THE WORLD ALLIANCE AGAINST ANTIBIOTIC RESISTANCE (WAAAR): A MAJOR PLAYER IN THE GLOBAL DRIVE TO PROTECT HUMAN HEALTH
Antibiotics are the most central part of post WWII modern health system as we know it.
Governments have been slow to respond even though
all knowledgeable medical authorities know the danger is mounting.
ACdeBMR / WAAAR (World Alliance Against Antibiotic Resistance), a non-profit NGO, was created on December 2, 2011, in Paris, France, by physicians and professors, most of whom had many years of research, advocacy, and practice on the threat of antibiotic resistance. President and founder, Dr. Jean Carlet was asked to chair and establish the National Task Force for the Preservation of Antibiotics for the French government in 2015. The document is available on the Ministry of Health website. He has published or spoken at numerous medical congresses for 30 years on antibiotic resistance. Today, in 2017, ACdeBMR/WAAAR is composed of 730 individual members from 60 different countries (including 400 in France). These members come from all continents, representing all stakeholders (physicians, especially infectious diseases specialists, hygienists, veterinarians, microbiologists, pharmacists, nurses, evolutionary biologists, ecologists, and patient advocacy groups, as listed in our materials).
As of 2019, the board includes an “elected president”, who will succeed the current president upon his or her departure. Prof. Vincent Jarlier, a microbiologist, will assume this mission. WAAAR programs are supported by more than 125 learned societies and professional groups around the world.
A document, called the WAAAR Declaration, has been circulated worldwide.
The last paper published at the Open Forum Infect Diseases in November 2020: Trends in Antibiotic Consumption and Resistance in France Over 20 Years: Large and Continuous Efforts but Contrasting Results. Carlet J, Jarlier V, Acar J, Debaere O, Dehaumont P, Grandbastien B, Le Coz P, Lina G, Pean Y, Rambaud C, Roblot F, Salomon J, Schlemmer B, Tattevin P, Vallet B
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.
WAAAR advocates for the following 10 actions
Strong cooperation among international political, economic and public health organizations, which, all together, must take the lead of this action against antibiotic resistance.
2- 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
3- Continuous access to antibiotics of assured quality, especially in middle and low income countries
4- 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
5- 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
6- 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)
7- 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
8- 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
9- 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.
10- Request for UNESCO to include the “concept of antibiotic” in the list of the intangible cultural heritage.
Network and activities
Our Alliance has several important assets: a multidisciplinary and multi-professional structure including veterinary medicine, strong consumer involvement, the participation of several parliamentarians (MPs), global programmes including antibiotic management, infection control, use of old and new diagnostic tools, research and upgrading of vaccination programmes, official support from many professional societies, many different countries and various organizations.
The non-governmental organization ACdeBMR (Alliance Against the Development of Antibiotic Resistant Bacteria) was formed on December 2, 2011. Subsequently, its internationally adopted name in English became: “The World Alliance Against Antibiotic Resistance (WAAAR).”
Actions in 2018–2019
2018 has been a Year of fruitful cooperation with the lobbying agency “RPP”, enabling actions to be taken.
Our industrial BD sponsor took care of the financial aspects. No expenses for ACdeBMR…but no income either. RPP is a serious, well-known structure with many contacts, especially political (parliamentary) contacts. Very discreet firm. No attempt to influence the content of the project!
Some information is sent to all members quite regularly, but we miss the newsletter. Comments, proposals, constructive criticism from members would be welcome.
Excellent cooperation with RPP. Frequent meetings with the steering committee of the ongoing actions (which includes all the members of the board).
Plans to organize sessions for all French and international members in some important congresses, in particular the ECCMID (trial run in 2019).
Actions with RPP/BD in 2018
Publication of a document entitled “The antibiotic resistance control policy: instructions for use” describing in an illustrated manner the mechanisms of AMR, the prevention possibilities by type of occupation, the role of the environment, and the similarity between AMR and sustainable development.
Widespread dissemination, to parliamentarians, DGS, involved agencies, specialists (infectiologists, microbiologists, ACdeBMR members, etc.).
Newsletter and AMR Control
The 2019 book “AMR Control” is online (www.amrcontrol.info), but not printed by the English publisher due to lack of sponsors. It has been renamed “AMR Control 2019-2020” pending publicity. Uncertain future
On the other hand, a French version of AMR Control will be published in 2018. Very wide distribution.
Regular contacts with the European Commission, Contacts with WHO, in particular via IACG (International and Interagency Monitoring and Working Group). Waaar reviewer of documents
Participation in a large international meeting organized by the United Nations in NY, one of the three founding structures of the “Antartica” group, and of an international prevalence study on resistance in the Caribbean (with ESICM and ESCMID). Study still in progress.
Stakeholder in EU-JAMRAI, Participation in international structures on “sepsis”, European (ESA) or international (GSA), Member of the World Alliance for Infection in Surgery.
WAAAR Board, Members and Collaborations
The members of the WAAAR Executive Board are:
Jean Carlet MD, Former President
Vincent Jarlier, MD, President
Jean-Pierre Hermet, Secretary General
Marie-Hélène Nicolas Chanoine
In addition to the members of the Executive Committee, the Board of Directors is composed of the following members:
Ivana Haluskova Balter
WAAAR’s 750 members are physicians, hospital directors, research scientists, public health nurses, patients and patient organizations, economists and concerned individuals from more than 55 countries.
