Director-General

WHO Director-General addresses G7 health

ministers meeting on antimicrobial
resistance
Dr Margaret Chan
Director-General of the World Health Organization
Remarks at the G7 Health Ministers Meeting. Session on antimicrobial
resistance: realizing the "one health approach. Berlin, Germany
8 October 2015

Honourable ministers, ladies and gentlemen,

The rise of antimicrobial resistance is a global health crisis. Medicine is
losing more and more mainstay antimicrobials as pathogens develop
resistance. Second-line treatments are less effective, more costly, more
toxic, and sometimes extremely difficult to administer. Many are also in
short supply.
Superbugs haunt hospitals and intensive care units all around the world.
Gonorrhoea is now resistant to multiple classes of drugs. An epidemic of
multidrug-resistant typhoid fever is rolling across parts of Asia and Africa.
Even with the best of care, only around half of all cases of multidrugresistant tuberculosis can be successfully cured.
With few replacement products in the pipeline, the world is heading
towards a post-antibiotic era in which common infections will once again
kill.
This will be the end of modern medicine as we know it. If current trends
continue, sophisticated interventions, like organ transplantation, joint
replacements, cancer chemotherapy, and care of pre-term infants, will
become more difficult or even too dangerous to undertake.
Adoption of the WHO Global action plan on antimicrobial resistance at
the May World Health Assembly has given concrete expression to this
growing level of concern.
The action plan sets out five strategic objectives: to improve awareness,
to strengthen surveillance and research, to reduce infections in the first
place, to use these medicines wisely, and to ensure sustainable
investment, also in R&D for replacement products and better diagnostic
tools.

Evidence that resistance is driven by the volume of antimicrobial use is

compelling. High antibiotic use can arise from overprescribing, easy
access through over-the-counter sales, sales via the internet, or pressure
from patients.
Decisions to prescribe antibiotics, in human and veterinary medicine, are
rarely based on a definitive diagnosis. Having rapid, low-cost, and readily
available diagnostic tests could help, but will not solve all problems.
For example, rapid and reliable tests for malaria are available, but fragile
antimalarial drugs are still handed out, in many endemic countries, to any
child with a fever. This practice, too, hastens the development of drug
resistance.
Overprescribing also occurs in animal husbandry and agriculture, and in
the food industry, especially when massive quantities of antibiotics are
used to promote growth, not to treat sick animals. Routine use of
antibiotics at sub-therapeutic levels kills the weakest bacteria, but lets
the more resistant ones survive.
Farmers working with cattle, pigs, and poultry infected with drug-resistant
bacteria are at much higher risk of being colonized or infected with these
bacteria. In addition, human consumption of food carrying antibioticresistant bacteria can lead to the acquisition of a drug-resistant infection.
The World Economic Forum has identified antibiotic resistance as a
global risk beyond the capacity of any organization or nation to manage
or mitigate alone.
At the international level, WHO collaborates closely with the International
Organization for Animal Health, or OIE. Relevant sections in OIE
standard-setting codes promote the responsible and prudent use of
antimicrobials to preserve their therapeutic efficacy and prolong their use
in both veterinary and human medicine.
In another mutually reinforcing activity, the WHO list of critically important
antimicrobials for human health is paralleled by an OIE list of
antimicrobial agents of veterinary importance, which recommends the
restricted use of certain agents.
In 2008, WHO established an advisory group on integrated surveillance
of antimicrobial resistance associated with the use of antibiotics in foodproducing animals. This advisory group adds support to OIE standards
for monitoring the quantities of antimicrobials used and the extent of
resistance. Specifically, it helps formulate and prioritize risk assessment
and risk management strategies.
As in public health, authorities responsible for animal health face a
number of obstacles, including poor regulatory control and large
quantities of adulterated or substandard products circulating in world
trade or readily purchased via the internet.

Ladies and gentlemen,

I have a final comment.
Consumer groups and civil society can play an important role in
combating antimicrobial resistance. They are important movers, shakers,
and front-line players, especially in this age of social media.
Consumers who question the safety of food produced from heavilymedicated animals, and make purchasing decisions accordingly, can
have a profound impact on industry practices.
Thank you.

Related links
WHO's work on antimicrobial
resistance