Antimicrobial Resistance Stakeholder Mapping

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Sarah Winthrope - Australia

Riya Sharma - India

Isabella Turilli - Ireland

Yasmin Cürük - Netherlands

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• Antimicrobial resistance (AMR) occurs when a bacteria, virus, fungus or parasite develops the ability to survive exposure to a treatment (i.e., an antimicrobial agent) that was previously effective in treating the infection it causes
• Significant and growing global public health issue
• Recent estimates attribute as much as 1.27 million deaths (95% CI 0.911-1.71 million) and 47 million DALYs (95% CI 35.0-63.4 million) to AMR
• Disproportionately affects LMIC
• AMR is accelerating and likely to increase without sufficient change to the status quo

Intro to the Project

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• Partnership with ARMoR
• NGO working on targeted advocacy campaigns for pull-funding policies for new antimicrobials and equitable LMIC access clauses
• Researchers created a stakeholder map of the current policy and pharmaceutical landscape in one of the following countries:
• Australia
• India
• Ireland
• The Netherlands
• Research question: What are the relevant policy organisations, pharmaceutical actors and other NGOs in the country currently working on this? What are the biggest bottlenecks to getting pull-incentives passed for AMR?

Intro to the Project

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• Last semester of Medicine at Monash University in Melbourne, Aus
• Working with Good Ancestors and Pour Demain, future-oriented think tanks,
• Researching synthetic DNA screening policies
• Involved in community EA work - EA Monash Uni and High Impact Medicine
• Going to work in a hospital in rural Australia next year to complete my training
• Love hiking, musical theatre, and audiobooks

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Project Members: Sarah

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• First year medical student at the Royal College of Surgeons in Ireland
• ERA Biosecurity Research Fellow at Cambridge over the summer
• Researched confidence-building measures in the BWC
• Co-founder of EA UAE and Intro Fellowship Manager at High Impact Medicine
• Undergrad Research Assistant at Tissue Engineering Research Group
• Enjoy doing and teaching ballet, hiking, and reading

Project Members: Riya

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• First year MPhil in International Relations student, University of Oxford
• Has researched on global health security with
• Council on Foreign Relations
• Georgetown Center for Global Health Science and Security
• Georgetown Global Irish Studies Initiative
• Experience as an ambulance worker during COVID
• Lived in Korea and fluent to an advanced low level in Korean

Project Members: Isabella

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• Last semester of B.Sc. in Economics at the University of Bonn
• Work for the Institute for Peace Research and Security Policy
• Project CBWNet: Strengthening the norms against chemical and biological weapons
• Live in Berlin
• Enrolled in the BlueDot Impact Biosecurity Fundamentals: Pandemics course
• Organizing the German EA Intro Program
• Interested in the intersection of Biosecurity and China, spent a year there and learning Mandarin

Project Members: Yasmin

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Overview of the Political System

• Australia is a federal constitutional monarchy
• Part of the British Commonwealth under King Charles - his role is ceremonial
• Aus is governed by the Prime Minister and the government - ministers who are elected representatives
• Federal system: Bicameral (=two houses) Parliamentary democracy
• Upper house / senate
• Lower house / house of representatives
• State system: Similar bicameral system in each of the six states and two territories
• Elections take place every 3 years to elect ruling party

Australia

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Current organisations in the space

Governmental

• Departments: The Australian Research Council (ARC), The National Health and Medical Research Council (NHMRC), Australian Government Department of Health and Aged Care, Department of Industry, Science and Resources:
• Public groups/agencies: Antimicrobial Resistance Governance Group (ARGG), Australian Strategic and Technical Advisory Group on AMR (ASTAG), Antimicrobial Use and Resistance in Australia (AURA) Surveillance System , Australiasian Society for Infectious Diseases, Australian Antimicrobial Resistance Network (AAMRNET)

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Research institutes (most universities have one! these ones seem to be particularly focused on novel interventions)

• University of Queensland - Australian Infectious Diseases Research Institute, Monash Centre to Impact AMR, The Peter Doherty Institute for Infection and Immunity

