Stefanie McBride (00:00:00):
Hello. Thank you so much for joining us. My name is Stefanie McBride, and I am the Associate Director for Policy and Partnerships [00:00:30] for the Antimicrobial Resistance Coordination and Strategy Unit (ARX) at the U.S. Centers for Disease Control and Prevention. Welcome to the ninth installment of CDC's AMR Exchange series where we plan to cover actionable commitments and targets from the UNGA High-level Meeting political declaration, what government and non-governmental partners are doing to turn that political commitment into public health action, and approaches to strengthen One [00:01:00] Health collaboration across the globe. CDC hosted this AMR Exchange webinar on December 12th, 2024. Unfortunately, we experienced technical difficulties for the first few minutes of the recording. The first portion of the Exchange, which will include a brief introduction to the topic and an introduction of our speakers was re-recorded and combined with the original recording of our panelists' remarks. [00:01:30] Thank you so much for understanding.
(00:01:34):
Joining us for this AMR Exchange, we have several speakers and panelists. First, we have Rob Purdie, who is an antimicrobial resistance patient advocate and a member of the World Health Organization Task Force of AMR Survivors. Michael Craig is the Director of the Antimicrobial Resistance Coordination and Strategy Unit (ARX) at [00:02:00] the U.S. Centers for Disease Control and Prevention. Hebah Mahmoud Dada is the Director of AMR at the Public Health Authority of Saudi Arabia. Hania Farhan is the Senior Director of Research and Methodology at Gallup and David Lowrance is the Senior Advisor and Team Lead for Pandemic Preparedness and Response with the Global Fund.
(00:02:25):
Before we begin today's webinar, I want to express my appreciation to the team [00:02:30] that planned our event today. Thank you to Tiffany Pomares, Fakari Gresham, Dana Carter, our CDC Antimicrobial Resistance communications team, and the Weber Shandwick webinar team for all of their work that went into plan such a wonderful event. I'd like to kick off our webinar today by providing a short background presentation that introduces the topic. Could you please share my slides? [00:03:00] Thank you. During our time together today, we'll hear from several experts about what we can do together to make progress combating antimicrobial resistance. I'd like to share a little bit of information about the progress we've already made, and the impacts additional investments could make. Next slide, please.
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Over [00:03:30] the past decades, the world has made progress combating antimicrobial resistance, but as this slide shows, there's more to do. For example, while almost 180 countries have developed an antimicrobial resistance national action plan, only one quarter of those plans are fully financed. Across the globe, billions of dollars have been invested in the development of new drugs and as well as in the development of new diagnostics, but many countries still [00:04:00] lack the capacity for basic microbiology testing. More than two-thirds of countries have national infection prevention and control (or IPC) programs, but less than 10% of countries meet the WHO minimum requirements for IPC. And while vaccination over the past half century has saved more than 150 million lives, there are still challenges with access to, and uptake of, existing vaccines. [00:04:30] Next slide, please.
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While these challenges remain, there's reason for hope. Recent analyses show that if we act now, we can slow the spread of AMR, save lives, and protect economies. One study estimated that nearly 100 million deaths could be averted by 2050 if there was better care for severe infections and improved access to antibiotics. [00:05:00] Another study estimated that we could save nearly a hundred billion dollars a year in healthcare costs through a comprehensive set of interventions that includes better treatments, enhanced vaccination, and improved access to clean water. It's especially encouraging to think about the progress we can make using tools that we already have. Improving IPC in low- and middle-income countries through cost-effective, proven approaches could prevent [00:05:30] at least 337,000 AMR-associated deaths each year, and achieving 90% coverage with existing vaccines could reduce annual antibiotic use by more than 140 million doses.
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Next slide, please. However, none of these investments and actions are possible without commitment. Political commitment from [00:06:00] leaders of all countries and commitments across nongovernmental sectors. This past September, we saw this commitment in action during the second United Nations High-level Meeting on Antimicrobial Resistance in New York City. I'd like to first share a personal perspective. That week in New York was one of the most exciting of my career. It was wonderful to meet with so many colleagues, to hear about the progress made around the world during side [00:06:30] events throughout the week, and to see what's possible through collective action. For our time together today, we're going to focus on what comes next after the High-level Meeting. How can we work together to accelerate progress towards the commitments and targets established in the High-level Meeting’s political declaration? Next slide.
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There's no way in 90 minutes that we can cover all of the critical aspects [00:07:00] of the answer to that question. So today, we'll focus on four areas. First, we will talk about targets. Michael Craig will join me to dive into some of the specific targets and commitments in the political declaration and how CDC is working with our partners to achieve them. Then we will focus on the importance of collaboration. We'll hear from Hebah about the outcomes of the November 2024 High-level Ministerial Meeting on AMR [00:07:30] in Jeddah, and how the Kingdom of Saudi Arabia is supporting regional solutions to the AMR challenge. Next, we'll talk about the importance of data. Excuse me. Hania will join me to discuss a new effort to help fill a gap in our global data on AMR, the lack of global data on AMR awareness and behaviors. Finally, we will discuss financing.
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Sustainable financing to combat AMR is critical, but it is [00:08:00] one of the most daunting challenges we face. David and I will talk about other successful models of global health funding and how lessons learned from those models could be applied to AMR. But first, we want to start by hearing from Rob Purdie. We hope that by having Rob share his experience combating an antimicrobial-resistant infection, and his dedication to preventing these infections in others, that we highlight the most important reason that we are here: to reduce illness and death [00:08:30] to AMR. Now that's enough from me and I'd like to introduce our first speaker.
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Rob Purdie was diagnosed with a fungal infection commonly known as Valley Fever in 2012. Since his diagnosis, he has been dedicated to raising awareness of the impact Valley Fever and antimicrobial resistance have on individuals and on communities, [00:09:00] and fighting to improve outcomes for his fellow patients fighting this challenging fungal infection. To this day, he is still taking medications to control this infection. Rob, could you share some more about your experience with Valley Fever, the importance of the issue of AMR, and your ongoing work as a patient advocate? What have you learned about the importance of global awareness of AMR [00:09:30] and of fungal diseases? Over to you.
Rob Purdie (00:09:33):
Yeah, sure. I was diagnosed with meningitis that was caused by a fungal disease called Valley Fever in 2012. Since then, I've become an advocate for other patients with fungal diseases and that led me to start my nonprofit, MyCARE, in 2023 and also led me to apply and be appointed to the WHO Task Force of AMR Survivors. My story really began New Year's Day of 2012. I just [00:10:00] woke up with a headache. I often like to tell people that I woke up with a hangover on New Year's Day, like a lot of people, but I didn't drink, I wasn't feeling good. I was home in bed by eight o'clock and just woke up with the worst hangover of my life.
