May 19, 2016 – Tackling Drug-Resistant Infections Globally: final report and recommendations

This report outlines the Review’s final recommendations. It first discusses the mounting problem of resistance and why action is needed to combat it and then provides an overview of the solutions that the Review thinks should be implemented to curtail unnecessary use and increase the supply of new antimicrobials. It then looks at the role of public awareness campaigns, the need to improve sanitation and hygiene, reduce pollution from agriculture and the environment, improve global surveillance, introduce rapid diagnostics and vaccines, the need to increase the number of people in this area, and use of market entry rewards and an innovation fund to generate more drugs. Finally the paper examines how these solutions can be funded and looks at ways to build political consensus around them. Supporting Documents Commissioned study by Dr. Nimalan Arinaminpathy the impact of diagnostics and new treatments against TB main report .

Commissioned study by the Foundation for Innovative New Diagnostics (FIND), into the future of TB diagnostics main report .

. Commissioned paper by ReAct-Action on Antibiotic Resistance Strategic Policy Program and Center for a Livable Future in the Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health main report.

Commissioned study by Katy Turner et al. into the impact of rapid diagnostics against gonorrhea main report and the model used .

and the . Study by LSE Master’s in Public Administration students on the cost and benefit of WASH interventions in Brazil, India, Nigeria and Indonesia main report .

. Commissioned study by NIHR Diagnostic Evidence Cooperative Oxford, into the future of diagnostics for antimicrobials main report .

. Commissioned study by Pierre Nouvellet et al. into the impact of new drugs and better diagnostics in the treatment of E. Coli main report .

22 March 2016 - Infection prevention, control and surveillance: Limiting the development and spread of drug-resistance This report examines the central role that infection prevention, control, and surveillance need to play in combatting the rise of drug-resistant infections. This is based on the recognition that fundamental improvements in these areas are the key to sustainable gains in health outcomes, and yet are often given insufficient attention in our response to the global challenges of rising drug resistance. The paper looks first at the role of infection prevention in the community through improved water and sanitation infrastructure. It then looks at the need to prevent and control of infections in health and care settings. Finally, it looks at monitoring resistant infections through surveillance systems that will provide valuable information for doctors, patients as well global and national policymakers.

11th February 2016- Vaccines and alternative approaches: reducing our dependence on antimicrobials

This report provides an overview of the markets and the pipelines for vaccines and other alternative approaches to tackling drug-resistant infections, by reducing the need for, and the use of antimicrobials. It makes three recommendations: First, available vaccines should be more widely used; both in humans and animals, and that this may require financial support. Second, there needs to be a renewed push for research into new vaccines and alternatives, through the Review recommended Global Innovation Fund and long-term sustained funding from philanthropic, public and private sources. Last, it recommends strengthening the market for new vaccines and alternatives through interventions such as market entry rewards and Advance Market Commitments (AMCs).

8 December 2015 - Antimicrobials in agriculture and the environment: reducing unnecessary use and waste

This report provides an overview of the use of antibiotics in animals and agriculture, and the role that manufacturing and use of antimicrobials play in bringing these into the wider environment. It calls for three interventions: First, a global target needs to be set to reduce use of antibiotics in food production and that we should reassess which antibiotics should be used in both animals and humans. Second, it recommends that there be minimum standards set to limit the release of active pharmaceutical ingredients during the manufacturing process. Finally, it proposes that there be improved surveillance to monitor the situation with respect to both these issues and to help to inform global standards and targets. Supporting Documents

A list of the papers used in our literature review and how they were characterised

Safe, Secure and Controlled: Managing the Supply Chain of Antimicrobials

This report examines two specific aspects of the AMR problem: the online sale of antimicrobials without prescription, and the supply of poor-quality and falsified antimicrobial drugs. A growing number of online pharmacies exploit gaps in the global regulatory mechanisms to offer antibiotics for sale around the world, often without prescription or clinical guidance – something that fuels dangerous self-medication habits and encourages the development of drug-resistant strains of infection by increasing unnecessary and excessive antimicrobials use. Meanwhile, poor quality and falsified antimicrobials fuel the development of resistance by delivering a sub-therapeutic dose of antimicrobials, providing enough exposure for the drug for microbes to begin developing resistance, without properly treating the infection. November 20, 2015 - The paper calls for improved global regulation and monitoring of both of these issues. The material in the paper relating to poor quality and falsified medicines is drawn from a paper prepared for the Review by Elizabeth Pisani.

October 23, 2015 - Rapid Diagnostics: Stopping unnecessary use of antibiotics

This report provides an overview of how diagnostics can play an important role in the fight against antimicrobial resistance, by reducing unnecessary use. It addresses how we can improve innovation as well as encourage the uptake of diagnostics. We suggest that Diagnostic Market Stimulus pots, to subsidise the purchase of diagnostics, would increase both uptake and innovation. We also propose that diagnostic developers should be able to bid into a global innovation fund to support early stage research, and that we need more research into the long-term economic case for rapid diagnostics.