In order to discuss the Antimicrobial resistance a major threat in Asia, a meeting of Health Ministers of Asian countries held in Tokyo on 16 April 2016. On this occasion, the Regional Director of WHO South-East Asia, Dr Poonam Khetrapal Singh stated that the Antimicrobial resistance is a threat to global security and economic stability. It is a looming health and economic crisis that requires both global and local solutions. Since drug resistant genes can travel, countries with higher levels of economic and social organization have a stake in the success of measures taken by less developed countries. In the fight against antimicrobial resistance, we are only as strong as the weakest link.
At the end of the meeting, the Health Minister delivered a communique as follows:
Communiqué of Tokyo Meeting of Health Ministers on Antimicrobial Resistance in Asia
We, the Ministers of Health and representatives from countries in the Asia-Pacific region, namely, Australia, Bangladesh, China, India, Indonesia, Japan, Malaysia, Myanmar, Philippines, Republic of Korea, Thailand and Viet Nam, have come together on the occasion of the Tokyo Meeting of Health Ministers on Antimicrobial Resistance (AMR) held in Japan;
Noting that effective antimicrobials are critical to health and are a foundation for the practice of modern medicine and that the emergence of AMR is accelerating due to human actions, particularly the inappropriate use of antimicrobials, and causing morbidity and mortality in humans;
Recognizing that AMR is a public health threat that has broader social implications, transcends borders and endangers global and regional health security;
Recognizing further that the health, economic and social consequences of AMR constitute a growing burden for low-, middle- and high-income countries, requiring urgent action at national, regional and global levels, particularly in view of the limited development of new antimicrobials;
Recalling the strong commitments of countries made during the World Health Assembly in 2015, as well as during relevant meetings of the Food and Agricultural Organization of the United Nations (FAO) and the World Organization for Animal Health (OIE) to support the implementation of the WHO Global Action Plan on Antimicrobial Resistance;
Recalling the discussions, concerns, role and commitments of various global and regional mechanisms — including the United Nations (UN) agencies, the Association of Southeast Asian Nations (ASEAN) Health Ministers meeting, WHO South-East Asia Health Ministers meeting, Asia-Pacific Economic Cooperation (APEC), G7, G20, among others — to combat AMR;
Noting with concern that the health status, rapid economic development and sociodemographic and cultural changes, as well as weak health system capacities in the Asia-Pacific region, lead to increased unregulated consumption of antimicrobials and put populations at higher risk for increasing levels of emerging drug-resistant infections, as evidenced by the spread of multidrug-resistant strains of malaria and tuberculosis among others, unless effective actions are taken;
Emphasizing that the problem of AMR is compounded by insufficient and a lack of awareness, cultural practices and system challenges — from weak health systems with inequities in access to affordable and quality health-care services, weak antimicrobial regulations both in humans and animals, insufficient law enforcement, poor infection prevention and control practices in health-care institutions, and inappropriate use of antimicrobials across all sectors, which are larger development issues;
Noting the variations in country-specific drivers of AMR across the Asia-Pacific region will require effective and sustained local and regional solutions and actions, as appropriate, to contribute to global efforts and progress to contain AMR;
Recognizing the potential impact of AMR on socio-economic development in countries, and the possible effect that AMR may have on the achievement of Sustainable Development Goals (SDGs),
Acknowledge the urgent need for:
- Increased advocacy, education and awareness-raising activities involving all stakeholders in relevant sectors about AMR and the responsible use of antimicrobials;
- Accelerated progress towards universal health coverage (UHC) to ensure access to quality essential health-care services and to promote access to safe, quality, effective and affordable antimicrobial medicines, diagnostics and vaccines for all, including antimicrobials under proper measures to preserve their effectiveness;
- Cross-cutting, multisectoral “One Health” approaches in all countries, involving different stakeholders, such as human and veterinary medicine, agriculture, aquaculture, the environment and others, as appropriate to enable collaborative action to minimize AMR and attain optimal health for humans and animals;
- Global, regional and national cooperation and collaboration to preserve the effectiveness of antimicrobials as a global public good;
- ) Implementing and monitoring regulations, including production, distribution and use of vaccines, diagnostics and antimicrobials for both human and animal use;
- Accelerated research and development (R&D) in AMR, including the development of new antimicrobials, diagnostics and vaccines;
Reaffirm our commitment to contain the emergence and prevent transmission of AMR, through multisectoral actions at global, regional and national levels to:
