The Quadripartite Alliance has become a shield against superbugs

This year, The World AMR Awareness Week wasopened in Russia on 20 November with a seminar at the Marriott Hotel, organized by the offices of the World Health Organization, the World Organisation for Animal Health (WOAH), Food and Agriculture Organization of the United Nations (FAO) and the United Nations Environment Programme (UNEP).

In addition to the members of the Quadripartite Alliance established by the UN for the implementation of the One Health approach, the workshop was attended by the representatives of the leadership of Russian specialized agencies of the Ministry of Health, Rospotrebnadzor, Roszdravnadzor, Rosselkhoznadzor, leading scientific institutions, and Russian world-known scientists.

Dr Melita Vujnović, World Health Organization (WHO) Representative in the Russian Federation opened and moderated the workshop. In her opening speech, she noted in particular that “Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi, and parasites stop responding to prescribed antimicrobials. As a result of the development of drug resistance, antibiotics and other antimicrobials become ineffective and infection treatment turns to be difficult or impossible, and this increases the risk of further spread of a disease, development of severe forms of a disease and leads to death.”

“Ultimately, the situation with AMR affects the health care system, the human health, and becomes one of the most difficult public health issues. But that is not all,” highlighted Dr Vujnović, “this undermines national economies, macroeconomics, household and personal economies. Antimicrobial resistance poses a threat not only to human, but also to animals, plants and the environment. This problem concerns all of humanity.

In order to really reduce AMR,” Melita Vujinović noted, “all sectors must prudently and appropriately use antimicrobials, take preventive measures to fight infectious diseases, and follow best practices in the disposal of waste containing antimicrobials.”

“In the Russian Federation, at the legislative level, the problem of AMR is considered as a biological threat” Andrey Plutnitsky, Deputy Minister of Health of the Russian Federation, stressed in his welcoming speech. “In order to control it, a whole range of measures aimed at protecting the population and the environment is being applied.

In 2017, the Russian Federation adopted a Strategy to Prevent the Spread of AMR to 2030. All measures have been developed taking into account the main provisions of the 68th World Health Assembly Resolution. The strategy is being implemented through the joint efforts of the sectors of health, sanitary and epidemiological surveillance, veterinary and agriculture, and food production. As part of the Strategy, we are constantly implementing a number of measures to develop the skills of competent use of antibiotics among the population: information campaigns for citizens, educational programmes for patients and specialists, the introduced system for monitoring the circulation of medicines.

In the Russian Federation, molecular genetic tests have been developed to determine the resistance of microorganisms, epidemiological surveillance of AMR and constant monitoring of the residual amounts of antibiotics in industrial raw materials and food products are being carried out in all industries, the mechanisms of AMR occurrence are being studied, standards for the content of antibiotics in drinking water and in water bodies have been introduced.

As a digital decision-making support, the Russian professional community has developed an online platform, an antibiotic resistance map, which analyzes and visualizes data on antimicrobial susceptibility. This system is by far the best in the world.

We are stepping up our efforts not only domestically, but also in the international arena. Since 2016, the WHO AMR Research Centre has been operating in the Russian Federation. We are also actively involved in the development of key documents in the FAO/WHO Commission on Food Standards (Codex Alimentarius).

Since 2017, together with FAO, the Russian Federation has been implementing a project to assist countries in Eastern Europe and Central Asia in combating AMR. In 2022, at the initiative of the Russian Federation and Armenia, a plan of joint actions of the CIS member states to combat AMR was adopted.”

In conclusion, Dr Andrey Plutnitsky expressed the hope that in the coming 2024, the high-level meeting of the UN General Assembly and the 4th WHO Global Ministerial Conference will set new ambitious goals, the achievement of which will make it possible to ensure sustainable containment of AMR spread at the global level.”

The presentation of “The new AMR Roadmap for the WHO European Region for 2023-2030” was made by Dr Danilo Lo Fo Wong, Regional Adviser on Antimicrobial Resistance (WHO Regional Office for Europe).

The need for the Roadmap, as Dr Lo Fo Wong explained, is due to the fact that although “most countries have developed AMR national action plans,” there is a lack of high-level political support, financing and management of these processes, there are problems with coordinating actions within the framework of the One Health approach, as well as monitoring. 

The WHO has created the AMR Compass to “support countries to identify, prioritize, implement and monitor high-impact interventions to tackle AMR.” The Compass is a diagnostic tool to assess national AMR capacity, identify national priorities and targets and measure progress achieved.”