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Like most people who have undefined symptoms, I went to a local urgent care. I sought medical care and was prescribed empiric antibiotics. Completed those, prescribed a second set of empiric antibiotics. While I was taking those, [00:10:30] for what I was told was a sinus infection, I was just blessed enough to actually reach out to an ear, nose and throat specialist who happened to, lucky for me, be next to a radiologist's office. Got into the ENT. He said, "Well, you can go next door, get an x-ray and we can find out if you have a sinus infection." And I was told I did not have a sinus infection, and that one step right there probably shaved maybe as much as three months off my diagnosis. [00:11:00] Fungal diagnosis, fungal diseases often take months and months to be diagnosed. The average Valley Fever patient is prescribed four unnecessary courses of antibiotics.
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The point of that being that we are the unnecessary consumers of antibiotics in the AMR space, and we are also then consumers of antifungals in the AMR space. So, we represent kind of a different side of the coin from most stories that focus on antibiotic resistance. [00:11:30] So I was actually diagnosed on... I got my diagnosis on Valentine's Day 2012, so February 14th, so only six weeks after my symptoms started. I was discharged from the hospital after being admitted in mid-February, in mid-March, and my symptoms finally started to go away around May. So, for those of you keeping, that's about five months of the worst migraine you can possibly imagine. Imagine a headache so severe that I had a little [00:12:00] blue light on my cable box in my bedroom and I had to cover that light. That's how severe it was. Thought I was on the path to getting better, didn't understand the differences in the impact of fungal diseases, but was readmitted in October to the hospital and failed my first fungal drug, which is an azole called Fluconazole.
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Went on to fail three oral medications for lack of efficacy with my disease and then failed again because of [00:12:30] the side effects of those drugs. One of those drugs that I failed due to side effects I'm still on because it's the only option for me, and that's a drug called Amphotericin. I've been pretty steady on my current treatment of oral azoles, a drug called Posaconazole since 2015. That's a high-level view of the clinical aspects of my disease. What's really hard to quantify is the indirect cost. I missed months of work. My circle of friends is much [00:13:00] smaller. I've dealt with depression, I've dealt with isolation, I've dealt with a lot of mental health issues since then. And not just me, but my family as well. My wife has panic attacks now. She had one... last one was about six months ago. I literally was, we were upstairs, and I said, "Hey, I'm not feeling good."
(00:13:21):
And just me saying that, she went in the bathroom and vomited from the stress of me saying, "I don't feel good." So that's the impact [00:13:30] on patients and families. It impacted my children. It's impacting my grandchildren. So, while every patient has a unique experience and story to tell, there are some things that are very common amongst all of us. First and foremost is like many patients with chronic infections and related AMR, I wake up everyday dependent on a drug that may or may not work for me that day. There's a limited number of anti-infectives and I'm relying on those to survive. And every day, not [00:14:00] only do I have to worry about that those drugs will no longer work or be available to me, but my family has those same concerns, and it can be very stressful. And the reality is the foundation of modern medicine is built on anti-infectives and every patient like me with a drug-resistant infection, we're a crack in that foundation and the foundation is crumbling, and that's what AMR really is.
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And because of that, I started my work in advocacy in 2014. I was able to work on, in the state [00:14:30] of California in the United States, I was able to work at the state level initially to pass some legislation to help increase and improve surveillance of the disease that I have, as well as allocating millions of dollars to state-level interventions and research. I've also worked at the national level most recently, done a lot of advocacy work around the Pasteur Act and appropriations for fungal diseases and also through the WHO, been able to be active internationally in spreading awareness and advocating for [00:15:00] resources for AMR.
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And one of the things that I've learned is that AMR is completely misunderstood, and until we can communicate in plain language that translates well to the general public and policymakers, it's going to continue to be misunderstood. And so, to that effect, I know there's a lot of labels that we use for AMR, I use AMR exclusively, and I'm okay with people not knowing what that is. I actually count on that [00:15:30] and I use that as an opportunity to educate people about it. And the other thing that I do is avoid using the terms antibiotic-resistant and antifungal resistance unless I've clarified that they are sub-parts of the AMR issue because linking them all together is one of the things that's going to be important for us to impact and have a change.
Stefanie McBride (00:15:56):
Rob, thank you so much. There was so much good information [00:16:00] to take away from that. I want to highlight just a few points. One, I think what you shared demonstrates the power of an individual. Sometimes we feel like with the challenge, this big one person can't do a lot, but I think what you shared about efforts that you started in California that have now led to better surveillance and investment into Valley Fever is an incredible example of what one person's initiative can do. I think the other thing I took away from that was the importance of the relationship between healthcare providers and their patients. Both healthcare [00:16:30] providers considering what could be an antimicrobial-resistant infection, maybe one they've never seen before, and their willingness to ask their patients, excuse me, to discuss with their patients what that might be, encourage them to get appropriate tests and use those diagnostic results appropriately.
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And then the third thing is you hit on a huge issue that came up during the High-level Meeting and inside events throughout the week, and that's the communications challenge around AMR, and I'm so glad you brought that up. We're going to touch on that throughout [00:17:00] several of our presentations today, and it's something I think we'll continue to discuss throughout 2025. And so, Rob, thank you again and we look forward to hearing from you again for our final question at the end of today's panel.
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All right, so I'm going to transition now and welcome Michael Craig. Michael, thank you so much for being here today. Could you introduce yourself before we jump into the first question?
Michael Craig (00:17:29):
Absolutely. [00:17:30] Thank you Stefanie. I'm Michael Craig. I'm the Director of Antimicrobial Resistance Coordination and Strategy (ARX) at the U.S. Centers for Disease Control. So, my group oversees the antimicrobial resistance portfolio at U.S. CDC.
Stefanie McBride (00:17:45):
Thanks, and welcome again. For your first question, during the UNGA High-level Meeting, global leaders adopted a political declaration that established global goals, commitments, and targets for combating antimicrobial resistance. [00:18:00] Could you please share what some of those commitments and targets are and why they are so important?
Michael Craig (00:18:06):
Absolutely, and I think before I just jump into the targets, I do want to note, I think the political declaration really represented a seminal time in all the work on antimicrobial resistance. This is a topic that I've been working on for two decades, and I think what we accomplished this summer politically and what I think we came together [00:18:30] as a globe to be able to set these targets and have consensus on these targets, I think is going to really be a model and a pathway for us to make progress against all of the threats that we face both individually and collectively. The document itself has a number of high-level targets. The one that I think is most important is we now have a global target for the reduction of 10%, reducing the deaths associated [00:19:00] with antimicrobial-resistant infections by 10% by 2030. This is really the first time we've had an overarching target related to mortality from AR infections, and I think it's really important for us to be able to focus on that and to be able to highlight the interventions that could address that.
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The document really talks about and places a large amount of importance on access to the appropriate therapeutics, prevention modalities, [00:19:30] treatment options, diagnostics to be able to address antimicrobial resistance. And it also places a huge amount of importance on prevention. On the prevention side, there's a number of targets related to specific areas that will improve and help us actually achieve that 10% reduction in AMR deaths. So, there are, for example, a goal for 100% of countries to have WASH programs related to healthcare. [00:20:00] 90% of countries to meet minimum requirements for infection prevention and control in healthcare, which as you noted at the outset, Stefanie, that number is currently less than 10%. So, getting to 90% of the globe being able to reach that is an ambitious and very worthy target that will have a lot of positive benefits.
