The burning issue at this year’s World Health Summit in Berlin was health security. At this 8th WHS it was clearer than ever that the walls between the traditional disciplines of ‘global health’ and (European) ‘public health’ are rapidly coming down, with health threats anywhere in the world becoming a domestic challenge as well as an international development issue. The topics driving the agenda in Berlin are increasingly preoccupying European Heads of State as well as their G7 and G20 counterparts. It is a welcome signal that the patrons of the WHS, Chancellor Merkel and European Commission President Juncker, are joined by France’s President Macron. Nevertheless, in a blistering keynote speech MSF International President Joanne Liu challenged the mostly-European audience to protect health wherever and whenever threats arise and not only when they reach our shores.
Antimicrobial resistance (AMR) emerged as one of the principal topics under discussion at the 2017 World Health Summit in Berlin, with a number of sessions looking at it from a global, “One Health” perspective and in the broader context of international policy action in support of achieving the Sustainable Development Goals.
Ahead of the WHS, the UK government, with the Wellcome Trust and the governments of Ghana and Thailand, organised another event in Berlin hosted by Professor Dame Sally Davies. EPHA Secretary General Nina Renshaw was invited to present and spoke about the importance of binding measures to tackle pollution in the antibiotic supply chain, as a major accelerator of resistant bacteria in the local environment of pharmaceutical factories which can then spread rapidly.
At the WHS session on AMR, Dr Rüdiger Krech (WHO), underlined the global scope of the AMR problem, recalling that gonorrhoea is becoming increasingly resistant to antibiotics, while also mentioning multi-drug resistant TB, E.Coli and hospital infections including MRSA.
EPHA’s points appear to be echoed by attendees at both events. Notably, Thomas Cueni (Director General, International Federation of Pharmaceutical Manufacturers & Associations) recognised the problem of environmental spill-over in e.g. India in the supply chain of cheaply produced generic drugs, with public procurement (e.g. certified suppliers) and consumer choice as powerful tools that could be exploited. He also stated that if voluntary initiatives don’t work, regulatory approaches could be considered, with some companies willing to share data with WHO.
Jeremy Knox of the Wellcome Trust emphasised that the evidence base regarding behaviour change is not as developed as it should be. He pointed out that Wellcome is developing a new policy and advocacy stream on AMR working in collaboration with civil society, while at the same time making a major investment in the CARB-X Global Partnership.
Discussion turned to the question of developing and managing antimicrobials effectively as a “global public good” and the flawed business model for antibiotics, with companies not following rhetoric with action, according to Dr Krech, keen on investing in more profitable medicines and on avoiding any regulation. In turn, Cueni explained some key industry obstacles, noting high risk of failure in the development process. He argued for a globally funded model but was sceptical that this would happen anytime soon. Mr Knox stated that it was high time that governments and companies began to experiment with available innovation models, the best of which combine push and pull incentives.
Another problem highlighted by participants was that antibiotics are cheaper than diagnostics, which means it is easier to omit testing before prescribing them.
Representing the German Federal Ministry of Health, Karin Knufmann-Happe also mentioned the environmental dimension of AMR – specifically, antibiotic waste and residues in water – as a key element of Germany’s inter-sectoral national strategy (2015), designed to be closely aligned with the WHO Global Action Plan. She revealed that Germany’s efforts to influence the G7 and G20 agendas is motivated by the recognition that some issues cannot be tackled at the national level alone, and that tackling AMR also involves health systems strengthening. A new global AMR R&D hub is planned to be established in Germany to pursue a long-term vision.
Vaccination also featured strongly at the WHS, including as a measure to reduce antibiotic use, especially reflecting growing concerns over vaccine hesitancy and recent vaccine-preventable disease outbreaks, including measles in Europe.