Civil Society Roundtable on AMR featuring ARC members and Marc Sprenger
On Thursday, July 13, members of the Antibiotic Resistance Coalition met in Washington, DC, with the Director of the WHO Antimicrobial Resistance Secretariat, Dr. Marc Sprenger, and his colleague James Pfitzer for a two-hour roundtable discussion on the role civil society plays in tackling antimicrobial resistance and how we can work together with the WHO toward future progress. The discussions organized and hosted by ReAct and Public Citizen were moderated by Anthony So, Director of ReAct’s Strategic Policy Program. Marc Sprenger opened with a presentation and discussion of issues surrounding the UN Inter-Agency Coordinating Group (IACG), WHO Global Action Plan (GAP) and National Action Plan implementation, and the tripartite collaboration with FAO and OIE. Civil society groups, in turn, shared their perspectives across issues of food systems and AMR, innovation and access to antibiotics, and One Health concerns.
Addressing food system issues, Sarah Sorscher from the Center for Science in the Public Interest (CSPI) discussed their efforts in petitioning the U.S. Department of Agriculture (USDA) to treat drug-resistant organisms as food adulterants. Recalling the 1993 E.coli outbreak at Jack in the Box, she recounted how the incident prompted a new USDA sampling program for E. coli O157:H7 with sampling of raw ground beef at slaughterhouses and retail stores. Importantly, samples testing positive were treated as adulterated, and the program has now been extended to six non-O157 shiga toxin-producing E. coli (STEC) strains as well. Another screening program carried out in the 1970s involves the FDA, which selectively screened and blocked all imported shrimp contaminated with Salmonella, regardless of whether resulting illness could be documented. In 2011, CSPI petitioned to the USDA to classify four strains of antibiotic-resistant Salmonella as adulterants in ground meat and ground poultry. CSPI argued that this would directly prevent outbreaks by disposing of contaminated meat, and indirectly, this could encourage improved processing practices and more judicious use of antibiotics in animal production. USDA concluded that more data would be needed to determine whether antibiotic-resistant Salmonella should be treated like Salmonella strains susceptible to antibiotics. USDA denied the petition “without prejudice,” which left the door open for a new petition with additional evidence in 2014. The presentation led to discussions on how the transparency of food testing might serve as a trigger for policy change, both at the national level and in international trade between countries. Participants also flagged concerns over the continued use of colistin in food animal production.
Touching upon issues of innovation and access, Justin Mendoza from Public Citizen described how an ideal innovation ecosystem would embrace the principle of delinkage, engage open research initiatives and expand compound libraries, ensure transparency of clinical trial data, and oppose expanded monopoly protections. He discussed the implications of recently enacted U.S. laws on antibiotic innovation—how extending monopoly pricing under the GAIN Act and how lowering clinical trial standards under 21st Century Cures Act run counter to these goals. Several legislative efforts, however, at the federal and state levels have promise. Ali Greenberg from Universities Allied for Essential Medicines (UAEM) shared their work across university campuses to support humanitarian access licensing of health technologies, the principles of which were put forward in the Global Access Licensing Framework. With partners including Public Citizen, Médecins sans Frontières and the Treatment Action Group worked with Hopkins students and alumni to petition Johns Hopkins University not to license a promising treatment for multidrug-resistant tuberculosis exclusively to Sequella. With a petition that recruited hundreds of signatures, UAEM and its allies were able to persuade the University to license Sutezolid non-exclusively to the Medicines Patent Pool. This represented the first license between a U.S. university and the Medicines Patent Pool and the first TB drug license for the Medicines Patent Pool. The TB Alliance received the first sublicense under this arrangement. UAEM noted the value of alternative models of R&D, like those supported by the Medicines Patent Pool, in fostering needs-driven and access-oriented innovation. Participants urged WHO to build upon its work stemming from the Consultative Expert Working Group on R&D: Financing and Coordination (CEWG) and to support these normative principles among global health funders in this space.
A panel of civil society groups working on One Health issues discussed the potential of supply chain interventions to encourage procurement of food animal products sourced without the routine use of antibiotics and how such efforts might be globalized. Erik Olson from the Natural Resource Defense Council (NRDC) described how groups initially targeted poultry for sourcing without the routine use of antibiotics. The Urban School Food Alliance working with NRDC committed to adopting such a standard for procurement of chicken for low-cost meals in the nation’s largest school districts. Erik also recounted San Francisco’s efforts to pass an ordinance that would require major grocers in the City to report antibiotic use policies for each line of meat or poultry sold in their San Francisco stores. Next, Jean Halloran from Consumers Union presented the Chain Reaction scorecard report as an example of how consumer monitoring for accountability might work to target food retail chains. Significantly, more food retail outlets shifted their procurement practices between the first and second Chain Reaction report, and now a third report will be coming out. Matt Wellington from US PIRG then talked about the importance of engaging key constituencies such as consumers, students and healthcare professionals to raise awareness and and ensure action on AMR in National Action Plans. In particular, US PIRG has launched the Health Professional Action Network with 40,000 health professionals collected from its door-to-door canvass operations. Calling for more than awareness raising, Matt suggested that World Antibiotic Awareness Week be changed to World Antibiotic Action Week. Finally, Stacia Clinton from Health Care Without Harm also emphasized the influence hospital and healthcare system networks can have in reshaping procurement practices to take action on AMR. She discussed the work of Health Care Without Harm’s global network of over 25,000 hospitals and the Clinical Champions in Comprehensive Antibiotic Stewardship (CCCAS), a collaborative of Health Care Without Harm and the Pediatric Infectious Disease Society. CCCAS released a core guidance resource in 2017 applying the Center for Disease Control’s Core Elements of Stewardship to AMR action steps through hospital food procurement and clinical advocacy.
Remarking on these presentations, Marc Sprenger emphasized his belief and interest in seeing civil society as part of the policy process. He welcomed the input of civil society groups, from the upcoming public consultation on indicators to monitor progress on AMR to WHO’s emerging work on behavior change for AMR.