TATFAR Fact Sheets: Key Area Summaries

Appropriate Antimicrobial Use in Human Medicine

Working together, members improve appropriate antimicrobial use in human health care through actions like:

• Publishing an online report titled Data for Action: Using Available Data Sources at the Country Level to Track Antibiotic Use pdf icon[PDF – 10 pages].
• Publishing an article with detailed information on the reduction goals targets and corresponding metrics titled Targets for the reduction of antibiotic use in humans in the TATFAR partner countries. external icon
• Aligning campaigns that promote appropriate antimicrobial use, including collaboration with other partners, like the World Health Organization, to support World Antimicrobial Awareness Weekexternal icon (WAAW).

Canada

Develops and shares guidance and products for appropriate antimicrobial use and infection prevention and control for health professionals and the general public. For example:

• With support from the Government of Canada, Choosing Wisely Canada published a toolkit addressing the management of respiratory tract infections with considerations of COVID-19 and virtual care, including when to prescribe antibiotics.
• The Government of Canada’s WAAW social media campaign reached approximately 383,000 Canadians through Facebook, Twitter, and LinkedIn.

 European Union

Aims to inform and assist in activities that promote prudent use of antimicrobials in the public and healthcare professionals. For example:

• In 2020, ECDC released a video on “Antibiotic Resistance: What can you do as a healthcare specialist?”, receiving more than 1,000 views.
• The EU developed Guidelines for the prudent use of antimicrobials in human healthexternal icon, for relevant actors: from health authorities, to doctors, pharmacists, and patients.

Norway

Collaborates with healthcare personnel to promote antibiotic stewardship and ensure that the necessary tools are available. For example:

• Published in 2017, an AMR action plan pdf icon[PDF – 48 pages]external icon focused on disease prevention and prudent use of antibiotics.
• Facilitates use of vaccines and diagnostics (e.g., C-reactive protein (CRP) in primary care), including reimbursement.
• Provides antibiotic prescribing guidelines (both primary careexternal icon and secondaryexternal icon) as an app for mobile devices.
• Actively engages with the public in antibiotic awareness campaigns, especially during European Antibiotic Awareness Week.

United States

Improves antimicrobial use by increasing education and awareness among providers and the public and driving enhancements to prevent infections. For example:

• CDC had more than 5,000 downloads of its Be Antibiotics Aware print materials during WAAW 2020, and more than 350 participants attended a continuing education webinar on antibiotic use in hospitals.

 Moving Forward

TATFAR partners will:

• Continue to coordinate around the WAAW campaign for the next five-year implementation period.
• Continue to exchange information on actions and approaches related to the appropriate use of antimicrobials in human medicine.

Appropriate Antimicrobial Use in Veterinary Medicine

Working together, TATFAR partners:

• Developed a table of risk profile elements, focused on the Codex Guidelines for Risk Analysis of Foodborne AMR to streamline future risk profiles the time and data needed for those elements and considerations for which elements would be required depending on the problem.
• Shared information to promote antibiotic stewardship principles in veterinary communities and efforts to improve surveillance of AMR in foodborne bacteria.

Canada

Collects annual reports on the sales volume of veterinary antimicrobials considered to be important in human medicineexternal icon to support AMR surveillance programs and stewardship. For example:

• Mandatory collection of annual antimicrobial sales data from manufacturers, importers and compounders of medically important antimicrobials intended for use in animals, called the Veterinary Antimicrobial Sales Reporting (VASRexternal icon)
• Published the 2018 Veterinary Antimicrobial Sales Highlights Report,external icon which reflects the first year of sales data submitted through the VASR system.

Develops guidance to address appropriate antimicrobial use. For example:

• Provided a comprehensive view of efforts to develop their Pan-Canadian Framework for Action to address AMR.

European Union

Sets a legal framework with concrete measures to fight AMR and to promote a prudent and responsible use of antimicrobials in animals. For example:

• Adopted Regulation (EU) 2019/6 on veterinary medical productsexternal icon.
• Adopted a concept paper settingpdf iconexternal icon the scope of the guideline to be developed.