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There's also some targets in the document specifically related to laboratory detection, having 80% of countries around the globe being able to detect [00:20:30] GLASS pathogens both for bacterial and fungal species. And that will be very important for us to be able to monitor and understand how antimicrobial resistance is evolving, how it's emerging, and how we may need to deploy different interventions to be able to stop it.
Stefanie McBride (00:20:49):
Thank you for that. Given the breadth of those goals and targets and commitments, the task at hand may seem daunting both to AMR experts like yourself and also [00:21:00] maybe especially to newcomers in the AMR space. In your view, what are some of the most important first steps that we can take together to begin progress toward achieving these commitments and targets?
Michael Craig (00:21:15):
Yeah, it's a great question and I think the thing that I want to underline and point to for everyone is we're not starting from scratch and the intersection of antimicrobial resistance with everything else we do in global [00:21:30] health is significant and one that we need to remember and take advantage of. When we're talking about improving IPC to achieve the targets for antimicrobial resistance, we need to remember that things like improving IPC have benefits well beyond antimicrobial resistance. They have benefits across healthcare systems and settings and strengthen our ability to prevent multiple types of infectious diseases. [00:22:00] If you're a country that's focusing on preventing the next pandemic, preventing the emergence of new infectious diseases and the transmission in your communities, meeting those minimum requirements for IPC will help you do that. If you're a country that's focused on HIV, TB and malaria, meeting the minimum requirement targets for AMR and those IPC targets I mentioned before will help you do that.
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So when we focus on antimicrobial resistance, [00:22:30] we need to remember that we're not focusing on that at the exclusion of anything else. And that in fact, meeting those targets helps us meet other healthcare goals, other global health goals that we all have, and we need to see how we can actually leverage and work together to be able to recognize that and to be able to address those. So, the countries that are able to detect antimicrobial-resistant pathogens because they have a good laboratory infrastructure, [00:23:00] stop the transmission of those because they have good IPC, and they have good WASH to be able to prevent those infections, because they have vaccines readily available and they have distribution networks for those vaccines. All of those tools are going to help that country address a myriad of global health and other issues. So we need to recognize that and leverage all of that work together.
Stefanie McBride (00:23:29):
Thank you so much [00:23:30] for that. I think it's a nice transition into our final question for you today, and that's that implementing those activities in every country, that's not something that any country or any group can do alone. And one of the common themes that emerged throughout the High-level Meeting, both at the High-level Meeting itself as well as the numerous side events throughout the week, was the importance of partnerships and the need to strengthen global partnerships for combating AMR. In your role and [00:24:00] leading the AMR programming at CDC, can you share some of the examples of how CDC is working with partners to help make progress towards the goals and commitments in the political declaration?
Michael Craig (00:24:11):
Absolutely, and I guess I just want to note whatever we do in public health is interrelated and nobody can go it alone. And especially for antimicrobial resistance, we see the transmission of these pathogens from one country to another, from one healthcare setting to [00:24:30] another, from one community to another, and we have to work together to be able to address them. And that means working together not only as countries, but it means working together across industries, because this is a One Health issue. It means working together across civil society, we need to have organizations like The Global Fund to be able to leverage their work and what they're doing in protecting patients from HIV, TB and malaria, [00:25:00] and making sure that they're not getting secondary bacterial infections that are resistant, that they're supporting some of those things. We need to work together with groups like Gallup who might have opportunities to be able to do that.
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We need to come up with and engage patient groups like Rob is representing and that WHO has in that engagement. We need to have countries come together and have regional supports like KSA is working on in the Middle East. From our perspective at the CDC, we [00:25:30] see partnership as fundamental to what we do. We host events like this where we bring folks together to be able to talk about that, but we also have work ongoing already in over 60 countries. We're working specifically on the ground with partners both at the Ministry of Health, partners in healthcare, partners in the community to be able to organize and understand what is the problem at hand in that country, and how can we work together to be able to address it.
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We are [00:26:00] really focused on the prevention elements related to AMR, and that's sort of where CDC starts and places the most of its efforts. And I think we need to remember that prevention always involves partnership in some way. Prevention from a public health perspective means that CDC is working with a clinician to make sure they have what they need to work with their patient, and that patient is well-informed and understand [00:26:30] all of the things that they need to be able to do to protect themselves and their family. So, partnership is fundamental to prevention and I think we need to remember that and build on that as much as we can moving forward.
Stefanie McBride (00:26:43):
Thank you so much. Appreciate all that information you shared and just want to recap a few points that I took away from your responses. The first thing that I think it's really important to reemphasize is that the political declaration from the High-level Meeting, both the process to develop it [00:27:00] and the final product, could be a model for other global health challenges that we face. And that's especially important because of the connection between antimicrobial resistance and the solutions we have to solve that challenge and other global health threats. And I think what you said about leveraging the investments we make in AMR to help also make progress towards those other global health challenges is critical.
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I wrote a couple of quotes down that I think I might put on a button. One is “you can't go it alone when it comes to AMR” [00:27:30] and also “prevention means partnership.” And I think really again, I just want to highlight what you said about that partnership happening at every level from the healthcare facility or even in someone's home, parents and children working together to prevent the spread of germs, all the way up to global leaders coming together to make political commitment. Michael, thank you again for being here and look forward to you seeing you again at the end of our call today.
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[00:28:00] We will transition now to our next panelist and I'm so excited to welcome Dr. Hebah Dada. Hebah, thank you so much for being here. We appreciate you joining. Could you take a minute and introduce yourself?
Hebah Mahmoud (00:28:18):
Thank you very much. I'm really glad. Thank you for the invitation. I'm really glad to be with you here today. I'm Hebah Dada, Director of Antimicrobial Resistance at Public Health Authority [00:28:30] Saudi Arabia.
Stefanie McBride (00:28:34):
Thank you and welcome again. Let's jump right in. Hebah, last month in November, Saudi Arabia hosted the Fourth High-level Ministerial Conference on AMR in Jeddah. Michael and I both had the opportunity to attend and we're so glad we did. It was a wonderful opportunity to connect with colleagues from around the world and continue some of the momentum that started in New York City in September. The [00:29:00] meeting was an exciting opportunity that brought together stakeholders from across the One Health sectors of human health, animal health, and the environment. For those that weren't able to join, could you please tell us a little bit about the goals and the key outcomes of the meeting?
Hebah Mahmoud (00:29:17):
First of all, I would like to thank you all, the audience for coming here today and also, I'd like to thank Michael for setting the floor, actually as he mentioned about [00:29:30] working and engaging together and partnership where is the most important in antimicrobial resistance. Of course, the High-Level Ministerial Conference on AMR, which took place as you mentioned on November 15th and 16th, and it was preceded by a full day of side events on November 14th. The title of this ministerial meeting was From Declaration to Implementation -- Accelerating Action Through Multisectoral Partnerships for the Containment of AMR. It was a pivotal moment in our collective efforts to combat one of the most global health threats of our time and define the way forward.
