans of all the project countries due to due to planning processes,
arrangements with CSOs, management capacity of partners, local challenges and paperwork related
to contracts, LoAs and disbursements of funds.
A combination of the aforementioned problems in Ghana resulted in only one Year One scheduled
project activity initiated, in November 2012, but not completed by end of Year One, i.e. the baseline
survey. In November 2012, the General Manager of the project worked with the Coordinator of the
Ghana component of the CSO project to re-work the Year One activities and plan for the Year Two
activities, bringing forward all of the unfinished Year One activities into the Year Two schedule.
38
In LA, differences in approach, in the baseline survey, development of materials and training
activities, between the lead CSO in Ecuador (CCF) and the partner CSO in Nicaragua (CISAS), led to
several delays and changes in the workplan. Local problems with governmental changes to policy
with regard to teachers being involved in extra-curricula activities, such as those of the project, led to
further delays in scheduled activities. Despite these challenges, however, both Ecuador and
Nicaragua managed to complete most of their scheduled Year One activities successfully. The few
remaining unfinsihed Year One activities have been brought forward to Year Two.
In SEA, similar problems as mentioned above saw a delay in implementation of activities in Malaysia
(mid-June 2012) and Thailand (August 2012). Malaysia, however, successfully managed to complete
all scheduled Year One activities by December 2012. Thailand successfully managed to complete
most of its scheduled Year One activities, bringing forward to Year Two unfinished ToT workshops
and development of materials. Indonesia, which saw an early start of their project activities (January
2012) was able to successfully complete all its scheduled Year One activities.
The global component of the CSO project (aimed at linking the project objectives with international
CSOs) was also delayed somewhat in Year One. But discussions at sidelines of various global
meetings, especially related to ReAct’s CDU activities, have set the stage for further meetings to link
up with a view to clearer and specific collaboration with international CSOs in 2013.
Successful strategies
Successful strategies that bore results were partnerships with key stakeholders, inculcating a sense of
ownership in the project, consultation in decision-making projects regarding approaches to activities,
building on existing health promotion projects of the CSOs, and use of creative and innovative media
in training and communication.
Examples include
Indonesia
•
•
•
•
Recruitment of dedicated volunteers (medical doctors and parents) from YOP’s programs to
participate in the project
Utilization of existing health promotion interventions to reach wider audience in locations
outside Jakarta
Collaboration with existing partners to disseminate information on AB and ABR through various
events and channels
Improvement of the volunteers’ capacity as AB/ABR campaigners among foster families and
wider target communities.
Malaysia
•
The aspects of the project that were particularly successful are the planning and implementation
of activities, which showed great enthusiasm and commitment of the project team and
community members.
39
•
The training module and booklet on AB use and ABR, developed by the project team were very
useful and they are being considered for use in the MoH programme on ABR.
Thailand
Thailand has the advantage of the established Antibiotic Smart Use (ASU) programme in several
communities across the country. The CSO project is, therefore, benefitting from a pool of expert
trainers, leaders and volunteers from the DMD, and the Family Network Foundation has the
members of parents and guardians in each school in many areas. The ASU programme also has rich
resources of effective info-communication tools and media materials.
Nicaragua
The project implementation in Nicaragua has the strategic advantage that it is integrated into a CISAS
health programme involving five schools in Managua and six in Chinandega, working on health
promotion among teachers, students, and parents. There already a good network of local authorities,
school principals, school counselors and school children exists.
Challenges/constraints
Project team in the participating countries faced challenges and constraints of different sorts. All
project team members have other work commitments in their organisations apart from their
responsibilities in the project.
In Indonesia, for example, project team members are practising physicians, medical students and
parents, whose time need to be balanced between project work, family commitments and
professional duties. Additionally, the time and skills in project process documentation is demanding.
Nonetheless, the project implementation organisation has taken measures to overcome the
challenges with extra training, engaging more volunteers and identifying opportunities to distribute
and share the work commitments.
In Malaysia, the delay in starting project activities, from March to June, meant that project activities
for Year One had to be implemented within six months. The project team members are also full time
professionals who need to balance their time between project and professional work commitments.
The Project Team, however, with the cooperation of the community leaders, stepped up to the
challenge and was able to carry out all of the scheduled Year One activities.
In Thailand, project staff had to be trained in conducting the baseline survey and its analysis.
