The ACdeBMR / WAAAR (World Alliance Against Antibiotic Resistance), not-for-profit NGO, was created on December 2nd, 2011 in Paris, France, by doctors and professors, most of whom had many years of activities in research, advocacy and practice on the threat of antibiotic resistance. President and founder Dr Jean Carlet was solicited to Chair and put together the National Task force For the Preservation of Antibiotics for the French government in 2015; he had been publishing, or speaking in medical congresses, over a 30 year period on antibiotic resistance, as another WAAAR founding member Pr Jacques Acar, member of the WHO Advisory Group on Integrated Surveillance of Antimicrobial Resistance (AGISAR) and of OIE (World Organization for Animal Health), him since 1972! WAAAR founders included prominent consumers and patients organizations as well.
Now, in 2017 WAAAR is made up of 730 individual members from 55 different countries representing all the key stakeholders (physicians, veterinarians, microbiologists, pharmacists, nurses, evolutionary biologists, ecologists, environmentalists, and patient advocacy groups). WAAAR’s programs are endorsed by more than 140 learned societies or professional groups throughout the world.
The increase in antibiotic resistant bacteria poses a major healthcare threat. In the face of an almost complete absence of new antimicrobial drugs in development, antibiotic resistance (ABR) has become one of the main public health problems of our time. Antibiotics are a unique class of medications because of their potential societal impact; use of an antibiotic in a single patient can select for ABR that can spread to other people, animals, and the environment, making an antibacterial used in one patient ineffective for many others. Bacterial resistance can evolve rapidly. As bacteria acquire resistance mechanisms, the altered bacterial genetic material coding for resistance mechanisms can be transmitted at times readily between bacteria, broadening the reach and extent of resistance. Treatment failures because of multidrug resistant (MDR) bacteria, once rare, notable, and limited to hospitals, now occur very commonly in hospitals and increasingly in the community as well. It is estimated that at a minimum 25000 patients in Europe and 23000 in the USA die each year from infections caused by resistant bacteria. The cost of antibiotic resistance is tremendous, whether measured as the personal and societal burden of illness, death rates, or healthcare costs.
Although it is a never-ended phenomenon, antibiotic resistance is directly related to the volume of antibiotics used. We are using increasing amounts of antibiotics in health care and agriculture, and discharging these active drugs into the environment. The impact of widespread antibiotic use is enormous, promoting the development and dissemination of antimicrobial resistance.
Safeguarding antibiotics will require a concerted effort by citizens, patients and prescribers. The primary goal of WAAAR is to raise awareness about the urgency and magnitude of the threat and to promote an international dialogue to assist in effective responses. The Alliance, in particular through this declaration, is dedicated to actively promoting antibiotic preservation and to raising awareness among antibiotic prescribers, politicians and policy-makers, patient safety and advocacy groups, the pharmaceutical industry, international health organizations, and the general population. Individual actions, no matter how well intended, are doomed to failure unless there is an international dialogue, a common sense of purpose, and broad consensus on how best to proceed.
We must change how antibiotics are used and adopt proactive strategies, similar to those used to save endangered species. Preservation of the efficacy of antibiotics and to stabilization of antibiotic-susceptible bacterial ecosystems should be global goals.
We urge all of you to participate in this crusade, in your own field of interest. The medical miracle of antibiotic therapy must be protected – this is a global priority and our duty. Please, help us to act NOW, by supporting this declaration, to promote wiser use of antibiotics in animal and human health, and the necessary accompanying political actions to support better education, integrated surveillance for public health action, and research.
- Promotion of awareness of all the stakeholders - including the general public - of the threat represented by antibiotic resistance
- Strong cooperation among international political, economic and public health organizations, which, all together, must take the lead of this action against antibiotic resistance.
- Organization, in each country, ideally by Ministries of Health or regulatory bodies, of a financed national plan for the containment of antibiotic resistance, with the participation of all stakeholders, including patient advocacy groups
- Continuous access to antibiotics of assured quality, especially in middle and low income countries
- Integrated Surveillance of antibiotic resistance (ABR) and antibiotic use Standardized monitoring of antibiotic use and resistance at institution, regional, and country (comprehensive national data instead) level (through a Centers for Diseases Control and Prevention model) to allow comparative statistics (benchmarking), to be updated preferably in real-time and at least every 12 months. This will require adequate laboratory capacity using international standardized methods that may be facilitated by a centralized technologic coordinating infrastructure and information technology
- Use of diagnostic tests
- Appropriate use of existing diagnostic tests and development and implementation of new rapid, cost-effective and accurate diagnostic tests, adapted to the local context, to aid in distinguishing bacterial and nonbacterial etiologies. Rapid diagnostics may help clinicians avoid unnecessary treatments, rapidly select appropriate targeted therapies and inform the duration of treatment
- Antibiotic stewardship (prudent, controlled and monitored approaches to the use of antibiotics)
- In humans (hospitals, long term care facilities and primary care).
- In animals (animal husbandry, agriculture, aquaculture and animal health /veterinary setting), in a “one health” philosophy.
- Progressive elimination of the “over the counter” (i.e. available without a prescription) access to antibiotics (systemic and topicals) for humans or animals.
- Ban of the use of antibiotics as growth promotion in food animals, and exceptional use in prophylaxis.
- Rational use of metaphylaxis (Prophylaxis when some animals in the livestock are sick, or at high risk to be sick), and of animal treatment.
