Dr. Agnes Agunos, Antimicrobial Resistance Project Coordinator of the FAO Regional Office for Asia and the Pacific appeals health and animals professionals to work together in combating the global threat of AMR

FAO ECTAD (Emergency Centre for Transboundary Animal Diseases) has appealed to human and animal health professionals to collaborate in combating the rising global threat of AMR.  The statement was delivered officially by Dr Agnes Agunos during the International Scientific Conference on Antimicrobial Resistance, in Jakarta, on 28-29 November 2018.

Thoughtful and fruitful discussions and information exchanges between FAO speakers and key participants/stakeholders during the 2-day event generated the appeal.

The Indonesian Ministry of Health, supported by WHO Indonesia hosted the event titled “Raising Awareness and Understanding on AMR through the One Health Approach for Health Professionals.”  The event brought together leading academics, researchers, practitioners and policy makers to exchange and share their experiences and research results on all aspect of antimicrobial resistance.  Meeting participants were updated on progress with implementation of the Indonesia National Action Plan (NAP) on AMR, including AMR control issues in hospitals and communities; AMR surveillance development; AMR control in animals and the environment and strategies to strengthen antibiotic stewardship. 

Indonesian Health Minister, Her Excellency Mrs. Nila F. Moeloek officially opened the conference and highlighted the global AMR threat. “Ten million people will die a year in 2050 from AMR and it will cost around USD 100 trillion in cumulative costs between now and 2050 should the threat not be progressively contained.”

Nila acknowledged and stressed the One Health Approach of the Global Health Security Agenda (GHSA) in addressing the AMR issue, which includes AMR control as one of the most important 11 GHSA action packages: Antimicrobial Resistance (Prevent 1). 

Agnes Agunos, Antimicrobial Resistance Project Coordinator of the FAO Regional Office for Asia and the Pacific delivered a paper on “Lessons Learned from AMR Implementation in Agriculture (animal health, fisheries, food industry): Future Challenges” during the first plenary session on 28 November 2018.

Referring to increasing AMR trends in health and agriculture, Agnes stressed the importance of multisectoral involvement in closing the gaps in legislation and the need for strengthening regulations on antibiotics use.  She also made a clear appeal to include social and anthropological aspects to generate behavior change in reducing the overuse of antibiotics in agriculture in the future.

Agnes also delivered a paper titled “The Problem of High Antibiotic Use Worldwide” on the second day of the Conference (29 November). She highlighted the overuse and misuse of antibiotics in Southeast Asia both within hospitals and communities. She also highlighted ineffective AMR stewardship programs, low awareness of AMR in Indonesia and India (recent WHO survey), and the common practice of over-the-counter access to antibiotics despite existing policies and regulations due to weak law enforcement.   

Recognition from MoA

During the conference, speakers from the Ministry of Agriculture (MoA), such as Mr. Fadjar Sumping Tjatur Rasa, Director of Animal Health, repeatedly recognized FAO’s role in supporting the Ministry, especially the extensive ECTAD technical support on emerging infectious diseases (EID) and AMR control through awareness raising campaigns.

Studium Generale Seminar on AMR

James McGrane, FAO ECTAD Indonesia Team Leader added that education is one of the key elements in building AMR awareness in Indonesia. 

“We have close relationships with all eleven veterinary faculties of the major Universities in Indonesia, where the Directorate of Animal Health (DAH) with FAO support has conducted Studium Generale seminars on AMR for students and lecturers. In this way, universities can become aware of what’s really happening in the field and what academia can do to disseminate knowledge of AMR and how to reduce the global threat.”

During the same event, Mr. Syamsul Ma’arif, MoA Director of Veterinary Public Health also expressed his appreciation of the FAO ECTAD EPT-2 programme for providing continuous assistance to his Directorate in implementing AMR policies and activities across Indonesia – as one of the most important mandated programs under his authority.  Syamsul added that Veterinary Public Health would allocate a special budget for AMR control in 2019 to sustain AMR activities.

Action Points

The 2-day conference generated action points for human health, animal health, and One Health.

Human Health

1. To designate a national coordinating center (NCC) and national reference laboratory (NRL) for AMR surveillance, as well as establish a multisectoral (MoH-MoA) committee for AMR control;
2. To continue and expand the education program and continuing professional development on AMR and Antimicrobial Stewardship for health professionals;
3. To develop an antibiotics disposal mechanism for households between MoH, the Pharmacists’ Association and the Ministry of Environment;
4. To develop, maintain and fully implement antibiotic susceptibility testing (ASP) nationwide using an electronics-based system and support replication of best practices of champion’s hospitals on ASP implementation; and
5. To revitalize and strengthen Infection Prevention and Control (IPC) activities in health facilities involving management, doctors, nurses and other hospital staff to reduce AMR pathogen transmission.

 Animal Health

1. To consolidate and enforce existing AMR control regulations in the livestock and animal health sectors, and harmonize regulations with existing regulations in other sectors: i.e. treatment of waste from farms, and veterinary drug manufacturing plants;
2. To increase AMR research and surveillance, and explore initiatives to maintain livestock productivity: i.e. research on antibiotic substitutes, conduct studies on the cost benefit of using antibiotic substitutes, improve the quality of day-old-chicks (DOC) and poultry feed;
   1. To improve cross-sectoral collaboration and commitment i.e. collaboration on monitoring existing regulations, development of joint regulations;
   2. Strengthen and standardize laboratory methods for AMR surveillance.

 One Health

1. To fully implement the National Action Plan (NAP) on AMR, supported by adequate budget for each sector.
2. To develop a multicenter surveillance system to provide an Early Warning System for emerging resistance at the national level.

 More than 200 participants from all the major AMR stakeholders attended the event. They included: the Hospitals’ AMR Control Committee (PPRA), medical doctors/microbiologists, provincial/district health offices, MoH AMR points, the National Antimicrobial Resistance Control Committee (KPRA Kemenkes), health professionals and hospital organizations, university researchers, Ministry of Agriculture, Ministry of Environment and Forestry, Ministry of Marine Affairs and Fisheries, WHO, FAO, INDOHUN, and USAID.