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Private companies

• Pharmaceutical companies: GSK, Pfizer, Merck & Co. (MSD in Australia), Novartis (Swiss company), AstraZeneca, Johnson & Johnson, Bayer, Roche (Swiss)
• Biotech companies: Starpharma, Nyrada Inc., SpeeDx Biotron Limited, AdAlta Limited:

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Australia

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Some possibly promising leads to pursue

• AAMRNET is an independent, NFP established by the Aus Government to champion the continuing growth of the Aus medical products sector.
• They have advocated for piloting a new Australian antimicrobials funding model, like UK and Sweden approach → reimbursement is not linked to the volume of antimicrobials sold, but rather to their broader societal value and guarantee of ‘as needed’ supply.”
• Collaborating with NHMRC - this might be hard
• Collaborating with a Uni research group - eg the Australian Infectious Diseases Research Institute and/or Monash Centre to Impact AMR

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Australia

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Recommendations for ARMoR's next steps

Probably depends on

• How research in other areas went
• What is ARMoR hoping to achieve
• next?
• in the medium or longer term?

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• It seems worthwhile to be in touch with AAMRNET, since they seem to be advocating for similar changes to research funding models
• ascertain how successful they have been until now
• Investigating possibility for collaborations with NHMRC

Australia

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• Overview of the Indian Political System
• India is a Sovereign Democratic Republic
• The government is modeled after the Westminster system

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• Three primary branches: the legislative, the executive and the judiciary
• The powers of these branches are vested in the Parliament, the Prime Minister (head of government) and the Supreme Court respectively
• The President is ceremonial head of state

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• Federal system: bicameral legislature divided into the Lok Sabha (lower house) and the Rajya Sabha (upper house)

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• State system: the country is divided into 28 States and 9 Union territories

India

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• Overview of Current Organizations in the Space
• Government organizations & research institutes:
• Ministry of Health and Family Welfare, Indian Council of Medical Research, Indian Council of Agricultural Research, National Centre for Disease Control, NITI Aayog, Central Drugs Standard Control Organization, Tata Institute for Genetics and Society
• Private organizations:
• Bugworks (Aims to develop new broad-spectrum antibiotics with low resistance), Gangagen (Researching alternative therapies to antibiotics), Organization of Pharmaceutical Producers of India (Supported public health measures to limit overuse of antibiotics)
• Several universities, hospitals and labs have AMR groups and are involved in the Antimicrobial Resistance Surveillance and Research Network

India

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• Recommendations for Next Steps
• Reach out to NITI Aayog, particularly members involved in the multisectoral AMR meeting
• Provide inputs for the National action plan on antimicrobial resistance (NAP-AMR) 2.0, currently in development by the Union government
• Speaking to senior management in new pharmaceutical companies focused on AMR such as Bugworks and Gangagen

India

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Structure of Government

• Legislative
• Unitary parliamentary democracy using a common law system
• Bicameral legislature called “Oireachtas”
• Lower house: Dail Eireann, all members (TDs) elected
• Upper house: Seanad Eireann, members elected/appointed/selected
• Most work is done through bicameral committees
• Executive
• President (head of state), largely ceremonial, directly elected
• Prime Minister/Taoiseach (head oof govt), is a communally chosen TD

Ireland

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ECDC: “the control of AMR in Ireland is a positive example for other countries”

• Has a National Interdepartmental AMR Consultative Committee
• Coordinates strategies via “One Health National Action Plans on AMR”
• Five year plans: currently in 2020-2025 iteration (aka iNAP2)
• Incorporates all relevant health/agricultural agencies within government while also taking into account voices of trade unions and industrial groups
• Just completed a 2023 “Midterm Review” of iNAP2

Ireland

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• Possible avenues for action
• Get involved as a stakeholder or contributing voice in the AMR plan negotiations
• Meet at least twice a year, with heads of virtually all agencies
• Attend or potentially present at joint departmental events on iNAP2
• Last one held in June 2022
• Featured speakers from European Medicines Agency, Queen’s University Belfast, NUI Galway, University College Cork
• Key moment as government seeks to transition to “Slaintecare”