- Develop national action plans on AMR, in line with the Global Action Plan on Antimicrobial Resistance and based on a multisectoral “One Health” approach, including goals/objectives and appropriate national and local governance arrangements to oversee and monitor implementation;
- Identify underlying problems and implement sustainable actions and system changes to benefit human health, animal health, agriculture, food security, and the environment, in accordance with national action plans;
- Promote prevention and containment measures for AMR, in line with national strategies for the attainment of SDGs, as appropriate;
- Increase awareness and understanding of the use of antimicrobials in humans, animals and agriculture, provide practical guidance and take concerted actions during the annual World Antibiotic Awareness Week to raise awareness of responsible antibiotic use across all sectors;
- Monitor progress of national action plans on AMR and report to appropriate bodies;
Commit to build resilient health systems, underpinned by the concept of UHC, that will:
- Make AMR containment one of the core elements of quality and safe healthcare services – including by strengthening infection prevention and control measures in health-care institutions and communities and improving access to clean water and sanitation in health-care institutions to decrease the occurrence of infections and prevent transmission;
- Promote access to safe, effective, quality and affordable antimicrobial medicines, diagnostics and vaccines for all;
- Develop and implement integrated “One Health” national surveillance programs to monitor AMR and antimicrobial use, and participate in regional and global surveillance networks, in line with the Global Action Plan on Antimicrobial Resistance;
Strengthen capacities to conserve effectiveness of antimicrobials as a national, regional and global public good through:
- Implementing national antimicrobial stewardship programmes that promote the appropriate and prudent use of antimicrobials in humans and animal health and agriculture;
- Using quality information generated from national AMR surveillance systems following standardized protocols to guide policies and clinical decision-making in human and veterinary medicine;
- Developing laboratory capacity to identify pathogens and their antimicrobial susceptibility in order to guide optimal use of antimicrobials in clinical practice;
- Developing internationally agreed standards for collection of data and reporting on AMR in human health, animal health, and agriculture, and supporting national, regional and global laboratory networks to improve the quality of data gathered through AMR surveillance;
- Taking sustainable actions to strengthen regulatory systems across countries for effective regulatory control of antimicrobial licensing, production, distribution, use and quality assurance, depending on a country’s situation, for example:
- Strengthening implementation of mechanisms that ensure the safety and quality of antimicrobials from importers and manufacturers to authorized retailers for humans, animals and agriculture;
- Enforcing prescription-only or veterinary-equivalent-only sales in human and veterinary medicine;
- Regulating production and domestic/international distribution of active pharmaceutical ingredients of antimicrobials, medicated feed production, and registration of antibiotics to be used in animals, based on scientific risk assessments;
- Phasing out the use of antibiotics for animal growth promotion and crop protection in the absence of risk analysis;
- Curbing economic incentives in all sectors that promote inappropriate use of antimicrobial agents, and encouraging the introduction of incentives to optimize their use;
- Taking multisectoral innovative approaches to finance and stimulate research and development (R&D) of new medicines, diagnostics and vaccines to combat AMR, and their rational use, and promoting their accessibility and affordability in low-resource settings;
- Fostering international and regional collaboration and partnerships to strengthen the regional response and R&D capacity to combat AMR;
Do hereby declare launching an “Asia-Pacific One Health Initiative on AMR” to jointly identify and tackle challenges posed by AMR in the Asia-Pacific region by drawing a roadmap to actualize the regional frameworks on AMR in the following priority areas of work:
- Surveillance system and laboratory network;
- Health-care management;
- Antimicrobial access and regulation;
- Research and development;
Commit to:
- Support collaborative efforts of Member States of the United Nations, UN agencies and partners, calling on them to highlight imperatives for urgent actions, political commitments and leadership on AMR at the UN General Assembly to fully implement the WHO Global Action Plan on Antimicrobial Resistance;
- Work together with regional and global initiatives — including G7 and other collaborative mechanisms — in their ongoing efforts based on common and concerted interests to stem AMR, employing the unique strengths of Asia- Pacific countries to enhance national, regional and global health security by combating AMR;
Continue to closely collaborate with ministers from other sectors, including animal, agriculture and the environment, in the Asia-Pacific region to fight AMR while calling on all countries to recognize that AMR is a global development and health security issue that requires a coordinated multisectoral “One Health” approach.
Adopted in Tokyo, Japan, on this day, 16 April 2016.