The Global Antibiotic Resistance Partnership

1. The Global Antibiotic Resistance Partnership Global Health Council Conference Tuesday 14 June 2011 HellenGelband CDDEP

3. The Global Antibiotic Resistance Partnership--GARP The Global Antibiotic Resistance Partnership (GARP) aims to address the challenge of antibiotic resistance by developing actionable policy proposals in four low- and middle-income countries: India, Kenya, South Africa and Vietnam

4. Why GARP? • Antibiotic resistance has been defined by high-income countries. Why it matters: • Access • Cost • Action takes place at the country level • Local knowledge • Locally-generated research • Sustainability

5. Key Elements • CDDEP organization • International Advisory Group • Working Groups in each country • Affiliations with premier medical and research organizations • Coordinators +/- • All sectors represented (human/animal, public/private sectors; urban/rural)

6. International Advisory Group--IAG Keith Klugman, Emory University, Atlanta, Chair ZulfiqarBhutta, Aga Khan University, Karachi Adriano Duse, University of the Witwatersrand, Chair, GARP-South Africa NWG NK Ganguly, National Institute of Immunology, New Delhi, Chair, GARP-India NWG David Heymann, Health Protection Agency, London Dean Jamison, University of Washington Samuel Kariuki, Kenya Medical Research Institute, Chair, GARP-Kenya NWG Nguyen Van Kinh, National Institute of Infectious and Tropical Diseases, Hanoi, Chair, GARP-Vietnam NWG Eric Simoes, University of Colorado

8. International Advisory Group--IAG Keith Klugman, Emory University, Atlanta, Chair ZulfiqarBhutta, Aga Khan University, Karachi Adriano Duse, University of the Witwatersrand, Chair, GARP-South Africa NWG NK Ganguly, National Institute of Immunology, New Delhi, Chair, GARP-India NWG David Heymann, Health Protection Agency, London Dean Jamison, University of Washington Samuel Kariuki, Kenya Medical Research Institute, Chair, GARP-Kenya NWG Nguyen Van Kinh, National Institute of Infectious and Tropical Diseases, Hanoi, Chair, GARP-Vietnam NWG Eric Simoes, University of Colorado

9. Country-level Process

10. Interesting and Useful Findings • In all GARP countries, sufficient data can be found to support high levels of antibiotic resistance, at least in some places • No GARP country has a functioning surveillance system to monitor trends • Information on antibiotic use in animals is incomplete • Most studies concentrate on urban areas and hospitals

11. Policy Ideas Reducing Antibiotic Demand • Vaccines • Infection control in hospitals • Eliminating some animal use (e.g., growth promotion) Altering Antibiotic Supply • Restricting sales of advanced drugs (e.g., carbapenems in India)

13. Evidence-Based Change in Policy and Practice: The GARP Strategy • All options identified, a small number chosen • Thorough and transparent analysis • Feasibility, cost, acceptability, etc.—specific to the country situation • Presented to the right people and organizations • Local supporting evidence, when possible The Critical Path

14. Evidence-Based Change in Policy and Practice: The GARP Strategy [2] • Becoming a trusted source • Seizing opportunities for input • E.g., news stories about infections, antibiotic resistance, drug prices • Persistence Opportunist Path

15. GARP Phase 2: The Next 3 Years • Deepening the relationship in the GARP founding countries • Expanding the partnership: GARP phase 2 countries • Structuring the partnership itself • Developing tools: PneuMOD, DRI • Developing a sustainable plan for the future