“Over the years of the Quadripartite Alliance “Moscow” unit’s work, we have achieved significant results, and there is a share of our efforts in the fact that the AMR issue has reached the level of a national strategy in Russia," said Oleg Kobiakov, Director of the FAO Liaison Office with the Russian Federation. “At the same time, the scale of the challenges associated with AMR is growing faster than our actions to neutralize it. In this regard, coordination of work at the intersectoral and national scales is at the top of the agenda.

I am convinced that the Russian Federation can be at the forefront, serve as a guide and donor for developing countries,” continued the head of the FAO Moscow Office. “I want to emphasize the successful cooperation of FAO with Rospotrebnadzor on the implementation of a Russia–funded project on the potential to combat AMR in a number of countries in Europe and Central Asia.

I would like to add that the lead institution – the Central Research Institute of Epidemiology of the Federal Service for Supervision of Consumer Rights Protection and Human Well–being, headed by Academician V.G. Akimkin, – has received the status of one of the 9 global FAO Reference Centres on AMR. Recently, the first plenary meeting of the Multilateral Partnership Platform on Antimicrobial Resistance has been held at the FAO headquarters in Rome. The meeting has been attended by over 150 interested delegations from all over the world, including representatives of governments, civil society, academic institutions, the private sector, financial institutions, intergovernmental organizations, and specialized UN agencies.

The participants have adopted the following recommendations to reduce the need for antimicrobials and minimize the risks of AMR: strengthen infection prevention and control in health facilities, farms and food-processing enterprises; ensure access to clean water, sanitation and hygiene, as well as vaccines; minimize pollution and ensure proper waste management and sanitation; ensure access to high-quality medical care for all; provide access to expert advice in the field of animal husbandry, food production and agricultural products.

Oleg Kobiakov noted that FAO Director-General Qu Dongyu made the following statement at that meeting: “The first Inaugural Plenary Assembly brings together the pioneers and champions of AMR, who share common concerns and shoulder collective responsibilities. The success of the Platform will depend on clear goals, an effective governance structure, visionary leadership, trust, transparency, and the sustained engagement of Members to drive change.”

Vladimir Moshkalo, Representative of the Moscow Office of the United Nations Environment Programme (UNEP), for his part, stressed that “reducing pollution created by the pharmaceutical, agricultural and health sectors is important to reduce the emergence, transmission and spread of superbugs – strains of bacteria that have become resistant to all known antibiotics – and other cases of resistance to antimicrobials.

This is the key message of the report published recently by the United Nations Environment Programme (UNEP) on the environmental aspects of AMR, which are already causing serious damage to human, animal and plant health, as well as the economy.

Vladimir Moshkalo quoted the statement of Inger Andersen, Executive Director of UNEP, which she pronounced at the presentation of the report: “Pollution of air, soil and waterways undermines the human right to a clean and healthy environment. The same drivers that cause environmental degradation are worsening the antimicrobial resistance problem. The impacts of antimicrobial resistance could destroy our health and food systems, so cutting down pollution is a prerequisite for another century of progress towards Zero Hunger and good health.”

Dr Budimir Plavsić, Head of the Regional Office of the World Organisation for Animal Health (WOAH), spoke about the WOAH Strategy for Combating Antimicrobial Resistance and the Rational Use of Antimicrobials, consistent with the Global Action Plan developed by WHO. This fact, according to a well-known expert, “underlines the importance of the “One Health” approach, which covers human and animal health, farming methods and environmental considerations.”

Budimir Plavsić quoted the saying: “A gramme of prevention is worth a tonne of treatment.” He then stressed that “time is crucial. The structure of our strategy is consistent with the goals set out in the Global Action Plan, with an emphasis on 1) raising awareness, 2) expanding our knowledge through surveillance and research, 3) supporting good governance and capacity building, and 4) encouraging the implementation of international standards.”

The Head of the WOAH Moscow Office announced some specific results of the work. Since 2015, the WOAH has been creating a global database on antimicrobials used in animal husbandry and has compiled annual reports on this basis. “In 2022, we transformed this into the ANIMUSE global database, an online platform that allows participating countries to inform, extract and visualize data.

The recent training in Belgrade highlighted the high interest among our 53 Member States, which confirms the collective commitment to this global challenge. In our region, 33 countries have reported on the preparation of national antimicrobial Use (AMU) Reports, with 12 countries publishing their reports on the ANIMUSE platform. The WOAH actively encourages and assists in the development of these critical national reports.”