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I would like to also thank those who have joined us and actively participated to make this a real success. When we started [00:30:30] developing the Ministerial Conference around 12 months ago, we were determined to bring together a diverse, influential group of stakeholders, governmental, international organizations and also private sectors, civil society to foster and strengthen the partnership, global partnership and to enable us to make a tangible difference in tackling antimicrobial resistance for our communities.
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Throughout the year, [00:31:00] we have worked closely with the UN Quadripartite Institution to ensure that the interconnection between human, animal and environmental using the One Health approach is fully addressed in our discussions. By working with the collaboration with the WHO, the Quadripartite, the GLG group, the G20 Presidency and Italian G7 and Oman, the previous host for the ministerial meeting, [00:31:30] we were ensuring the alignment on a selected number of practical steps that will help to better contain AMR and focus on One Health approach. The Fourth Ministerial Conference provided an opportunity to discuss and share best practices, translate many good elements of the High-level Meeting declaration into a concrete and implementable action. The themes of the Fourth Ministerial Meeting [00:32:00] was surveillance and stewardship, capacity development, access and affordability and better local, regional and global governance. Of course, also, we had the role of innovation and R&D was featured prominently throughout the days of the summit. Thank you.
Stefanie McBride (00:32:25):
Thank you for that. Now that you've shared a little bit about the process to plan [00:32:30] the meeting and what some of the most important goals and outcomes were, could you talk about some of the key actions that meeting participants identified to help move from the political commitments in the High-level Meeting declaration to action globally, nationally, regionally and locally?
Hebah Mahmoud (00:32:49):
Yeah, thank you for that question. I think our outcome document, which was the Jeddah Commitment, which includes 16 commitments, which was endorsed by [00:33:00] most of the countries, and we are still working towards endorsing more countries to that Jeddah Commitment. It included different aspects, a couple of process-related outcomes, which include a bi-annual ministerial meeting and the Troika process, which we hope will help maintain the momentum and ensure the continuity of the joint efforts [00:33:30] by having the previous, the current host and the next host working together toward maintaining the momentum. Further, we have announced two innovative and practical outcomes aligned with the Saudi 2030 Vision, which will support countries and partners in the implementing their cross-sectoral multi-national AMR national action plan. The first outcome is [00:34:00] the AMR One Health Learning Hub. As we all know, the best practices sharing, learning and capacity building is one of the key components of tackling the complex question related to AMR.
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The Learning Hub will be housed at the Public Health Academy in Riyadh where it initially will be regional aspect. The focus [00:34:30] lies on practical implementation and One Health approach training best practices models will be offered virtually using a variety of digital tools and media and as well as hands-on training on the laboratory available that can be used to innovative even forms in-person training. Also, courses will be tailored to support implementation of National Action Plan. We [00:35:00] envision the hub to serve equally as a training and exchange platform of experience-sharing, ensuring that national contexts and specific local challenges are considered. Very importantly, we are envisioning not to duplicate any of the existing initiative or structures. We are looking forward to working with all stakeholders, global stakeholders, including Quadripartite [00:35:30] organizations, MSPP and implementing partners, regional entities, and also global entities of existing programs to bring these all expert and all training courses together and move forward filling the gaps that we have, especially in our region.
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We hope to form a network of learning hubs internationally and community of [00:36:00] practice for true best practice sharing and also to improve our collective ability to progress our national action plans. The second outcomes, which was antimicrobial access and logistic hub. We are all fully aware that the key challenges, as you mentioned in your beginning to contain AMR specifically in LMIC is access to safe, effective, affordable antimicrobial [00:36:30] medicine and diagnostics. Robust supply chain pool procurement, strategic stockpiling and supply guarantee mechanism are some of the proposed solutions and piloted approaches, minimizing falsified medicine in the supply chain as we see this a problem in some country.
(00:36:58):
The medical and the logistic [00:37:00] hub is proposed to build on the advanced existing Saudi Arabia structure and to serve the range of purposes. These include quality, assured, cost-effective, stable supply of antibiotics to the countries in the region. It'll also serve the mechanism to responding to humanitarian crisis, situation, and request for LMICs. We are exploring currently mixed model of [00:37:30] commercial and subsidized operation for the lower resource settings. And our vision of the hub is to contribute to the efforts on strengthening the supply in the region and hopefully globally that we can do later on. And currently we are working on the operational model of both initiative and also we already started planning the plan for [00:38:00] the learning hub to start working on the plan and strategy for that hub and hopefully we'll have a lot of further collaboration with all of the different entities and organization around the world.
Stefanie McBride (00:38:18):
Thank you for that. And that's a perfect transition to our final question. We have just a couple of minutes left in this session, but you just alluded to the regional work that the Kingdom of Saudi Arabia [00:38:30] is leading and the collaboration with regional partners in efforts to slow the spread of AMR. Is there anything else you'd like to share about some of those regional efforts that Saudi Arabia is leading?
Hebah Mahmoud (00:38:44):
On top of what I have shared, which most of them are regional, I'll also add that we have a multiple initiatives in terms of surveillance, stewardship and also infection control standards in the collaboration with the countries in the [00:39:00] Gulf region, with the Gulf CDC, as well as we have the region of the WHO where we have a lot of initiatives that we are working together in the region. Adding to this also at the Kingdom of Saudi Arabia, we're committed to work closely with the host of the 2026 AMR ministerial meeting to ensure the commitment for the recent UNGA meeting and the outcome of the ministerial meeting [00:39:30] fully realized. Thank you.
Stefanie McBride (00:39:33):
Thank you for that. And for those who haven't heard, the 2026 ministerial meeting will be hosted in Nigeria, so we're very excited for the first of the ministerial meetings that will be hosted on the African continent. And so again, just want to spend one minute summarizing a few of those key points.
(00:39:53):
I think first I want to just congratulate you again on the true One Health nature of the Ministerial [00:40:00] Conference and not just One Health governmental sectors, but across the private sector, civil society, international organizations, et cetera. And I think you were the first person that had mentioned the Quadripartite today, and I think it's a great opportunity to highlight the role that international organizations and their regional bodies like the WHO regional offices play in all of our efforts to combat AR. And then the last thing I want to note is that again, access is coming up and I think Michael had talked earlier about how [00:40:30] sort of the progression from the previous political declaration to this one and sort of how much deeper it was able to go into the challenge of AMR and really providing practical and concrete solutions and access is one of those areas.
(00:40:42):
So thank you so much for sharing some of the new efforts to increase access in the Gulf region. And thank you again for being here today and we'll see you again in a few minutes. [00:41:00] Transitioning now to our next panelist and welcome Hania. Thank you so much for being here today. We really appreciate you taking time to join us. Could you please introduce yourself to the group? Hania, I think you're still muted.
Hania Farhan (00:41:25):
Someone had to start.
