Debate in the Federation Council focuses on antimicrobial resistance (AMR)

Awareness of the urgent need to address the problem of antimicrobial resistance (AMR) assembled a wide range of experts and practitioners at a round table held at the Federation Council, the upper chamber of the Russian Parliament. Humanity risks “going back to the ‘pre-antibiotic’ era, when people died en masse from infectious diseases,” Igor Kagramanyan, first Deputy Chairman of the Committee on Social Policy of the Federation Council, said in his opening remarks.

The round table was co-organized by the World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO) and the World Organization for Animal Health (OIE).

“The long period of virtually uncontrolled use of antimicrobials in health care, veterinary medicine and agriculture has led to the spread of forms of microorganisms, including infectious agents with genetic characteristics, that govern resistance to antimicrobials, including antibiotics, anti-tuberculosis, antiviral, antiparasitic and antifungal drugs, as well as disinfectants,” Igor Kagramanyan stressed opening the discussion on “Antibiotic resistance as a global challenge to humanity: problems and solutions.”

“The problem of AMR over the past 20 years has become particularly relevant in countries with developed health systems and intensive agriculture. AMR has started to be perceived as a factor of global biological threat,” Lyalya Gabbasova, Assistant Minister of Health of the Russian Federation, said in her presentation.

WHO forecasts that should the current situation persist, by 2050 mortality due to the inefficiency of antibacterial drugs will exceed the mortality rate from malignant tumors.

Both animal-origin and non-animal-origin food is a potential source of antimicrobial-resistant infections in humans. Bacteria that are resistant to antibiotics easily cross borders. Preventing disease in animals through proper livestock management will reduce the use of antibiotics and therefore the spread of AMR. For this reason, the One Health approach promoted jointly by WHO, FAO and OIE is one of the effective ways for countering the growing threat.

In the Russian Federation, AMR has been identified among the priorities in the “Fundamentals of state policy in the field of chemical and biological safety of the Russian Federation for the period to 2025”, adopted by the Russian President.

Russia actively participates in international cooperation in the fight against AMR. Russia is involved in multilateral events and is the co-author of rule-setting documents, in particular, the UN High-Level Meeting on Antimicrobial Resistance in 2016, which adopted a Political Declaration defining the multidisciplinary and intersectoral approach to addressing AMR at the national, regional and global levels.

The Global Center for Research and Development in AMR (Global AMR R&D Hub) was established at the initiative of the German presidency of G20. It was presented in May 2018 on the sidelines of the World Health Assembly in Geneva. Russia has joined the Permanent Board of Global AMR R&D Hub.

On 25 September 2017, the Government of the Russian Federation signed a decree “On the strategy for preventing the spread of antimicrobial resistance in the Russian Federation for the period to 2030” detailing the following main activities to prevent the spread of antimicrobial resistance: 

• Inform the public about the use of antimicrobials (AMU) and antimicrobial resistance (AMR)
• Increase the quality of specialists’ training in relevant industries on issues related to AMR
• Improve measures to prevent and limit the spread and circulation of pathogens with AMR
• Ensure a system to monitor the spread of AMR
• Study the mechanisms of AMR and development of antimicrobial drugs and alternative methods, technologies and means of prevention, diagnosis and treatment of infectious diseases of humans, animals and plants
• Upgrade measures to control the circulation of antimicrobials, chemicals and biological agents
• Promote intersectoral interaction and development of international cooperation in the field of prevention and control of the spread of AMR

With reference to tracking antimicrobial-resistant threats, the Reference Center of Rospotrebnadzor (the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing) plays an important role in monitoring the residual amount of antimicrobials in food raw materials and food products and antibiotic resistance of bacteria, said Vasily Akimkin, Director of the Central Research Institute of Epidemiology (Rospotrebnadzor). The Reference Center cooperates with FAO and provides advisory and methodological assistance to territorial bodies and organizations of Rospotrebnadzor, organizations and institutions of the Eurasian Economic Union (EAEU) and members of the Commonwealth of Independent States.

“Despite the relatively large proportion of antibiotics among other drugs, the number of newly developed antibiotics is quite small. For the last 30 years, no new class of antibiotics has been developed,” Irina Seregina, Deputy Head of the Federal Service for Supervision of Healthcare, pointed out, adding, “Only last year, preclinical studies began on a new type of antibiotic with a potentially low risk of resistance.”

The expert noted the need to support “the development of domestic, fundamentally new antibacterials, new combinations of known antimicrobial drugs, and the expansion of the use of methods to study the sensitivity of pathogens to antibiotics in medical practice.”

