Quadripartite alliance and shield against the development of super bacteria

As part of the annual World Antimicrobial Awareness Week, held from 18 to 24 November, the representative offices in Russia of the World Health Organization (WHO), the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE) and the United Nations Environment Programme (UNEP) held a traditional round table of main stakeholders who are involved in the implementation of the Russian National Antimicrobial Resistance Prevention Strategy (AMR). The theme of this year's roundtable was "Raise Awareness, Stop Resistance."

Opening the expert meeting conducted online, Melita Vujnović, WHO Representative in the Russian Federation, reminded the participants, “this is already the fifth forum of its kind." In effect, a quadripartite alliance has been formed, and it is ready to confront "the biggest threat to global health in parallel with the COVID pandemic to which we must say ‘Stop!’"

Yuri Arkharov, Deputy Chairman of the Federation Council Committee on Social Policy, spoke about the Federation Council's efforts to improve the healthcare system. Russia has adopted a strategy to combat antibiotic resistance by 2030. "The widespread use of antibiotics by the population without a prescription for the prevention of coronavirus infection and the prescription of antibiotics by doctors as a precaution, despite the evidence showing that antibiotics do not help and may even cause harm, is one of the new issues caused by the pandemic," stressed Yuri Arkharov.

Oleg Gridnev, Deputy Minister of Health of the Russian Federation, delivered the welcoming address and described the One Health approach as a global action plan, including in the fight against antimicrobial resistance with the support of FAO, WHO, OIE and UNEP. He highlighted that the government has targeted support for the research and the development of new antimicrobials and alternative antivirals, which in the future could to some extent substitute conventional antibiotics.

Elena Boyko, Deputy Director of the Department of Organization of Emergency Medical Care and Health Risk Management of the Ministry of Health of the Russian Federation, in her presentation noted that antiviral resistance poses biological and economic threats to all countries of the world without exception. She stressed that the national policy on ensuring chemical and biological security and the Federal Law of 30 December 2020 № 492-FZ "On Biological Security in the Russian Federation", adopted late last year, identified the problem of antimicrobial resistance as one of the main biological threats.

The Russian Ministry of Health together with the concerned federal executive authorities are closely involved in preventing the spread of antimicrobial resistance, said Elena Boyko. "Awareness-raising work among the population is being carried out, information resources on the use of antimicrobials have been created, and inappropriate use of antivirals to prevent infectious diseases is decreasing", added Elena Boyko.

Sevil Salakhutdinova, Senior Health Specialist of the World Bank Country Office in the Russian Federation, emphasized that if effective measures to combat the spread of antimicrobial resistance are not taken, the world could lose 3.8 percent of its annual GDP by 2050, and the loss of human lives could reach ten million people per year by 2050.

Lyalya Gabbasova, Deputy Director of the Lomonosov Moscow State University’s Medical Research and Education Center, spoke about the achievements of the Russian Federation in the Global Monitoring of the Progress of Countries towards Antimicrobial Resistance (AMR). She presented the data on Russia's accomplishments in the global monitoring of the progress of countries with regard to antimicrobial resistance.

The expert touched on a topical issue of whether the COVID-19 pandemic had affected the process of developing and implementing the national plan of action on AMR. According to Lyalya Gabbasova, the efforts had been ongoing regardless of the pandemic. She also noted that the questionnaire placed great emphasis on the inclusion of the classification of antibiotics in the National Essential Medicines List. Although Russia is a significant contributor to the Global Plan of Action, this classification has not been implemented yet.

Roman Kozlov, Rector of the Federal State Budgetary Educational Institution of Higher Education, Smolensk State Medical University, Chief External Specialist of the Russian Ministry of Health for Clinical Microbiology and Antimicrobial Resistance, delivered a presentation on the "Success of the Russian Federation in Overcoming Antimicrobial Resistance." The expert spoke about the AMRcloud online platform for sharing AMR data. The platform allows creating secure user credentials and tracking the dynamics of the spread of AMR. He also highlighted a number of activities and educational programmes that are being conducted to increase the population’s knowledge level about antibiotics and their relevance in the current context.