Developing new training materials in the context of the project goals required more research,
meetings and consultations, which took more time and human resources.
In Ecuador, a major challenge was recent changes in education policy restricting the activities of
teachers in extra-school related projects. Many meetings and much negotiation with the authorities
40
were necessary to resolve the issue, which meant delays in implementing the project activities. The
project team in Nicaragua faced similar challenges because of constraints in national policy
Ghana faced the most challenges and constraints. Lack of capacity, delays in preparing the
paperwork on work plans, budgets, contracts and Log frame analysis, which resulted in delays in
funds disbursements, saw the project team being able to only initiate one project activity in 2012. A
revised work plan for 2013 has been developed for Ghana to meet its delivery of project outputs and
outcomes in 2013.
4. CHALLENGES AND FUTURE PROSPECTS
Although 2012 has been a highly productive year for ReAct it has not been free from challenges. First,
the unexpected departure of ReAct´s director Andreas Heddini in March 2012, implied a significant
loss of capacity.
Second, the growing network of ReAct has generated increased demands on support and internal
communication and created challenges on how to maintain an overview of all ongoing processes in
the regions where we work.
ReAct’s major funding comes from Sida, but intense work to expand the funding base has been
undertaken and is planned to be expanded further. A science journalist, covering health and
pharmaceuticals in a major Swedish business journal worked with ReAct one month to identify and
approach potential funders. So far, these contacts have not generated interest in supporting ReAct.
In 2012, ReAct received continued co- funding from Uppsala University and component funding for
specific projects from the Swedish Ministry of Social Affairs and the Beijer foundation.
ReAct funders 2012:
Funder
Total amount ( 1000 SEK)
Sida core-funding
7 000 000
Sida CSO-project funding
2 540 600
Uppsala University
1 000 000
Ministry of Social Affairs
2 000 000
Beijer foundation
500 000
Substantial co-funding and voluntary work is also contributed by the regional partners, see the
separate ReAct financial report for 2012.
Meetings are planned during 2013 with several of the larger, international donors. The regional
partners of ReAct have engaged several boundary partners in co-founding and in-kind contributions
to ReAct activities.
41
The first year of the CSO project saw a slow start in most countries due to planning processes,
capacity of partners, local challenges and paperwork related to contracts. However ReAct believes
that the implementation of project activities will start to take shape during 2013 and give some good
results.
The development of a national policy on antimicrobial resistance in Ghana is in an advanced planning
stage for roll out. ReAct sees great potential in Ghana serving as a pilot country for the African region
and WHO AFRO has expressed interest in facilitating the sharing of Ghana’s national ABR policy
process as a model for other countries in the region WHO AFRO.
There are mature plans to further strengthening the ReAct African network by recruiting a well
renowned experienced coordinator based in Africa.
Continued development and evaluation of innovative solutions that help changing the perception
and attitudes regarding antibiotics to stimulate change in practice at the hospital, clinical and
community levels as well as policy is another focus for 2013. ReAct's civil society components can
help test and disseminate the results to wider audiences and help bring about behaviour change.
Good results have already been accomplished in projects such as the Fotoresistencia that has a
potential in scaling and replicating in other countries and is now being evaluated by the University of
British Colombia.
Development of training courses on ABR will be explored by ReAct by during 2013. In January 2013,
ReAct organized an introductory pilot course on ABR for students from mainly Iraq and Pakistan.
ReAct sees a potential in tailoring and expanding the course concept for an international audience.
However it will require additional resources to actually launch a full-scale course program and we are
currently investigating potential funding.
ReAct initiated in the autumn 2012 a process to address and stir debate on how to ensure controlled
and rational use of any future new antibiotics while securing the equitable access and affordability.
To this end, ReAct in cooperation with a consultant has developed a debate paper to lay down
exploratory ways to preserve new effective antibiotics. The plans for 2013 are to publish the debate
article in an international journal and to convene meetings that will lead up to a high-level workshop
in 2014. ReAct's role and perspective is unique on this landscape. Its voice is independent of
pharmaceutical company support and the international experience and many contacts at the global
policy level have rendered ReAct significant credibility.
42
Annex 1 - ReAct publications 2012
Lack of action on antibiotics a threat (pdf) Joint debate article on ABR in The Financial Times,
November 13, by Carlet J (World Alliance), Cars O (ReAct), Piddock L (BSAC Antibiotic Action),
Laxminarayan R (GARP) and Levy S (APUA ).
