Drug-resistant infections

Iraq: Antibiotic resistance in Mosul

Drug-resistant infections Feature story Iraq

Antibiotic resistance (ABR) is a major health issue and can affect anyone, of any age, anywhere.  It is caused by the overuse or misuse of antibiotics. Antibiotic resistance (ABR) is a looming challenge for MSF’s work around the world and especially in Middle-East.

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MSF's response to consultations by the IACG on antimicrobial resistance

The September 2016 UN Political Declaration of the High-level Meeting on Antimicrobial Resistance established an Interagency Coordination Group on Antimicrobial Resistance (IACG) tasked with providing practical guidance for effective global action to address antimicrobial resistance and reporting back to the UN Secretary-General in 2019.

The IACG will present a final report to the UN Secretary-General ahead of the 73rd General Assembly in 2019. In preparation for this the IACG held two consultations, one in the summer of 2018 based on a series of discussion papers, and a consultation on the final report in February 2019. MSF Access Campaign provided written comments on four of the 2018 discussion papers, as well as the final consultation in 2019.

antimicrobial resistance World Health Organization Drug-resistant infections Technical brief innovationresearch and development (R&D)
o diagnose all bacterial diseases which are affected children. The laboratory also includes a blood bank. In 2013, more than 1,600 bags had been collected of which 16% provided by volunteer donors. On 14 June 2014, MSF organized, in partnership with the Ministry of Health, various promotional activities to promote voluntary blood donation, on the occasion of the World Blood Donor Day. Photograph by Aurelie Baumel

Five technical briefs available to download

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68th WHA: MSF Intervention on Antimicrobial Resistance

WHO 68th World Health Assembly, 2015
Provisional agenda item 15.1. Antimicrobial Resistance

Speaker: Dr Arlene Chua

MSF has documented very resistant bacteria in our projects ranging from child nutritional centres in Niger to adult trauma centres in Syria. However, there remains a tremendous gap in our ability to diagnose and understand the burden of resistance because of the lack of diagnostic tools adapted to the contexts where we work.   We have started to use polymyxin, considered to be the last line of antibiotics for multi resistant infections.

The GAP is an urgent first step towards addressing the systemic challenges causing and resulting from AMR. MSF urges WHO and Member States to provide the resources needed to fulfil this plan and to coordinate efforts to combat AMR. This should include mechanisms for accountability and evaluation.

WHO and Member States should take the following actions:

  • Provide resources to implement infection control measures at all levels of health care, beyond education and training.

  • Monitor and address important data on appropriate and inappropriate use of antibiotics, including information on access to antibiotics for patients who truly need them.
  • Ensure affordable access to key vaccines for all LMICs to reduce disease burden and the need for antibiotics.

  • Revise registration policies for old antibiotics being revived for multidrug resistant bacteria, harmonising recommended dosing, and promoting manufacturing of quality-assured products.

  • Promote development of point-of-care and rapid diagnostic tests for resource-limited settings.

  • Support the call for innovative mechanisms for R&D of new antibiotics, with the immediate establishment of a new product development entity ensuring that the cost of R&D is de-linked from the price of resulting products and that use of new products is governed by a public health framework that ensures conservation while securing affordable access to those in need in line with the GSPA and CEWG report.

Now is not the time for business as usual.

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World Health AssemblyWorld Health Organization Drug-resistant infections Statement
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MSF Response to the launch of the Global Research & Development Collaboration Hub for Antimicrobial Resistance (AMR)

Geneva, 22 May 2018 — Médecins Sans Frontières (MSF) welcomes the launch of the Global Research & Development (R&D) collaboration hub on antimicrobial resistance (AMR) at the World Health Assembly. The development of the Hub was initiated by the German G20 presidency in 2017 with an aim to promote coordination of existing and future financial investments for AMR R&D initiatives.

This Global R&D Hub on AMR has the potential to be an important part of the international response that is urgently needed. MSF has released a statement with several proposals for the Hub to ensure the delivery of patient-needs-driven R&D for new and affordable medical tools that address the AMR crisis in an equitable, cost-effective and sustainable way.


Read the statement below.
A full list of briefing documents and interventions for the 71st WHA can be found here.


Quote from Els Torreele, Executive Director, MSF Access Campaign:

“MSF has been witnessing, with alarming regularity, the challenges caused by antimicrobial resistance in our clinics: from war-wounded patients from Syria undergoing reconstructive surgery in Jordan, to burn patients in Haiti; from newborn babies in Pakistan to patients with multidrug-resistant tuberculosis (MDR-TB) in South Africa, India and Eastern Europe. 

We are encouraged by the launch of the Global R&D Hub on AMR which could be an important catalyst to address the urgent need for medical tools for use by people in real life conditions to tackle the worldwide AMR crisis. With more than half a million new cases each year and around a quarter of a million deaths, MDR-TB also needs to be a key focus of the Hub.

To provide a truly effective response, the AMR Hub has to go beyond business as usual, and foster a cost-effective and sustainable R&D ecosystem that maximizes public return on investment and delivers effective new treatments that people need, that are adapted to the health contexts in which people are treated, and available and accessible at prices people can afford. A new diagnostic, medicine or vaccine won’t do much good if the majority of the people who need it don’t have access.”

antimicrobial resistance G20 World Health AssemblyWorld Health Organization Drug-resistant infections Statement
 The laboratory of the health center of Kinyandoni, managed with the support of Doctors Without Borders, located about 70km north of Goma in the province of North Kivu, in the Democratic Republic of Congo, on December 19th, 2015. Photograph by Gwenn Dubouthoumieu
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MSF calls on G20 leaders to manage the AMR crisis with the right tools, practices and principles

Background:

As a medical humanitarian organization, Médecins Sans Frontières (MSF) witnesses first-hand the public health challenges caused by antimicrobial resistance (AMR) in a wide range of our operational contexts, including antibiotic resistance (ABR), drug-resistant tuberculosis (DR-TB) as well as resistance to treatments for malaria, HIV and other infectious diseases.
 