Yuri Schmidt, Head of the Press Service of the Novosibirsk Region Veterinary Department and Member of the Expert Council Section under the Federation Council Committee of the Russian Federation on Agro-food Policy and Natural Resources Management, made a presentation on the "Experience of the Novosibirsk Region Veterinary Department in preventing the spread of antimicrobial resistance." "We are witnessing that in veterinary practice the effectiveness of the existing antimicrobial agents is constantly decreasing," said the expert. "We have been actively developing such technologies as the use of probiotics, algae, chlorella, forest resources (pine meal, medicinal herbs for the treatment of young animals) in feed." Phytobiotics significantly expand the microbiological composition of the gastrointestinal tract of animals and help maintain animal health without the widespread use of antibiotics.

Maria Novikova, Director of the Veterinary Department of the Ministry of Agriculture of the Russian Federation, spoke about the issue of antimicrobial resistance in agriculture. She stressed in particular that many of the microorganisms could be involved in the spread of antimicrobial resistance from animals to humans. The expert reiterated the Ministry of Agriculture's support for the One Health concept. "We wholeheartedly embrace the One Health concept which is embodied in the global plan of action to combat antimicrobial resistance," she added.

Aleksey Tuteljan, Corresponding Member of the Russian Academy of Sciences, Head of the Laboratory of Healthcare-Related Infections, Federal Budgetary Academic Institution Central Research Institute of Epidemiology, Rospotrebnadzor, shared data on the antibiotics detected in food products, specifically highlighting that there is a downward trend in the detection of antibiotics in food products in the Russian Federation. He spoke about the recent developments in the detection of antibiotic resistance genes. "Our institute, as a center of a global genomic level, is working on the development of the Crispr CAS9 system for the detection of antibiotic resistance genes and bacteria," he added.

Alexander Matviychuk, Deputy Head of the Veterinary Control Department for Foreign Trade and Transport of the Federal Service for Veterinary and Phytosanitary Surveillance, spoke about modern methods of animal husbandry and the use of antimicrobials in this sphere. "Modern animal husbandry cannot be imagined without the use of antibiotics. Antibiotics are usually added in small doses in order to prevent digestive disorders of young animals, and in this case, the drug does not completely destroy even microbes sensitive to it, but only slows down their reproduction, which probably suits most farmers who use them and thereby reduce the appearance of hidden infections. The result is a situation in which a person himself works out resistance to drugs in microbes. In addition, veterinary drugs are used without taking into account the fact that resistance to them is growing," said Alexander Matviychuk.

"According to FAO researches, at least 700,000 people die from drug-resistant infections every year, and this problem continues to grow," he added. The expert noted that the continued use of antibiotics in animal husbandry will lead to a decrease in the productivity of farm animals, which, in turn, threatens malnutrition, increased hunger, and poverty in some regions.

Melita Vujnović, WHO Representative to the Russian Federation, noted, in her speech, that the fight against antibiotic resistance should be carried out both at the intersectoral and interdepartmental levels, as well as on the basis of the concept of One Health. "All four agencies: FAO, WHO, OIE and UNEP continue to work together with our partners to ensure that the One Health strategy occupies an important place on the national agenda, as well as on the agenda of everyone around," added the WHO Representative to the Russian Federation.

Among the main methods for solving the problem of antibiotic resistance, Melita Vujnović highlighted the following ones: General prevention and control of infection measures primarily hygiene and vaccination – that will reduce the need for antibiotic use; Integration of epidemiological surveillance among sectors that will enable epidemiological information exchange between animal and human health domains.

Dr Vujnović noted that the fight against resistance affects many SDGs, including the fight against poverty, hunger, achieving good health and well-being, as well as environmental goals. In addition, the work to eliminate resistance will have a positive effect on the economy, expanding access to innovation, increasing the efficiency of food production, and strengthening partnerships between sectors both within countries and internationally.