Academician Andrey Shchekotikhin, Director of the FSBI Gause Institute of New Antibiotics, spoke at the Round Table about the implementation of the comprehensive research programmes (CRPs) to reduce antibiotic resistance, including the study of the mechanisms of its occurrence, the development of antimicrobials and alternative methods, technologies and tools of prevention, diagnostics, and treatment of infectious diseases.”

“These programmes include the development of test systems (6 projects), the study of AMR mechanisms (8 projects), the development of antimicrobials (16 projects) and of alternative means and new methods (7 projects). The search, research and development of antimicrobials acting on resistant pathogens are also planned, which involves the search for new natural antibiotic substances (4 projects), modification of natural antibiotics (4 projects), synthesis of new antimicrobial drugs (6 projects) and the development of drugs alternative to antibiotics (2 projects).

Dr Alla Samoylova, Head of the Federal Service for Surveillance in Healthcare, revealed the sources of antimicrobial resistance. In the first place, she put problems with patients who tend to “use antibiotics in an independent and uncontrolled manner, violate doctor’s orders, be unwilling to see a doctor because of greater trust in the opinion of others, as well as faith in the antibiotic as a panacea.”

No less serious challenges, as Dr Alla Samoylova emphasized, are associated with doctors and medical institutions themselves, which are often characterized by insufficient skills-building, non-compliance with clinical recommendations, lack of explanatory work with the patient about the importance of AMR, errors in prescribing medications, as well as inability to make an appointment with a medical specialist.

This list of issues is complemented by substandard medicinal products (MPs), as well as errors by pharmacists and pharmacies – it often happens that MPs are dispensed without prescription, storage with violation of temperature conditions, lack of advice on taking and storing MPs at home.

A separate and sensitive topic is the distance retail sales of medicinal products. This year, Roszdravnadzor employees have analyzed more than 100 thousand Internet resources, of which 60 thousand have been blocked.

The reasons for blocking are as follows: sale of unregistered medicinal products – 71%; sale of prescription medicinal products without licenses and permits – 20%; sale of narcotic and psychotropic drugs – 5%; sale of previously purchased and not fully used medicinal products (including on such social networks as Telegram, VKontakte, Odnoklassniki.ru) – 2%; sale of antibiotics through Internet services on bulletin boards (Avito, Kupi-prodai, Yula, etc.) – 2%.

In conclusion, Dr Alla Samoylova spoke about the pilot project of Roszdravnadzor on online sales of prescription drugs in Moscow, Moscow and Belgorod regions. Its advantages: sale only on doctor’s prescription; control over dispensing a drug to a specific patient; exclusion of counterfeit prescriptions; preservation of a prescription; exclusion of unlawful repeated dispensing of a drug pursuant to the same prescription; the possibility of obtaining medicines by relatives and social workers. In this case, placing an order takes no more than 10 minutes.

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The forum was also attended by: Konstantin Savenkov, Deputy Head of the Federal Service for Veterinary and Phytosanitary Surveillance; Elena Boyko, Deputy Director of the Department of Emergency Medical Care and Health Risk Management Organization of the Ministry of Health of the Russian Federation; Professor Roman Kozlov, Rector of Smolensk State Medical University, Chief non-staff Specialist of the Ministry of Health of the Russian Federation on Clinical Microbiology and Antimicrobial Resistance; Professor Lyalya Gabbasova, Deputy Director of the Medical Scientific and Educational Centre of Moscow State University and National coordinator of data collection for TrACSS from the Russian Federation; Natalia Zhukova, Director of the Department of Sanitary, Phytosanitary and Veterinary Measures of the Eurasian Economic Commission; Marina Smirnova, Head of the Laboratory for the Prevention of Chronic Respiratory Diseases, National Medical Research Centre for Therapy and Preventive Medicine.

The seminar participants expressed their gratitude to the representatives of the UN Quadripartite Alliance and confirmed their intention to strengthen the coordination of the work of their departments and agencies to eliminate the threat of AMR growth at the national, regional and global levels.

THE BACKGROUND INFORMATION: 

The World AMR Awareness Weekis a global world campaign aimed at increasing understanding of the issue and promoting the best practices of the One Health approach to combat the spread and emergence of drug-resistant pathogens. This year’s appeal is focused on the role of the intersectoral cooperation for maintaining the effectiveness of antimicrobials.