Develops guidance and materials to address appropriate antimicrobial use in animals. For example:

• Established the “Better Training for Safer Food” initiative that included the promotion of prudent and responsible use of antimicrobials in animals.
• Produced yearly European Summary Reports for AMRexternal icon (EFSA-ECDC USR-AMR) on AMR in zoonotic and indicator bacteria from humans, animals, and food according to the European Legislation.
• Published a guidance on methods for antimicrobial data collection by animal species at a national level, as well as on the denominator to report the datapdf iconexternal icon.

Norway

Informs and assists in activities that promote prudent use of antimicrobials in animals. For example:

• Published an AMR action planpdf iconexternal icon focused on disease prevention and prudent use of antibiotics, 2017.
• Restricted the use in animals of certain human antibiotics external iconbecause of the potential consequences to public health of AMR to these antibiotics.
• Published guidelines for prudent use of antibiotics in horsespdf iconexternal icon, 2019.

 United States

Develops and shares products for appropriate antimicrobial use in food-producing animals.
For example:

• Released the latest annual antimicrobial sales reports, titled 2019 Annual Summary Report on Antimicrobials Sold or Distributed for Use in Food-Producing Animalsexternal icon.
• Published a proposed methodpdf iconexternal icon for adjusting data on antimicrobials sold or distributed for use in food-producing animals, using a biomass denominator.
• Funded five-year pilot projects to explore methodologies for on-farm antimicrobial use data collection for cattle, swine, and poultry.
• Published two reports titled Antimicrobial Use and Stewardship on U.S. Feedlots, 2017pdf iconexternal icon and Antimicrobial Use and Stewardship on U.S. Swine Operations, 2017pdf iconexternal icon.

Moving Forward

TATFAR partners will continue to share information on:

• Methodologies for reporting consumption of antimicrobials by animal species, summarizing the various methods used by TATFAR partners.
• Approaches to risk analysis for foodborne AMR, including ideas and expertise on how to effectively conduct risk analysis of foodborne AMR.
• Ways to promote antimicrobial stewardship principles in veterinary communities and efforts to improve surveillance of AMR in foodborne bacteria.

Prevention of Drug-resistant Infections

Working together, members prevent infections and their spread through actions like:

• Working on three collaborative manuscripts (pending publication) addressing point-prevalence survey (PPS) methods and PPS data use for hospitals and for long-term care facilities/nursing homes.
• Mapping the availability of genomic information on carbapenem-resistant Enterobacterales (CRE) across TATFAR partner countries.
• Addressing bioinformatics approaches and the need for available microbiological and epidemiological information with provisional agreement on essential information, such as the sample origin and type, date of sample collection, and country.
• Collaborating to improve communication between government agencies to alert one another of emerging and concerning AMR trends.
• Working with CLSI and EUCAST, international clinical breakpoint setting organizations, to harmonize breakpoints focused on bug/drug combinations.

Canada

• Conducted its first PPS in long-term care facilities of antibiotic-resistant organisms and antimicrobial use, with information on exposure to hospitals.
• Conducted its second PPS in smaller, remote, and northern Canadian acute-care hospitals of HAIs, antibiotic-resistant organisms, and antimicrobial use.
• Conducted its third PPS in large acute-care hospitals of HAIs, antibiotic-resistant organisms, and antimicrobial useexternal icon.

European Union

• Conducted its second PPS of HAIs, including AMR in HAIs,external icon and antimicrobial useexternal icon in European acute care hospitals.
• Conducted its third PPS of HAIs, including AMR in HAIs,external icon and antimicrobial useexternal icon in European long-term care facilities.
• Organized webinars for training of national staff (PPSs in acute care hospitals and in long-term care facilities), sending hospital feedback reports as the data came in (including the IPC indicators reported by WHO core components) and feedback on the validation results.

Norway

• Conducted and extended use of national PPS for HAIs and antimicrobial useexternal icon twice annually in LTCFs.
• Conducted national PPS for HAIs and antimicrobial useexternal icon in all acute care hospitals. The surveys are mandatory twice a year.
• Norway published a National Action Plan for IPC in health care as part of the overall strategy for AMR and HAI.
• Re-established a Nordic training in IPC in collaboration with Sweden and Denmark.