Stefanie McBride (00:41:27):
I'm impressed. We made it 42 minutes in, [00:41:30] so we are doing great today.
Hania Farhan (00:41:33):
Yeah, I'll take that for the team. Okay, well of course. Thank you very much Stefanie, and it's a great pleasure to be here. Thank you for inviting me to participate and of course thank you to everyone for joining this call. As you mentioned earlier, my name is Hania and I'm the Senior Director of Research and Methodology at Gallup. Gallup is a global research and analytics consultancy. [00:42:00] We work with many organizations worldwide, including in fact, several UN agencies for whom we collect global, nationally-representative, reliable data or even including data for a few SDG indicators. So, to talk about the... Sorry, Global AMR Monitor. Go ahead.
Stefanie McBride (00:42:24):
Yeah, let me jump in with our first question for you. I will say in full transparency, [00:42:30] I've had the opportunity to work with Hania and the Gallup team on the effort that Hania is going to discuss today for gosh, more than a year now. It's been a while, and it has been... I feel very lucky to have been part of this collaboration and just really excited for all the participants today to learn more about it. The project that I'm referring to is called the Global AMR Monitor. And so, Hania, could you first start by sharing with the audience what the Global AMR Monitor is?
Hania Farhan (00:43:00):
[00:43:00] Happy to. Of course. So, the Global AMR Monitor is in a nutshell, a data-based tool, which would be a catalyst for action on AMR. We know that public awareness, knowledge and attitudes towards AMR play a pivotal role in addressing this urgent global public health threat. It's in all the action plans, but it's essential [00:43:30] to measure and track this knowledge and attitudes so that we can support the efforts of governments and organizations to successfully tackle the AMR crisis. And yet currently, there are no consistent, rigorous global data or data sets that provide reliable and representative information about public knowledge of AMR or attitudes towards AMR. There are some studies [00:44:00] here and there in very few countries, mostly in high-income countries, but they all use different methodologies and approaches, which means it makes them really not strictly comparable to Hebah’s point, for example, when Hebah mentioned, I made a note here, best practice sharing, right?
(00:44:17):
Are we tracking knowledge? Are we tracking these things so that we can learn from each other? It's difficult to learn from each other's experiences when we all use different methodologies. So, the AMR, Global AMR Monitor will be consistent [00:44:30] methodology across all the countries. This data gap makes it really difficult, if not impossible, actually to assess whether efforts to increase awareness or change behaviors ultimately are making a significant and lasting impact. For example, how do we know that the annual World AMR Awareness Week is making a lasting impact? Which areas is it making an impact in? Which areas is it not? [00:45:00] Is it meeting its aims? And then where can it focus on more?
(00:45:06):
The same applies actually for national efforts. We need a tracker. We need a data set to measure that. Actually, indeed, I've seen in the literature, and we've seen that some argue that one of the reasons for the low levels of policy action and implementation of AMR action plans is the widespread lack of understanding and awareness [00:45:30] of AMR and the urgency of the need to address AMR or for that matter, how many people do we know who are aware of the disastrous consequences of inaction across human and animal health, agriculture, the environment.
(00:45:44):
This is really where our work with the CDC Foundation and the CDC, where this Global AMR Monitor comes in. It's a global survey initiative aiming to develop a rigorous, nationally-representative [00:46:00] data through a global survey that would for the first time measure and track people's awareness, their knowledge, and their attitudes to key aspects of AMR in over 100 countries. This would generate really excellent, hopefully rigorous high-quality data for all of those countries globally. And the insights would then be used to develop and design evidence-informed approaches and interventions to raise awareness and knowledge about AMR.
Stefanie McBride (00:46:30):
[00:46:30] Thank you for that. And I encourage people today, if you want to learn more about the infrastructure that's already in place to implement this type of national survey, check out some of the really exciting data that Gallup has published in the past using their World Poll. It's a great example of the types of data that we're talking about. During a side event as part of the UN High-level Meeting week in New York City, Gallup, our colleague Alana, presented results [00:47:00] from the first phase of the Global AMR Monitor. Could you share what the goals and outcomes of phase one of the Global AMR Monitor were?
Hania Farhan (00:47:10):
Yes, indeed. Very happy to. And so, thank you for mentioning that the quantitative part of the work, the global survey would be through the Gallup World Poll, sort of uniquely set up to survey all countries around the world. We started, for the Global AMR Monitor, the first phase of the work involved [00:47:30] qualitative research in three countries: India, South Africa, and the U.S. We conducted focus groups amongst members of the general public in the U.S. across different age groups, different demographics. We also conducted in-depth interviews in India and South Africa with doctors, pharmacists, veterinarians, and farmers. The topics covered across this qualitative work were awareness of AMR, understanding [00:48:00] of AMR as a threat to public health and experiences with various aspects of AMR. Focus was mostly on antibiotics as well. So, some key themes that came up, that emerged were that firstly, in general, they were really very different levels of knowledge about AMR and concern about AMR, concern about antibiotics not working or losing efficacy.
(00:48:28):
There's this sort of dichotomy [00:48:30] between knowledge and concern, and then next step would be action then. Even when there was some knowledge, which was very limited, there were also varying levels of concern. Often, most of the time, concern was very low. People were not worried. They didn't really realize how threatening that is to human health and welfare. So one small finding that we find, for example, that younger [00:49:00] people tended to be less concerned. Moving a step further, we found that even where there was knowledge and concern about the risks of AMR, there was a lack of consistency in action regarding the appropriate use of antibiotics.
(00:49:17):
This pattern was particularly worrying among professionals. That's where new sort of start getting worried really, when you don't see enough concern among some of the professionals in prescribing [00:49:30] antibiotics. This was especially noticeable in countries where regulation and enforcement in terms of prescribing antibiotics were not strict. It was very easy in some of these countries to get antibiotics without a prescription, which was a really big deal, and it was very important finding generally that we then looked to build on. So interestingly, we also found [00:50:00] that in the focus groups there was skepticism about the motives of pharmaceutical companies and government's role in regulation. That was when we're touching on new antibiotics, new drugs in the research into this area.
(00:50:16):
When it came to mitigating measures, for example, vaccinations, there was really a lot of confusion and lack of knowledge and awareness of the link to the efficacy of antivirals [00:50:30] and AMR. We saw that there was very little knowledge about how this one was really widespread, very little knowledge about how the use of antibiotics in farming impacts human health and effectiveness of antibiotics. We found farmers showed very limited awareness and understanding and very limited concern, often not recognizing the broader implications on human health of antibiotic use [00:51:00] in animals and how that contributes to reducing the efficacy of antibiotics in people. They often thought it was all about doctors and people, not using it in animals, but there's really a huge disconnect between in that sector, the veterinarian farming animal sector, the animal health side, and the links to efficacy and human health and efficacy of these medications. That's just a small taste [00:51:30] of some of the findings. There's a lot more, but we can... For another time.