3Rs for innovating novel antibiotics: sharing resources, risks, and rewards, Analysis report published
in British Medical Journal, BMJ, on April 3 by So A, Ruiz-Esparza Q., Gupta N, Cars O.
International Program for Training and Research on Comprehensive Primary Health Care, with
emphasis in Infectious Diseases and Containment of Antimicrobial Resistance
Quizhpe A, Murray M, Peralta J, Calle K, and Encalada L. Published February 2012.
PAHO magazine ReAct Latin America study on MRSA in children in indigenious communities.
Recovering Comprehensive Health and the Harmony of the Ecosystems to Contain Bacterial
Resistance to Antibiotics. Quizhpe A, Murray M, Muñoz G, Peralta J, Calle K
WHO monograph on “The Evolving Threat of Antimicrobial Resistance: Options for Action”
The book, "The evolving threat of antimicrobial resistance - Options for action”, launched by WHO on
March 8 2012, is the result of a collaboration between WHO and more than 50 international experts
in the field of antimicrobial resistance. ReAct contributed with working group leaders and main
authors of two of the chapters.
Other products 2012
Burden of Antibiotic Resistance. ReAct Fact Sheet produced for the Swedish/Ghanaian ministerial
side-event at the WHA.
Medical students’ views on the current and future antibiotic resistance situation. MSc examination
work by Cecilia Kållberg, supervised by Liselotte Diaz Högberg, ReAct.
Perceptions of acute respiratory infections, severity and treatment of the care givers of children
under 5 years. Printed in the journal of Faculty of medical Science in the University of Cuenca.
43
Annex 2 - Meetings and events 2012
Meetings organised by ReAct
Feb 17–18, ReAct’s Launch Meeting of CSO Project, network meeting in Penang, Malaysia
Feb 23, Launch of ReAct South East Asia/Thailand CSO Project, Bangkok, Thailand
May 5, A conference organized by ReAct Latin America, Faculty of Medical Sciences and Pediatriacs
Scientific Association on “Antimicrobial Resistance” including a presentation of the “FotoResistencia”
project .
Venue: Universidad Técnica Particular de Loja.
May 26–29, ReAct organized workshop at the Asia Pacific Conference on National Medicines Policies
in Sydney, Australia.
June 19, Seminar on the appropriate use of antibiotics in human health, aimed to 40 health workers
of the Ecuadorian Ministry of Health
Limón, Morona Santiago, June 19, 2012
Arturo Quizhpe, Lorena Encalada, Diana Andrade.
Nov 15-17, ReAct’s Global Workshop on CSO Project - Towards Policy Platforms to Manage Antibiotic
Resistance, Cuenca, Ecuador
Meetings attended by ReAct
Feb 3, Tapestry Networks, London
Mar 8, Participation in the WHO launch event in Geneva of the book "The evolving threat
of antimicrobial resistance - Options for action" which was a result of a collaboration
between WHO and more than 50 international experts in the field of antimicrobial
resistance. ReAct contributed with working group leaders and main authors for two of the
chapters.
Mar 12-13, the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) held an invite-only
meeting for stakeholders in ABR within the EU in Copenhagen, Denmark. ReAct were invited to hold
a presentation at the meeting.
Mar 14-15, Expert conference on AMR in Copenhagen during the Denmark´s EU presidency “The
impact of antimicrobial resistance in the human health sector and in the veterinary sector – a “One
Health” perspective”.
44
Mar 26 – 28, Drug Information Association 24th Annual Euro Meeting 2012 (DIA 2012), in
Copenhagen. ReAct participated in a session regarding the scientific and political challenges in
antibiotic development together with Richard Bergström, EFPIA, Line Mattiesen (EU Commisson, DG
Research).
Mar 21-23, ReAct hosted sessions at the 2012 EPN (Ecumenical Pharmaceutical Network) Forum and
General Meeting held in Addis Ababa, Ethiopia in March that had the theme "Access to quality
medicines: priority needs, priority actions for today and tomorrow".
Mar 31-Apr 3, ECCMID, European Congress of Clinical Microbiology and Infectious Diseases, London.
April 25-27, 2nd. International Congress in Advances on Clinic Laboratory, Hematology,
Microbiology, Genetics, Molecular Biology, Cuenca, Ecuador
A lecture on the ReAct Latin American research project “High proportion of ESBL – carriers among
neonates in a tertiary hospital in Ecuador” by Lorena Encalada.