United States

• Worked with the Emerging Infections Program (EIP) to complete a second, full-scale PPS in hospitals focused on antimicrobial useexternal icon and HAIsexternal icon in hospitals.
• Completed its first full-scale PPS in nursing homes focused on HAIs and antimicrobial use in nursing homesexternal icon.

Strategies for Improving the Pipeline of New Antimicrobial Drugs

• Working together, members strengthen the drug pipeline through actions like:
• Engaging in regular communication and focused collaboration among funders and the research community to facilitate research and product development opportunities and enable clinical research.
• Publishing papers that summarize economic incentivesexternal icon for antibacterial drug development.
• Transatlantic communication on research and development of new pharmaceuticals, new diagnostic tests, and clinical trials.
• Supported drug development programs collaboratively to meet EU, Canada, and U.S. regulatory requirements more efficiently.
• Exchanging information on approaches to authorizing alternatives underway to promote access to market for such products while ensuring appropriate levels of quality, safety, and efficacy.

 Canada

• Continues to be a top funder within the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) and leads the JPIAMR Virtual Research Institute (VRI) task with eight other member states.
• Engaged in a number of international efforts in the area of AMR and has supported declarations focused on AMR and framed Canada’s position at the international table of the WHO, WHA, UNGA, G7, and G20, and is developing action plans and frameworks.
• Invested $130.7 million in AMR-related research, including $26.3 million in 2019-2020 alone.
• Launched a challenge as part of the Innovative Solutions Canada program that provided investments to support Canadian small business in the development of point of care diagnostics to combat AMR.

European Union

• Supports the functioning of the JPIAMR.
• Since its launch in 2011 the Innovative Medicines Initiative (IMI), a public private partnership, has invested around EUR 950 M in the development of new antimicrobials via its New Drugs for Bad Bugs and its AMR Accelerator programs (around half of that comes from the EC budget).
• Serves as a founding member of the Global AMR R&D Hub, which collects and presents information on AMR R&D investments and market interventions.

 Norway

• Continues to invest in AMR-related research both through national funders and JPIAMR, Europe’s IMI, and others, calculated at a Norwegian krone 537 million (€53 million) annual investment in 2017.
• Performs leadership roles in multiple initiatives with a focus of stimulating antibiotic innovation and improving access, including DRIVE-ABexternal icon and the EU Joint Action on AMR and Healthcare-Associated Infections (EU-JAMRAIexternal icon).
• Actively engages in UN, WHO, Global AMR R&D Hub, and other fora related to AMR.

 United States

• Established CARB-Xexternal icon, an international public-private partnership focused on supporting the preclinical development of therapeutics, preventatives, and diagnostics. CARB-X has received $303M from funders and has supported 86 antibacterial therapeutics, prevention, and diagnostics programs, including new classes of compounds, compounds that reach new targets or have new mechanisms of action, and non-traditional approaches. Seven programs have advanced into Phase 1 clinical development.
• Invested over $1.5 billion in antimicrobial development both through CARB-X and the Advanced Research and Development (ARD) portfolioexternal icon since its inception in 2010, to bring 3 new antibacterials to market. The portfolio stands at 13 partnerships developing 16 drug candidates/product candidates that address a majority of the drug-resistant pathogens identified by the CDC as “urgent” and “serious” threats.
• Awarded a Project BioShield contract to Paratek Pharmaceuticalsexternal icon to support the advanced clinical development and procurement of Omadacycline.
• Announced the Antimicrobial Resistance Diagnostic Challengeexternal icon competition for $20 million and in August 2020 and awardedexternal icon the prize Visby Medical, Inc. for an innovative, rapid, point-of-need diagnostic test capable of accurately and reliably detecting gonorrhea and determining antibiotic susceptibility in less than 30 minutes.

 Moving Forward

TATFAR partners will continue to:

• Communicate on incentives for antibiotic innovation and access.
• Collaborate on research to support the development of new antimicrobials, alternative approaches, and diagnostic devices, by fostering international research and product development to address challenging problems in the management of AMR.
• Discuss antibacterial drug development programs, clinical trial designs for studying new antibacterial drugs, emerging safety issues, and coordinated efforts on scientific meetings to facilitate antibacterial drug development.
• Discuss the particular challenges related to authorization of novel veterinary therapies presented as alternatives to antimicrobials.