Stefanie McBride (00:51:33):
Yeah, no, that was fantastic. Thank you for that overview. In our last couple of minutes, now that phase one of the monitor is complete, what comes next? Can you talk a little bit about some of the opportunities and challenges that the next phase of the Global AMR Monitor is facing?
Hania Farhan (00:51:54):
Yes, well thank you. Well, based on what we know, it's clear that there is [00:52:00] really urgent need to do more research and to dedicate more resources to AMR. We know people, everyone thinks COVID-19 was bad, but compared to that, the AMR crisis is going to be by all accounts so much worse. And very few people don't seem to be aware outside of these halls, outside of the people, we are all in these echo chambers almost. It's the general public knows [00:52:30] very little about it, even practitioners know very little about it. We need to invest, I think a lot more in that area. Of course, a crucial, vital investment is in new antibiotics and diagnostics, for example. But without raising awareness and knowledge about AMR and about the inappropriate use of medicines such as antibiotics, we'll be in the same situation in 10 years and 20 years [00:53:00] after the new medications are invented.
(00:53:02):
We can invent new drugs, but if we don't change attitudes, then also we'll be in the same place later. For a sustainable solution, I think all of us, for all stakeholders, especially governments, we really need to raise our game to be honest and dedicate more resources and effort to increasing awareness and knowledge of AMR, which means we need systematic data-informed approach, policies of intervention. If we don't know where [00:53:30] we're starting from, we don't know where we're going. We need to measure that progress and pivot where more needs to be done.
(00:53:39):
And I guess it comes as no surprise to everyone here that in terms of government priorities worldwide, it is clear that AMR is not high enough on that list. There's been great work done in some countries and the declaration really, really laudable points, but it just doesn't make any sense that [00:54:00] it's still not such a high priority on policy makers’ lists. Yeah, so this proposed AMR Global Monitor is a start. It would enable us to understand what is the state of knowledge and attitudes about AMR? Then the data would be used to raise awareness and knowledge and to inform more targeted interventions. Hopefully it will contribute by serving as a, let's call it a flagship tracker that would [00:54:30] drive sustained worldwide media public policymaker attention to the crisis of AMR and the urgent need to raise it on government agendas.
Stefanie McBride (00:54:42):
Thank you for that. Lots of exciting opportunities ahead. So just to recap quickly what Hania shared with us today. First, without quality data, we can't track progress and impact, and this is as Hania noted, a data gap that the Global AMR Monitor could fill. [00:55:00] I also want to reiterate Hania's point that the results of the limited qualitative data collected in phase one really show the importance of scaling up to phase two. So just want to, before we transition, wish the entire team sort of the best as this moves forward and we're really excited to see the progress the monitor can make in 2025. And thank you again, and we'll see you again in just a minute.
(00:55:30):
[00:55:30] And with that, we will transition to our final panelist of today. Dave, thank you so much for being here, for waiting so patiently on camera for an hour. Why don't you introduce yourself and then we'll jump into a few questions.
David Lowrance (00:55:50):
Thanks so much, Stefanie. Thanks to you and to the organizers for the opportunity to be here and to be a part of this panel, which I found very impressively [00:56:00] global and really rich and insightful already. Again, I'm currently Senior Advisor and Team Lead for Pandemic Preparedness and Response at The Global Fund. I've been at The Global Fund for four years. I'm a medical epidemiologist by training and probably the most relevant thing about my being here today is that I have been on three country coordinating mechanisms of The Global Fund at country level.
(00:56:30):
[00:56:30] That was during positions at the U.S. CDC as Country Director. And so, I've seen the investments and the co-investments up close, and I also worked closely with The Global Fund when I was at the WHO, we had a number of collaborations around various normative products. I've seen it from other partner lenses as well at the global level. And I do want to kind of as a preface also [00:57:00] just highlight that most of my comments in our discussion will be really focusing on low- and middle-income countries, principally because those are the countries that are considered Global Fund eligible and the focus of our investment, so thanks.
Stefanie McBride (00:57:15):
Thank you for that. And it's always great to welcome back a former CDC-er to one of our AMR Exchanges. So, thanks again for being here. All right, let's jump right in. So, another theme that emerged during the High-level Meeting and during the Ministerial Conference was the need [00:57:30] for sustainable funding for combating AMR globally. The Global Fund has had tremendous success in mobilizing funding for the global health threats of HIV, of TB and malaria. Could you share a little bit about The Global Fund's model and the critical factors that can help countries achieve durable and predictable financing for these global health challenges?
David Lowrance (00:57:56):
Sure, great question. Thank you. And there's a lot to unpack there. [00:58:00] Global Fund's been operating now over 20 years and that in and of itself is a testament to its success. But let me run through what I think are a few of the key factors, and not only in The Global Fund's success, but in the ability of the Global Fund to provide durable and predictable financing to low- and middle-income countries. So, first and foremost, country ownership and that term can meet a lot of things to a lot of people. But [00:58:30] what it means that the Global Fund is that countries receive a funding opportunity, an envelope of funds, and they're really given broad leeway to develop proposals that are translated into grants that reflect the latest, most current and pressing country priorities. And those are largely anchored to national strategic plans akin to the national action plans for AMR, for [00:59:00] HIV, TB and malaria, for the various health systems, and during the COVID response, the National COVID response plans.
(00:59:09):
That's what I would start with. I think a second aspect that has been kind of a bedrock strength of Global Fund's model is recognizing that we're a fund and we're not a technical agency. And so from the very beginning we gave clear and explicit deference to WHO normative frameworks and guidelines, [00:59:30] clinical guidelines, and also those relating to health systems, which are obviously the frameworks and the guidelines that most of our Global Fund eligible countries and our grant recipients are thinking about and the guidelines and the frameworks upon which the plans are based on.
(00:59:52):
And that's a way of providing quality assurance to the Global Fund, to the donors [01:00:00] that invest in the Global Fund. The third thing that I would mention is the strong community and civil society engagement. I think everyone's aware of the pivotal role that communities and civil society played in the HIV response around the world, but I think the Global Fund model has really brought that in and then extended it over many years to the TB responses, the malaria responses, [01:00:30] and having communities and civil society engaged in every level of the Global Fund, literally from our governance to our technical review processes to the in-country consultations as implementers and also involved very importantly in monitoring roles, I think has been really key.
(01:00:51):
The next thing I'd mentioned is something we refer to as implementation arrangements, but it essentially means who gets funded to do stuff. [01:01:00] And the thing to highlight here is that the way we determine that is very context-specific and portfolio-specific. And I'll talk a little bit about more than a second, but I think that's been really key and that's been an evolving, I would say strength of the Global Fund, something we've innovated on over the years, including through the COVID response. The next aspect I'd mentioned, and this is something that a number of the speakers [01:01:30] addressed already, but it's this centrality of performance measurement and accountability and principally being able to commit to targets in a three-year period or year to year, and then to come back and to report on those and to be honest about what has been achieved, what has not been achieved, where there are bottlenecks and problems and challenges, and speaking to the board and speaking to the donors and the non-donor constituencies [01:02:00] about those issues, I think in a frank and open way, I think has been really, really important.