May 10, Meeting of the Ghana Policy Development Task Force, Accra, Ghana
May 22, A high-level ministerial seminar entitled "Saving lives through cost-effective measures
against antimicrobial resistance"was co-hosted by Sweden and Ghana in connection with the World
Health Assembly. ReAct helped shape the agenda and held an introductory keynote presentation.
May 27-30, Conveners and rapporteurs for a workshop on AMR and Rational Use of Antibiotics at the
Asia Pacific Conference on National Medicin Policies, Sydney, Australia
Jul 2, ReAct was invited to WHO Global HQ in Geneva, Switzerland to collaborate on a global
Surveillance strategy for AMR.
Jul 6-11, The Third People´s Health Assembly, Cape Town, South Africa
Jul 11-15, Euroscience Open Forum (ESOF) in Dublin, Europe´s largest forum for science
and research. ReAct participated together with the Swedish Research Council, the Swedish
Council for Working Life and Social Research, the Swedish Research Council Formas and the
Swedish Governmental Agency for Innovation Systems at an interactive exhibition on
antibiotic resistance entitled "The Good.The Bad.The Ugly".
Sep 9-12, 52nd ICCAC, International Conference on Antimicrobial Agents and Infectious Diseases, US.
ReAct through Otto Cars participated at the large International Conference on Antimicrobial Agents
and Chemotherapy in a “meet the expert session “, on ABR.
Sep 28, ReAct made a presentation on ABR at the ‘Truth is Concrete’ arts festival in Graz, Austria
Oct 2–4, The International Pharmaceutical Federation (FIP) World Centennial Congress of Pharmacy
and Pharmaceutical Sciences.ReAct was also invited to the high-level ministerial meeting held in
conjunction with the conference.
Nov 16 - 18, Knowledge for Global Health (K4GH) Leadership Institute. The ReAct strategic Policy
unit at Duke University hosted a leadership training, with an antibiotic resistance breakout session
45
component, co-organized with the American Medical Student Association, on several key issues for
U.S. and international health including policy innovation and access to medicines, tackling antibiotic
resistance, and ensuring open access to knowledge.
Nov 23, SciLifeLab Uppsala meeting “One health - In Joint Battle Against Infectious Disease and
Antibiotic Resistance”. ReAct organized the session, “Bridging the gap between science and policy”
by ReAct at the SciLifeLab Uppsala meeting held on November 23.
Nov 26, Meeting with WHO Assistant Director-General of Health, Security and Environment, Keiji
Fukuda, in Geneva( Otto Cars, ReAct) and Richard Bergström, EFPIA, to frame the issue of a “new
business model” for the development of new effective antibiotics.
Dec 11-13, Participation in The QUAMED (Quality Medicines for all) partner meeting held in Antwerp,
Belgium. ReAct was invited as speaker to share its views on controlled distribution and use of new
antibiotics and what can be learned from other initiatives like those working to evaluate and control
resistance to antimalarials.
Dec 18, Participation in technical expert session at WHO HQ in Geneva to draft a roadmap for global
surveillance of antimicrobial resistance.
46
Annex 3 - ReAct in the Media 2012
Datum
Namn på media och artikel + länk
2012-01-18
SVT Aktuellt kl 21.00. Inslag om resistens i Antarktis, spår efter forskare. Andreas blir intervjuad.
http://svtplay.se/v/2680621/aktuellt/18_1_21_00?sb,p102536,2,f,-1
2012-01-27
World Economic Forum. On the WEF blog presenting one of the Global Risks 2012:
What if antibiotics stopped working?", The Risk Response Network within World Economic
Forum invited to a discussion about a world without antibiotics. Referrals were made to several
facts and figures from ReAct.