Ireland

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Political System

• Constitutional Monarchy
• Eerste Kamer = Senate
• Tweede Kamer = House of Representatives
• Coalition & Opposition (always ruled by coalition), coalition agreement guides the policy-making
• Directly elected every 4 years, current election Nov 23 2023!
• The King is the head of state, but only has a ceremonial rule
• Clear right-shift in the snap election
• Situation is still very unclear, coalition talks will likely take months, center-left PVdA also gained a lot though

The Netherlands

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Legislative process

• Parliament & ministers can initiate new laws
• Consultation phase (this is where ARMoR could come in)
• Advisory bodies
• Tweede Kamer
• Goes to Eerste Kamer for approval (rarely gets rejected)
• Royal assent

Upcoming policy-windows

• Ministries of Health, Welfare and Sport (VWS), I&W and LNV are jointly working on a National Action Plan on AMR
• While the coalition is formed in the coming months, trying to get AMR in the coalition agreement
• When budgets are revised (before September) → Health budget has increased a lot recently

The Netherlands

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Opinions/actions of the current government on AMR

• Current coalition agreement includes little on health and nothing on AMR
• They have one of the lowest rates of AMR prevalence or deaths in the world, which is why they see their role globally in helping other countries deal with the problem
• AMR is already a priority in Dutch politics and they organise lots of projects tackling it, focus on:
• One Health
• International cooperation
• Letter to parliament (2015) indicated that the Ministry of Economic Affairs considers AMR a priority and is asking for a focus on R&D on new antibiotics
• Has been keen to align with EU & WHO recommendations in the past, EU has intentions to design a multi-country pull-incentive scheme

How would pull-incentives fit into current structures?

• Implement into the current system
• Dutch Medicine Prices Act (WgP)
• Medical Reimbursement System (GVS) → Minister of Health decides price ceilings & which
• Recent changes to the system, might not comply with EU law

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The Netherlands

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Relevant actors in this space

• Ministry for Health, Welfare & Sport (VWS)
• Medicines & Medical Technology is the team working on AMR, director Karla van Rooijen
• Minister Ernst Kuipers (D66)
• Dutch National Institute for Public Health and the Environment (RIVM)
• Advise the Ministry
• Dutch Healthcare Authority, National Healthcare Institute, etc. → complex healthcare system
• Lots of public-private mix: Dutch Working Party on Antibiotic Policy (SWAB), Health~Holland, Federation of Medical Specialists, etc. (lack of NGOs though)
• Pharma companies, some have AMR strategies

Main Recommendations

• Get involved in the national action plan on AMR - there was just a stakeholder meeting and it seems like RIVM is very interested in getting advice & opinions on this
• Try to get involved with party members during the coalition talks to get AMR on the agenda

The Netherlands

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• Write blogs
• Help with cost-benefit economic analysis of AMR pull incentives
• Help with pharma survey on what they need to pass pull incentives
• Help with LMIC access research
• Continue with stakeholder work
• Leave OBG
• Other?

What’s next?

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• Write blogs
• Help with cost-benefit economic analysis of AMR pull incentives
• Help with pharma survey on what they need to pass pull incentives
• Help with LMIC access research
• Continue with stakeholder work (maybe)
• Leave OBG
• Maybe a DNA synthesis project in a different term

What’s next? - Sarah

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• Write blogs
• Help with cost-benefit economic analysis of AMR pull incentives
• Help with pharma survey on what they need to pass pull incentives
• Help with LMIC access research
• Continue with stakeholder work
• Leave OBG
• Other?

What’s next? - Riya

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• Write blogs
• Help with cost-benefit economic analysis of AMR pull incentives
• Help with pharma survey on what they need to pass pull incentives
• Help with LMIC access research
• Continue with stakeholder work
• Leave OBG
• Other?

What’s next? - Isabella

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• Write blogs
• Help with cost-benefit economic analysis of AMR pull incentives
• Help with pharma survey on what they need to pass pull incentives
• Help with LMIC access research
• Continue with stakeholder work
• Leave OBG
• Other?

What’s next? - Yasmin

Thank you!

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