US-EU Task Force on Antimicrobial Resistance
Following the announcement of a new US-EU Task force to address antimicrobial resistance (AMR) the Center for Global Development in Washington D.C. raised some critical questions on how this task force would be constituted, for how long, to what ends and for what implications for global health. Global Health Europe has tried hard to answer these questions.
The questions were raised in a blog by Rachel Nugent the Center's deputy director for global health. The blog applauded the EU and the Swedish presidency for bringing AMR to the agenda of the summit, and for there actions on AMR in general. The US-EU AMR Task Force is seen as having great potential but the Center's ethusiasm for this inititive was limited by the lack of basic details available publicly available on the Task Force.
The Center for Global Health's Blog and Global Health Europe's response can be read in the original at http://blogs.cgdev.org/globalhealth/2009/11/a-low-key-summit-with-high-key-potential.php/comment-page-1#comment-5663
or for convience we've replicated them here:
A Low-Key summit with High-Key Potential
By Rachel Nugent and Emma Back
Last week's 2009 US-EU Summit was hosted in Washington by President Obama and, while it didn't exactly hog newspaper headlines, it did yield a few surprises. Alongside the expected commitments to co-operation on issues such as climate change and global security, the two parties also agreed "to establish a transatlantic task force on urgent antimicrobial resistance issues."
Wow! Where did that come from? This stated priority derives from Sweden's current Presidency of the EU, and we applaud Sweden and the advocates there at ReACT for bringing this issue to the US-EU Summit. There's no doubt that drug resistance presents an urgent threat to people's health across the world. Can the US-EU task force provide the global leadership we so desperately need to address it?
It certainly has promise. The EU has recognized resistance as a serious matter. Some of the Nordic countries have stellar track records in controlling resistance, and the European CDC has conducted thorough resistance surveillance in all its member countries and provided good resistance prevention advice to EU governments. The task force will have a broad remit, covering the "appropriate therapeutic use of antimicrobial drugs in the medical and veterinary communities, prevention of both healthcare- and community-associated drug-resistant infections, and strategies for improving the pipeline of new antimicrobial drugs." This comprehensive approach - embracing both prevention and treatment, in animal and human health - is necessary and welcome.
But many questions remain. We don't yet know how the task force will be constituted, or for how long, or what outputs it should generate. We don't know how much money either the US or the EU are prepared to invest in operating the task force or in responding to its recommendations. Crucially, it's not clear whether this work will take a global health perspective, or focus on the resistant bugs most troubling the US and EU right now - such as Methicillin resistant Staphylococcus aureus and C. difficile.
If it's the latter, then the US and EU will have missed the point. In a globalized world, drug resistant infections spread quickly from one country or region to another. Efforts taken in one part of the world can be rapidly undermined by a lack of effort elsewhere.
This new task force may be transatlantic in origin. But its research, deliberations and actions must be global. It should improve the use of medicines in Africa and Asia, as well as Europe and the Americas. It must consider the challenges of effectively preventing and treating disease in poorer communities with weak health systems infrastructure and human resource capacity. And the US and EU must be prepared to address those weaknesses and help out if the urgent threat of global drug resistance is to be contained.
Comment from Global Health EuropeWow is right! Over on this side of the Atlantic we are also excited and still amazed the topic was taken up considering it shared the floor with Pakistan, Iran and Climate Change. Sweden really made a fantastic effort and deserves our applause as well. You've raised some central questions in your blog, and Global Health Europe felt a responsibility to find some answers.
It's important to bear in mind that what started as a Swedish initiative has become a European initiative and now even a US-EU initiative-involving new groups of decision makers at each step. For this reason there can be no official answers to the questions you raise until January when the US and EU should have submitted a draft Terms of Reference (ToR) to the Task Force members for approval.
Much thought has gone into the blue prints of this Task Force which would report directly to the Obama Administration and the EU leaders in the 2011 US-EU Summit, about 18 months down the road. You noted the remit of the task force, but what about outputs? Although gaps in the knowledge on addressing AMR remain, I think the priority now is no longer to figure out what to do, but how we can do it. This is why what we need from this Task Force are explicit policy recommendations, specifically on cost-effective strategies and the means necessary to implement them at local, national and supranational levels. To get this job done right we'll need participation from the CDC, the FDA and NIH together with the European Centres for Disease Prevention and Control (ECDC) the European Medicines Agency (EMEA), and as there is no EU equivalent for NIH, we'll need a combination of Directorates from the European Commission, for example those responsible for health and consumer affairs, industry and research. It's difficult to say for sure if they would agree to join, but for political support it wouldn't hurt to have the upcoming EU Presidency countries on board, and as the veterinary/agricultural communities are crucial it makes sense to also engage the European Food Safety Authority (EFSA).
This Task Force comes at a pivotal moment in EU global health policy. A new framework communication on the EU's role in global health is expected in early 2010. Fundamental in the new policy is the notion that addressing global health challenges requires intersectoral and multidisciplinary approaches, which are exemplified in addressing AMR. The Swedish EU Presidency has been actively supporting the new EU policy-a clear sign that they will have instilled a global health perspective within the Task Force. Furthermore Sweden and the EU are firm supporters of reducing complexity in global health governance. Rather than compete with existing structures, I also suspect this Task Force will work to strengthen the WHO and implement the World Health Assembly Resolution on AMR already in existence.
While the architects of this Task Force have definitely not missed the point on global health there is one question I have no insight into as of yet, and that's how much money is promised for this initiative.