2012-02-19
Hindustan Times. Super laws can squash superbugs;
http://www.hindustantimes.com/Entertainment/Wellness/Super-laws-can-squashsuperbugs/Article1-813584.aspx
2012-02-22
SR, Vetandets värld. Industrin ska lockas till att satsa på nya antibiotika. Intervju med Anna H.
http://sverigesradio.se/sida/gruppsida.aspx?programid=412&grupp=16348&artikel=4976543
2012-02-15
SR, Vetandets värld. Vetenskaplig utmaning få fram nya antibiotika. Intervju med Otto.
http://sverigesradio.se/sida/gruppsida.aspx?programid=412&grupp=16348&artikel=4958608
2012-03-13
Expressen. Dödsbakterien är här för att stanna.
http://www.expressen.se/nyheter/dokument/dodsbakterien-ar-har-for-att-stanna/
2012-03-19
The Star Online. An end to modern medicine?
http://thestar.com.my/news/story.asp?file=/2012/3/19/focus/10942727&sec=focus
2012-05-10
SR, Bakterier överlistade forskare, studie stoppad:
http://sverigesradio.se/sida/artikel.aspx?programid=83&artikel=5101104
2012-05-25
UNT. Satsning ska hitta nya antibiotika. http://www.unt.se/sverige/satsning-ska-hitta-nyaantibiotika-1756024.aspx
2012-05-27
Financial Times. Public Health: Raised Resistance. http://www.ft.com/intl/cms/s/0/a796ecc0a644-11e1-9453-00144feabdc0.html#axzz274yvri9k
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2012-05-28
DN, SvD, Aftonbladet. Satsning på nya antibiotika. http://www.dn.se/ekonomi/satsning-skahitta-nya-antibiotika
http://www.svd.se/nyheter/inrikes/satsning-ska-hitta-nya-antibiotika_7230233.svd
http://www.aftonbladet.se/senastenytt/ttnyheter/inrikes/article14881617.ab
2012-06-06
Huffington Post. Generating Antibiotic Incentives Now: GAIN -- Or Just Greed. Debate article by
Anthony So, ReAct and Robert Weissman. http://www.huffingtonpost.com/anthonyso/antibiotic-resistance-_b_1572284.html
2012-06-17
SvD, Resistens hot mot fattiga. http://www.svd.se/nyheter/utrikes/antibiotikaresistens-hotarfns-millenniemal_7283481.svd (även som pdf-bilaga)
2012-06-28
Vetenskapsrådet. Stort intresse för antibiotikaresistens under ESOF 2012 i Dublin.
http://www.vr.se/franvetenskapsradet/nyheter/nyhetsarkiv/nyheter2012/nyheter2012/svenskt
fokuspaantibiotikaresistensunderesof2012idublin.5.405c4f3813823f65fee580.html
2012-07-12
UNT. Viktig antibiotika försvinner. http://www.unt.se/uppsala/viktig-antibiotika-forsvinner1793431.aspx
2012-07-14
Forskning.no, Antibiotika er for billig. http://www.forskning.no/artikler/2012/juli/328028 (även
som pdf-bilaga)
2012-07-19
Videnskabdk, Antibiotika skal ikkevaere en menneskeret. http://videnskab.dk/kropsundhed/antibiotika-skal-ikke-vaere-en-menneskeret (även som pdf-bilaga)
2012-07-21
UNT. Gammal medicin tillbaka. http://www.unt.se/uppsala/gammal-medicin-tillbaka1799466.aspx
2012-09-10
SR Nyheter/Ekot. Framsteg i forskningen om resistenta bakterier.
http://sverigesradio.se/sida/gruppsida.aspx?programid=83&grupp=10974&artikel=5263651
2012-09-10
SR Nyheter/Ekot. Antibiotika testas i nya kombinationer i
Grekland.http://sverigesradio.se/sida/gruppsida.aspx?programid=3304&grupp=6240&artikel=5
264504
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2012-09
Miljöforskning (Formas). Stora prövningar att vänta för sjukvården.
http://miljoforskning.formas.se/sv/Nummer/September-2012/Innehall/Temaartiklar/Storaprovningar-att-vanta-for-sjukvarden/
2012-09-25
What if we lost the use of antibiotics? Intervju med Otto för The World Economic Forum.
http://forumblog.org/2012/09/what-if-we-lost-the-use-of-antibiotics/
2012-09-28
DN Debatt. ”Stärkt infektionsforskning möjlighet för Sverige. http://www.dn.se/debatt/starktinfektionsforskning-mojlighet-for-sverige
2012-10-16
Life Science Sweden. Plåster nytt vapen mot resistens.
http://lifescience.idg.se/2.1763/1.471546/plaster-nytt-vapen-mot-resistens
2012-12-09
SVT Agenda, Intervju med Otto Cars. http://www.svt.se/agenda/varsta-hotet-mot-denmoderna-sjukvarden
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