WAAAR is one of the largest networks, together with REACT or APUA, of people actively working to make the world safe for humans in the “post-antibiotic era”, partner of World Septicaemia Day and collaborator of COMBACTE.
Our Executive Board
MD, Founder and Former President
Dr Jean Carlet, Trained in internal medicine, was head of the ICU in Hospital St Joseph in Paris for 25 years and has published in medical journals on the issue of antibiotic resistance for over 30 years. ACdeBMR WAAAR initially gained international recognition with the launch of the Paris Declaration. In 2015 he was nominated by France’s minister of health as the president of a Special Task Force for Antibiotic Preservation to elaborate the national plan on AMR. Dr Carlet is a leading steering committee member of several coalitions to combat AMR, such as the CDDEP’s CARA Coalition : The Conscience of Antimicrobial Resistance Accountabiliy. In November of 2017, he initiated the launch of ANTARTICA, The ANTimicrobiAl Resistance CriTIcal Care, a new coalition on scepsis, to achieve the WHO target, along with like minded specialist physicians in critical care. Along with WAAAR’s Vice-President Garance F Upham, Dr Carlet is Editor-in-Chief of the leading AMR publication for investors and decision makers : AMR Control, in collaboration with London publisher Global Health Dynamics. www.amrcontrol.info
Former President and Founder of ACdeBMR / WAAAR
Vincent JARLIER, M.D. PhD and PU-PH at the Faculty of Medicine, Sorbonne University, is a long-time member of ACdeBMR and its Vice-President today. He was head of the hospital bacteriology-hygiene department at the Pitié-Salpêtrière Hospital and a researcher for many years, notably on antibiotic resistance and nosocomial infections, especially on the prevention of transmission of multi-resistant bacteria in healthcare. He is a member of the organising team of EARS-net (European Antibiotic Resistance Surveillance System), of the organising team of EUCIC (European Committee on Infection Control). He was for several years Vice-President of the National Technical Committee on Nosocomial Infections (CTIN) at the Ministry of Health, and is Delegate for Nosocomial Infections at the "Direction de l'Assistance Publique-Hôpitaux de Paris". He has been in charge of the BMR-Raisin national program to monitor multi-drug resistant bacteria in French hospitals for about ten years. In 1997, he was one of the founders of ONERBA, the National Observatory on Antibiotic Resistance, of which he was in charge of the scientific council. Professor Jarlier is author and co-author of more than 300 international publications.
Jean-Pierre Hermet was Chairman of the Supervisory Board of EUROBIO Scientific, a leading French manufacturer of in vitro diagnostics, with more than €190 million in sales and listed on Euronext. He had taken over the management of this company in 2008, then named InGen Biosciences, when it achieved a turnover of €12 million. Since 2015, he has been a member of the Strategic Committee of NOVOLYZE, a food safety company. Since 2016, he has coached more than 37 laureates from Finland to Israel in the EIC Accelerator programme of the European agency EASME.
In 1999, he founded Hemosystem which developed a method for the rapid detection of bacteria in blood and blood products.
He is also the author of numerous studies on Medical Biology published by les Echos Etudes.
Secretary-General and Former Treasurer of ACdeBMR/WAAAR
Dr. Robert Cohen is a pediatrician-infectiologist, Associate Professor of Pediatrics. Throughout his career he has been involved in a quadruple activity. As an infectiologist in a medical bacteriology laboratory, providing antibiotic advice for all the adult and children's departments of a general hospital (Créteil intermunicipal hospital). An outpatient paediatrician, taking care of children with communal infections and vaccinating them. As an anti-infectious and vaccine evaluator with AFFSAPS for 15 years as vice-president and then president of the Working Group on Anti-Infectives (antibiotics, antivirals and vaccines). Finally, he was Scientific Director of the world's leading research group in community paediatric infectious pathology (ACTIV): more than 400 publications referenced on Pubmed. He initiated a policy of restricting the use of antibiotics, which has been widely followed by paediatricians, based in particular on the use of rapid diagnostic tests. Finally, he created InfoVac France with the help of InfoVac Switzerland: vaccination and antibiotic therapy being extremely linked.
Marie-Hélène Nicolas-Chanoine, MD and PhD, has been Professor Emeritus of the Faculty of Medicine, University of Paris, since September 2017. Her research activity, which began in 1984 (at the Pasteur Institute under the direction of Stewart Cole) and is still ongoing within the UMR 1137 (IAME), focuses on antibiotic resistance in Gram-negative bacilli and more specifically in enterobacteria. Her hospital activities as PU-PH and Head of Microbiology Department for 37 years at AP-HP, led her to (i) become deeply involved in the organisation of the fight against the spread of Multi-antibiotic Resistant Bacteria (MRB) in hospitals and (ii) to conduct various studies by obtaining Hospital Clinical Research Projects to clarify which factors are likely to be involved in the development in hospitals of infections caused by BMR strains in different species. Professor Nicolas-Chanoine joined the National Observatory on Antibiotic Resistance (ONERBA) one year after its creation in 1997, where she was a member of the Scientific Committee for many years and then President.
Marie-Hélène Nicolas Chanoine