Melita Vujnović noted the importance of the problem of antibiotic resistance in food issues. "Speaking about antiviral drug resistance, of course, we talk a lot about food safety, because these topics are very strongly related. Without ensuring the safe use of antibiotics in animal husbandry, we cannot get safe and high-quality animal source foods," she concluded.

On behalf of Dr Budimir Plavsic, OIE Regional Representative for Europe in Moscow, Dr Marina Sokolova welcomed the participants of the roundtable. In her speech, she spoke about the OIE AMR Strategy, adopted in 2016, which formulates four main objectives in the framework of an effective tackling against antibiotic resistance and its consequences. They are, firstly, to improve awareness and understanding. Secondly, strengthen knowledge through surveillance and research. Thirdly, support good governance and capacity building. And fourthly, encourage implementation of international standards to tackle AMR, included in the OIE Terrestrial Aquatic Animal Health Codes.

Dr Sokolova noted that the experience of many countries and the results of scientific research on the antimicrobial resistance of human and animal pathogens show that it is not too late to change the situation.

The FAO Liaison Office with the Russian Federation provides an exchange of information and knowledge on the problem of AMR. "Our goal is to create a platform for a broad coalition of all interested participants," highlighted Oleg Kobiakov, Director of the FAO Liaison Office with the Russian Federation.

He reminded that by 2050, according to the forecasts, in addition to economic losses because of the spread of AMR, up to 25 million people "will be thrown over the edge of poverty." For this reason, FAO has updated its 5-year plan to reduce the occurrence and spread of AMR across all production chains in all sectors of agriculture. FAO focuses on the strict targeted use of antibiotics exclusively for therapeutic purposes, for the treatment of diseased animals, and on the prohibition of their use as growth promoters.

"I am pleased to emphasize that the FAO Office in Moscow has built a fruitful partnership with Rosselkhoznadzor and Rospotrebnadzor, with industry science, with private companies. A project is being implemented to increase the competencies of CIS countries in the field of AMR monitoring and analysis, for which Russia has made a voluntary contribution of $ 3 million to FAO for the fight against AMR.

FAO highly values cooperation with Russia as one of the world leaders in medicine and veterinary medicine. "We are involved in informing all participants in the process – practicing veterinarians, representatives of large businesses, small farmers, and people who have their own subsidiary farm," said Oleg Kobiakov. The FAO Liaison Office with the Russian Federation proceeds from the fact that "strengthening the scientific and practical potential of our Russian partners will contribute to increasing Russia's assistance to other countries in the fight against AMR."

Humanity is entering an era when the treatment of many diseases will be impossible due to antimicrobial resistance (AMR) of pathogenic organisms. Hence, Vladimir Moshkalo, Head of the Representative Office of the United Nations Environment Programme (UNEP) in the Russian Federation, stressed AMR is "a global threat to humans, animals and the environment."

Previously, less attention was paid to the "environmental aspect" to counteract AMR, said Vladimir Moshkalo, but last year, within the framework of the One Health concept, UNEP joined a trilateral alliance consisting of the World Health Organization (WHO), the World Organisation for Animal Health, and FAO in order to eliminate the threat in the human-animal-nature relationship.

Sergey Kasparyants, Commercial Director of VIC Group, spoke about five main trends in the fight against antibiotic resistance: diagnostics, biosafety, vaccination, improvements, and treatment protocols in the modern field of production of medical antiviral drugs and antibiotics. He also stressed that the production of new antiviral drugs is not expected in the near future. Noting the quality of existing drugs, Sergey Kasparyants drew attention to improving the quality of antibiotics, which was facilitated by the standardization of processes and increased reliability of production.

Olga Ivanova, Head of the Department of Biotechnology of the Federal State Budgetary Institution "VGNKI", spoke about antibiotic resistance as a global problem of the world community. In her presentation, she spoke about the classification of antiviral drugs for utilization in animal husbandry. She also spoke about the main areas of scientific work of the Federal State Budgetary Institution "VGNKI", which include veterinary monitoring of bacteria and the development of PCR techniques for detecting resistance genes.

You can get acquainted with the speeches of experts at the round table in the recording