(01:02:07):
Another thing I would say is a complementarity of what is fundamentally a bilateral platform for financing with bilateral health programs, whether it's the Japan government, whether it's Germany or the U.K., whether it's the U.S. health programs, PEPFAR or the President's Malaria Initiative. Operationally, there's been [01:02:30] a lot of focus on ensuring that those partnerships are robust not only at global level, but most importantly at the country level where things really matter most.
(01:02:39):
And then the last thing I'd mentioned that's probably in the kind of wonkier category, but it has to do with a differentiated allocation model. And that is we have currently somewhere between 120-130 countries that are Global Fund eligible, but we think about each of them differently according to their economic context, according to their burden of disease and [01:03:00] a number of other things. And then with also differentiated within that is a co-financing requirement or conditioned co-financing. And for those of you in the audience that may have seen this recent CGD piece that was done by Victoria Fan and Sue Sparkes from WHO, they noted that across all the global health architecture currently Global Fund and GAVI are the only two financing organizations that have committed to co-financing requirements of any sort [01:03:30] within their models. And I think we found that quite impressive and we're a bit proud of that. Let me stop there, Stefanie, and let me know if I can clarify anything. Thank you.
Stefanie McBride (01:03:40):
No, that was fantastic, and you actually provided me a nice transition to the next question I have. And you talked about how you were able to leverage some of the innovation and development that the Global Fund has done over more than 20 years of existence into helping the world respond to the COVID-19 pandemic. As part of the global response to COVID-19, the [01:04:00] Global Fund awarded resources to countries to support health system strengthening and pandemic preparedness. Can you talk a bit more about the Global Fund’s COVID response mechanism and how those resources helped to strengthen the capacity of the health systems that were supported and to help with preparedness for health threats going forward?
David Lowrance (01:04:22):
Sure. Thank you. The story I think for all of us goes back to 2020. [01:04:30] And the first piece of the response that I would highlight is what Global Fund often does to help countries facing an outbreak, an epidemic, say like Mpox, is think about the resources that are already in-country, country-held and where there's flexibility and sometimes they increase that flexibility to use resources to direct it, to pivot resources, to address new challenges. So, in that first year, [01:05:00] 2020, that's basically what the Global Fund did with almost a billion dollars. There was some additional funding, but a lot of it was grant flexibilities and much of that was held product focus, it was RDTs, and it was PPE, and it was other commodities that were really essential countermeasures, many of which had faced constraints early on in the COVID response.
(01:05:28):
What I think happened, [01:05:30] so we ended 2021, we were focusing, we basically had a very generous contribution from the U.S. government that allowed us to really expand and to broaden the type of support that we were providing to countries. We did this much more deliberately with the full pillar around infection prevention and control, again, including in continuing support to PPE. But there was also a more [01:06:00] expansive approach to some of the health systems demands, laboratory systems, surveillance systems and workforce at large. And then of course, we were all tracking the evolving context very quickly. Even by 2022, epidemiology changes in a lot of the countries that we support, and countries were starting to pivot their limited resources to new challenges and sort of the baseline [01:06:30] challenges that they face. Unlike a lot of organizations, we adjusted and we started to think more about the post-pandemic recovery phase, health systems resilience, and pandemic preparedness and response.
(01:06:47):
And again, that meant taking sort of a scope that was quite broad and really cranking it down to some essentials. Of course, again, retained within that, [01:07:00] and we're talking at this point in this kind of extension phase in 2024, 2025, over roughly $2 billion. That was really focusing on lab systems, on surveillance systems, on workforce, including community health workers and where infection prevention and control beyond PPE. And we were quite deliberate there and really focusing on the systems aspects of IPC, and not the health products as much. And also, where there were an array of [01:07:30] AMR, direct AMR activities, these were cross-cutting in surveillance in laboratory, in some cases in workforce. And we started to see demand from a number of countries to address AMR-specific concerns as well. And I think Michael mentioned this, but it really was helpful to us in sort of shining a light, if you will, on some of the areas [01:08:00] of our core mandate supporting HIV, TB and malaria responses.
(01:08:06):
And for example, persons living with HIV who have advanced HIV disease and are facing severe bacterial infections and receiving services in contexts that lack access to quality-appropriate and quality-assured antibiotic products and the mortality attendant [01:08:30] mortality risk stuff and that sort of thing. So that has come into the context of the Global Fund in terms of how we're thinking about our support to AMR, both within our core model and some of the broader efforts that countries are taking. We're seeing some of the portfolios, some exciting synergies between HIV programs in particular and some of the AMR teams and national public health institutes, and we're looking to continue that kind of focus in the future. [01:09:00] I hope I covered your questions.  Stefanie, back to you.
Stefanie McBride (01:09:05):
That was fantastic. All right, one more question for you in the last minute we have remaining. As the global community, many of whom are represented on today's call, consider how to mobilize durable and predictable funding for AMR, what is one piece of advice that you would give based on your experience at the Global Fund, either in your position now [01:09:30] or in the work that you've done with the Global Fund in the past at WHO and as a CDC Country Director?
David Lowrance (01:09:36):
Thanks. I certainly did not get my timing right. There's so much more I'd like to say here, but I'm going to focus on one thing that perhaps hasn't been covered as much by other speakers. I would say be opportunistic and do not hesitate to leverage existing platforms. And an example is not only the Global Fund, but I would [01:10:00] call out the Pandemic Fund, which is focusing on the international health regulations, the joint external evaluation framework, you've got AMR in there.
(01:10:12):
That is an opportunity for countries and for stakeholders who are focusing on AMR to find the table, get to the table the next, the third call for proposals be a part of that proposal development and that prioritization. AMR has been included in the International [01:10:30] Pathogen Sequencing Network investment case and WHO is working on related investment cases for their health emergency preparedness and response plan, including for collaborative surveillance and consultation, I just returned from this week. The potential to build AMR into these investment cases. The AMR community should be looking at every opportunity very opportunistically to get this done because I think as others have emphasized, it's not going to be a magic bullet here. [01:11:00] I think I'll leave it there, Stefanie, and thanks again for the questions.
Stefanie McBride (01:11:05):
No, that was fantastic. I just really appreciated what you said. You talked a lot about connection. Connections that were happening in countries between governments and civil society, connections between the challenges we're facing with HIV/AIDS, TB, and malaria with AMR and the connection that the AMR community needs to be making with existing platforms to really, I think again, [01:11:30] my next bumper sticker or button is going to “be opportunistic” so that we don't miss those challenges in the future. So, thank you for that advice.