As the G20 Health Working Group meets in Geneva, Switzerland on the sidelines of (or in the runup to) the 71st World Health Assembly, Médecins Sans Frontières (MSF) is urging the G20 member countries make concrete policy commitments for a global coordinated response to TB as part of the broader AMR agenda. In addition, we encourage the G20 countries to commit to covering the TB R&D funding gap by 2020 and to development and equitable delivery of medicines, diagnostic tools and vaccines that are effective, affordable and suitable to control TB.


A full list of briefing documents and interventions for the 71st WHA can be found here.

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Ahead of G20 Health Minister meeting, MSF calls on governments to address three key medical humanitarian challenges

Attacks on hospitals, emergency preparedness and drug-resistant infections

Berlin, 17 May 2017 — Ahead of a meeting of G20 health ministers in Berlin, the International President of Médecins Sans Frontières (MSF) called on governments to urgently address three major issues of concern for the organisation’s work: attacks on hospitals, emergency preparedness and drug-resistant infections. “The health challenges the world faces demand change that will require your attention, resources and leadership,” said Dr Joanne Liu, International President of MSF. “We are calling on the most powerful governments in the world to make urgent changes that could alleviate people’s suffering in some of the world’s most precarious situations, and could improve people’s access to needed medical care and medicines.”

Specifically, MSF called on G20 governments to address:

1. Attacks on medical facilities

From Yemen to Syria, and from South Sudan to Afghanistan and beyond, health facilities are being looted, burnt and bombed by state and non-state parties to conflicts, resulting in the deaths of thousands of civilians, including patients, doctors and nurses. Such attacks also deprive affected people of the basic health services they need. Despite the UN Security Council one year ago putting its unanimous support behind Resolution 2286 on the protection of the medical mission, nothing has changed on the ground.

“Attacks on civilian medical facilities, including direct shelling and air strikes by states on hospitals and clinics, appear in some contexts to be a deliberate strategy of war,” said Liu. “There can be no more waiting. You should start your discussions on health systems strengthening by figuring out how to put a stop to the deliberate destruction of health systems themselves. We urge G20 governments to turn Resolution 2286 into concrete measures in war zones, in order to stop the attacks on facilities and people whose responsibility is to treat the wounded and sick.”   

2. Emergency preparedness and response

When the Ebola outbreak in West Africa was declared in 2014, only a handful of governments and organizations, including MSF, responded. G20 governments should support the World Health Organization (WHO) to ensure affected people are at the center of emergency and outbreak response, and make the needed resources available for WHO to carry out this role, working closely with national authorities. Countries must have incentives to declare outbreaks to WHO transparently and quickly, to allow a coordinated and efficient response. Additionally, preparing for emergencies should not be limited to infectious diseases seen as threats through the distorting security lens.

“Being prepared for emergencies is essential but not sufficient,” said Liu. “There’s no point being prepared if there’s no response when thousands fall sick or die. G20 governments need to be focusing on the wellbeing of people in the midst of emergencies and outbreaks, rather than tackling this issue from the angle of the threat such emergencies or outbreaks pose to their own countries.”
   
Moreover, research and development (R&D) efforts can no longer ignore the diseases that predominantly affect the countries and often poor and marginalized communities MSF serves. G20 governments should support recent efforts at the WHO and the Coalition for Epidemic Preparedness Innovations (CEPI) to address these gaps, while ensuring that the results of such R&D efforts are affordable and available to people in need in all countries.

3. Antimicrobial Resistance (AMR) and Drug-Resistant Tuberculosis (DR-TB)

MSF welcomes last September’s commitments by all governments made in the UN High Level Declaration on AMR, yet is concerned that G20 states are backtracking on hard-fought commitments to ensure the response to AMR is truly global, driven by patient needs and adapted to the needs of all health systems, especially low-resource settings.

“G20 governments must make sure public investment for developing effective medicines, vaccines and diagnostics for drug-resistant infections translates into products all people in need can afford and access,” said Liu. “This can only be achieved by separating, or ‘de-linking,’ R&D costs from the price and sales volume of end products. We also urge G20 governments to avoid policies that undermine or restrict access to antibiotics for neglected populations.”

G20 states should particularly focus on DR-TB, which accounted for more than one third of all deaths caused by AMR in 2015. Governments need to turn around the dismal global TB statistics, by making sure countries affected by the disease implement the best practices and policies recommended by WHO. MSF also calls on G20 governments to support the effort to develop new, affordable TB treatments that can cure all forms of the disease in one month or less, especially the 3Ps (Push, Pull, Pool) R&D Initiative.

tuberculosis Drug-resistant infections Press release research and development (R&D)
MSF staff member Nant Poe Ou performs an initial screening of a sputum sample for the presence of mycobacterium tuberculosis at MSF's Insein clinic in Yangon, Myanmar, Feb. 22, 2018. Photograph by Alessandro Penso
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