Moreover, Irina Seregina considers it expedient “to go back to developing bacteriophages, the production of which was well advanced in the USSR. In addition, special attention should be paid to the issue of creating vaccines for the prevention of infections, including purulent diseases, which were developed by Russian scientists.”

As a result of infection caused by bacteria with multiple resistance, in Europe one person dies every 4 minutes. 700,000 people die every year worldwide. “During our meeting, perhaps more than 100 people died because of the resistance of bacteria to antimicrobials,” stated Melita Vujnovich, Representative of the World Health Organization (WHO) in Russia. It has been estimated, “cumulative financial damage from AMR could amount to USD 40-120 trillion by 2050.”

The “One Health” approach is the only reasonable solution, explained Vujnovic, because “it combines the protection of human health, animals and the environment; reduces the prescription and use of antibiotics to the necessary minimum in both sectors, human health and veterinary; improves the prevention and control of infections, including hygiene and vaccination in both sectors as well.”

"WHO, FAO and OIE are determined to continue to work together with partners to ensure that the “One Health” approach is high on the national agenda,” Melita Vujnovic intoned.

“Focused primarily on the agri-food sector, FAO's own action plan, adopted in 2016, provides for four areas of action: raising awareness of AMR issues, building national capacity in AMR surveillance and monitoring, strengthening AMR-related management, and disseminating knowledge. Very similar goals with the strategy pursued by the Russian Federation,” Aghasi Harutyunyan, Officer-in-Charge of the FAO Liaison Office with the Russian Federation, noted.

“Antimicrobials are important medicines that must remain useful and effective tools for the treatment and prevention of animal disease. However, FAO supports the reduction or complete cessation of their use in animal feed as growth promoters,” Harutyunyan underlined.

In Russia this year, changes have been made in the legislation that relate to “prescription of drugs in general, including antimicrobials,” Polina Smyshlyaeva, Deputy Director of the Veterinary Department of the Ministry of Agriculture of the Russian Federation, said. A separate topic, the expert stressed, is “the illegal use of pharmaceutical substances in veterinary medicine.” This year, a ban on their sale directly to livestock farms was introduced, which should have a positive impact on the use of antimicrobials.

Since food safety issues are regulated by the technical regulations of the Eurasian Economic Union, work is underway to compile a list of drugs that will be banned for use throughout the EAEU.

Given the transparency of borders, there are “huge problems associated with the fact that countries use different approaches to regulating the sphere of circulation of medicines. The Russian Federation suffers greatly in the first place, taking into account the size of our market and the desire of many trading partners to cultivate this market,” Smyshlyaeva stressed.

In his presentation, Roman Kozlov, Rector of the Smolensk State Medical University, Chief Consultant of the Russian Ministry of Health for Clinical Microbiology and Antimicrobial Resistance, provided the list of concrete measures to combat AMR, carried out in Russia and worthy of mention:

• Large-scale multi-year information/awareness campaign  - “Antibiotics – a reliable weapon if the target is bacterial infection” (http://www.antibiotic-save.ru)
• Development of professional standard for “Medical Microbiology”
• Providing methodological assistance to Russian microbiological laboratories in organizing their activities in accordance with the established requirements
• Creation of a theoretical basis for the development of innovative test systems for molecular diagnostics of antimicrobial resistance
• Since 2015, the development of a unique online platform for the analysis of antimicrobial resistance data in Russia, the “Antimicrobial Resistance Map” (http://map.antibiotic.ru)
• Creation of the largest Bank of bacterial strains in Russia
• Defining mechanisms of formation and spread of antimicrobial resistance of the bacterium Acinetobacter baumannii (http://snptab.antibiotic.ru)
• Submission of expert opinions and proposals on inclusion/exclusion of antimicrobial drugs from the list of VED, as well as production of critical drugs in Russia on the instructions of the Ministry of Health
• Cooperation with agencies of Rospotrebnadzor and the Ministry of Agriculture of Russia to replenish the unified online monitoring system for antimicrobial resistance
• Establishment in 2015 of the only WHO Collaborating Center in Eastern Europe for capacity-building in antimicrobial resistance surveillance and research

In future, Roman Kozlov underlined, the “ecosystem” of IT products, including “Antimicrobial resistance Map”, individual projects (scientific projects, hospital laboratories), a system of annotation of antibiotic resistance genes, and a guide to antimicrobial therapy, will develop further.

The round table in the Federation Council was held in the framework and context of the World Antibiotic Awareness Week (WAAW). Each November, WAAW aims to increase global awareness of antibiotic resistance and to encourage best practices among the general public, health workers and policy makers to avoid the further emergence and spread of antibiotic resistance.

19 November, Moscow, Russian Federation