- Limitation of the use of critically important antibiotics in humans and animals (e.g., carbapenems)
- Educational efforts for change
- Educational programs directed at children/teenagers on antibiotics, bacterial resistance, and infection control (e-Bug model)
- Development of large coordinated, effective information and awareness campaigns directed at the public on expectations about the rational/appropriate use of antibiotics.
- Continuouseducation and training programs in the curriculum for all health care professionals in all settings (veterinarians, medical, dental, nursing, pharmacy and allied health care schools) and continuing professional education programs, on the rational use of antibiotics, including indications, dosing and duration of therapy. Education of farmers
- Containment of bacterial transmission and prevention of infection
- Promotion of universal hand hygiene and all infection control interventions that have been proven to reduce rates of resistance
- Relentless efforts to prevent transmission of MDR organisms in healthcare, food production and animal husbandry
- Programs to limit the contamination of drinking water with MDR bacteria, as well as contamination of the environment
- Promotion of the use of available vaccines, in humans and animals
- Basic and applied research, and development of new antibiotics
- Increased support for basic and applied research aiming at curbing bacterial resistance in human and veterinary medicine.
- Use of the principles of orphan drugs for new antibiotics
- Incentives to stimulate research of new drugs (antibiotics and novel compounds) and vaccines via regulatory pathways that allow for fast track development.
- New economic business models to support the cost of innovation while safeguarding public health interests.
- Request for UNESCO to include the “concept of antibiotic” in the list of the intangible cultural heritage.
Our Alliance has several important strengths: A multidisciplinary and multi-professional structure including veterinary medicine, strong involvement of consumers, participation of several parliamentarians (deputies), global programmes including antibiotic stewardship, infection control, use of old and recent diagnostic tools, research, and upgrades of vaccination programmes, official support from many professional societies, from many different countries or various bodies.
The non-governmental organization ACdeBMR (L’Alliance contre le Développement des Bactéries Multirésistantes aux Antibiotiques) was constituted on 2 December 2011. Subsequently, its internationally adopted name in English became: “The World Alliance Against Antibiotic Resistance” (WAAAR).
ACTIONS IN 2015–2016
WAAAR has joined the network of international not-for-profit civil society organizations initiated by CDDEP (Center for Disease Dynamics, Economics, and Policy) and which will be launched on the occasion of the United Nations General Assembly, 21 September 2016 in New York City, Unites States.
WAAAR President Dr Jean Carlet will attend, as well as Garance Upham, Deputy Executive Secretary of WAAAR and member of Medicus Mundi International.
WAAAR IN FRANCE
Founded in Paris, ACdeBMR/WAAAR is the major player in France itself and in the French speaking world on antibiotic resistance issues.
Dr Carlet and the WAAAR team campaigned for decisive action, and in early 2015 Dr Carlet was selected to put together and chair France’s National Task Force on the Preservation of Antibiotics for 2015 relying on the many experts who are members of the WAAAR in the field of human and animal health, diagnostics and economics, patient safety and hospital- acquired infections.
A major event is being prepared as part of the November European Union weeks of mobilization on AMR.
WAAAR has many members and collaborators in French speaking Africa who lead actions on AMR, such as Dr Frank Mansour Adéoty in the Ivory Coast, former Minister of Health of Bénin, Dorothée Kinde Gazard, or retired (but ever active) Senegalese Colonel physician Babacar N’Doye whose top level international and national expertise in infection control was found very pertinent during the recent Ebola epidemic in Guinea Conakry.
After AMR Control 2015, here is AMR Control 2016, with participation from well known experts such as Lord Jim O’Neill from the United Kingdom Review on AMR, one of the major think tanks on AMR, Dr Awa Aidara Kane from the AGISAR WHO expert groups, and many more.
AMR Control 2015, published by Global Health Dynamics, has had a huge success. The book has been widely disseminated, in particular to agencies, like WHO, ECDC, CDC, the European Commission. A pre- 2016 edition has also been presented to high-level Ministers and DGS at the WHO Executive Board in January 2016 and at the United Nations World Health Assembly in May 2016.
AMR Control 2017 is being planned with many hot topics, including small and medium size companies innovations which may be very key to assist LMICs in this endeavour.
The AMR-Times Newsletter, Le Temps de la Résistance aux Antimicrobiens, is a new free monthly email newsletter available in French and in English, with a less frequent edition in Arabic. And, it is expected, soon in Spanish and Portuguese. It has over 1,500 direct subscribers and an estimated reach approaching 6,000 via scientific and professional networks who are re-distributing the newsletter among their own network. To receive AMR-Times : firstname.lastname@example.org.
A mostly volunteer and doctoral students young team manages this project with offshoots in Algeria, Egypt, Lebanon, The Netherlands, France, United Kingdom and Switzerland.
AMR-Times reports on leading scientific news on AMR, conferences and events. An e-Journal is under construction.
WAAAR Board Members are Jean Carlet MD, President; Vincent Jarlier, MD, Vice-President; Garance Upham, Vice-Président, Jean-Pierre Hermet, Treasurer, Joël Leroy, MD, General Secretary.
The 750 members of WAAAR are physicians, hospital managers, scientific researchers, hygiene nurses, patients and patient organizations, economists and concerned persons, from over 55 countries.
In June 2014, the WAAAR initiated the Paris Declaration which enlisted the support of over 100 persons and, up to 145 societies or institutes.
WAAAR is among the largest networks, along with REACT or APUA, of people actively working to make the world safe for human beings in the “post-antibiotic era”, a partner of the World Sepsis Day and a collaborator of COMBACTE.