(01:11:39):
All right. Well, don't go anywhere, David, because we're going to bring all of our panelists back now for a final question. Before we jump into that, thank you again to all of our panelists and speakers for the insights and experiences and expertise that you shared with us here today. We're going to take our last few minutes together. [01:12:00] I'm going to have one question that we're going to go round robin and answer. We'll just go in the order with which everyone spoke. This question for you is: now that the UN High-level Meeting has ended, now that we have returned from the Ministerial Conference in Jeddah, what is one specific way that countries and non-governmental partners continue our momentum and strengthen collaboration so that we can achieve the commitments that we've made [01:12:30] and the targets that we want to meet? Rob, we'll start with you, and everybody will have just a couple of minutes.
Rob Purdie (01:12:37):
Yeah, thank you. I want to highlight a couple of things. One is within that political declaration, there's one thing that I was really excited to see, which is the discussion of the formulation of a committee for evidence for action at the global level. But I think that's something to be done at the national level as well, and I was really excited to hear the efforts being made by Gallup and CDC regarding [01:13:00] surveillance. I can tell you that for MyCARE for the 2025-2026 session at the national level, our focus is really going to be on removing silos and increasing opportunities. Where there's existing programs that maybe don't appropriately or at all encompass opportunities for AMR work, we want to remove those barriers. As Michael said, this is all about inclusivity, [01:13:30] so we want to make sure that existing programs are maximized for their impact in the AMR space, and that's not an easy thing to do.
(01:13:39):
But there are some things that everyone on this call can do. And I touched on awareness. Everybody can increase awareness. Everybody can have a conversation with somebody, talk to somebody, engage somebody else and bring somebody else into the AMR space, invite somebody to the next CDC webinar. [01:14:00] And everybody can also impact stewardship. Personally, when you have that next flu-like symptom or cold-like symptom, instead of just doing what I did and going immediately to an urgent care or a pharmacist and asking for a drug, be patient. Just realize that there's a good chance it's viral and that the antibiotics you're going to take are going to be pointless. And whether you take them or not, you're going to feel better in 48 to 72 hours. And then encourage your family members to do the same thing. [01:14:30] Not avoiding care, but being thoughtful in how you approach your care. I think those are the things that we can all focus on at the national level and at the individual level. Thank you.
Stefanie McBride (01:14:44):
Thank you for that. All right, Michael, over to you. Same question.
Michael Craig (01:14:48):
I think the bottom line I would say is take action and I'm going to say take action in partnership with someone else or another entity. I think we've heard so many different opportunities today [01:15:00] from what Rob noted on the patient side and the awareness side, to what Hebah noted in terms of what they're doing in their region, to what David noted in terms of existing platforms that could be leveraged. I think for all the organizations listening, whether you're a healthcare provider, whether you're at a ministry of health, whether you're a patient, figure out a way that you can get engaged and take action, and I would encourage you to do it in partnership with another organization. I think at CDC, [01:15:30] we are really thinking about how we can build some partnerships and how we can do and share our expertise on laboratory capacity, on infection prevention and control, on response to AR threats.

(01:15:44):
How can we share that more broadly with other ministries of health, with other organizations? How can we work in partnership with them so that we can get that expertise out there to all the places it needs to be? How could we do more training and do greater opportunities [01:16:00] for engagement? So, figure out what you can do, what your expertise is and figure out how you can then pair that in partnership with somebody else. And I really want to stress the in partnership because none of us can go it alone and we are going to have to come up with solutions that work across civil society, across industry, and across the globe. Really just want to encourage folks to take action and do it in partnership.
Stefanie McBride (01:16:26):
Thank you. Michael. Hebah, over to you. What is your [01:16:30] ask of our participants today?
Hebah Mahmoud (01:16:34):
Yeah, I'll reiterate some of what the colleagues have mentioned. The first thing, I think United Nations Independent Science Panel for Evidence will be crucial for establishment to fill the gaps of the knowledge gaps that happens globally. The second thing that I want to highlight also on a national level, we should all adjust [01:17:00] our plans to achieve these commitments and targets and also to work together, as Michael has mentioned, to work together on a regional, on a global level, collectively to share our best practices, experiences and collaborate on existing and new initiatives to combat antimicrobial resistance and achieve the new targets. As it was all mentioned by every single one, we cannot [01:17:30] work alone. We have to work together. Thank you very much.
Stefanie McBride (01:17:34):
Thank you for that. Hania, your advice and recommendations. Hania, you are muted.
Hania Farhan (01:17:49):
I just had to do that twice.
Stefanie McBride (01:17:52):
We appreciate consistency.
Hania Farhan (01:17:54):
There you go. That's exactly what I was doing. Being consistent. [01:18:00] It also tried to avoid the noise into the room, but so I agree really entirely with the comments and emphasis made by colleagues here. Collaboration being key, just taking some notes to be thoughtful, to increase awareness, partnerships, getting engaged, sharing best practices absolutely are key. I think we need clearly consistent, reliable data to measure progress to targets across all the five or the multi pillars of action plans. [01:18:30] But I also want to add that, so there's the experts, there's what we do, but there's also the general public and which is where awareness is so important. Attitudes, behaviors. I guess I just want to say that to be fair to people, why would we expect people to change their attitudes? Be they general public or for that matter, vets or farmers? Why would we expect them to change their attitudes or their behaviors towards something [01:19:00] if they don't know that it is harmful?
(01:19:04):
They don't know it's harmful to them. They don't know it's harmful to others. So, raising awareness is key. Understanding, raising, understanding of AMR through effective communication, education and training is really vital. In some countries we know there is great momentum in dealing with AMR, but in many others, real momentum is missing often because people really don't know how serious this is as a crisis. [01:19:30] Maybe to state the obvious, we need to know what people do not know, and then to use that information to design more focused interventions, to raise that awareness and to motivate stronger action and collaborations to achieve the specific commitments and targets applied in the political declaration.
Stefanie McBride (01:19:55):
Thank you for that. And David, you get the last word today.
David Lowrance (01:20:00):
[01:20:00] All right, well thanks, Stefanie. To follow on and be opportunistic, I'm going to go with governance matters most. And I think the obvious to this audience in this group is that AMR is complicated. You've got the lab piece, the surveillance piece, the clinical piece, and in some or many countries that translates into a challenging [01:20:30] governance landscape. Governance is critical, obviously to the planning and coordination that's needed to drive implementation and to be a focus point for community and civil society groups who want to support AMR. I want to call out national public health institutes or agencies. A lot of good work that IANPHI  has been doing for a long time that the WHO is supporting out and many other partners, including U.S. [01:21:00] CDC. But we're starting to see more and more low- and middle-income countries develop national public health agencies, which are inherently fit for purpose for AMR, at least as part of, noting the obvious cross-sectoral One Health dimensions of AMR, but for a health sector actor, they are holistic, they are horizontal, and they can provide that center of gravity to really [01:21:30] focus planning and coordination and prioritization. Thank you.
Stefanie McBride (01:21:40):
Now I'm the one on mute.
(01:21:41):
Yeah, what I was saying is that does bring us to the end of our webinar today. I know that I feel especially inspired after these last remarks with the reminder of everyone has a role and also everyone needs to [01:22:00] find a partner. As you leave here today, please share with your networks and your colleagues what you plan to do based on what you've heard here today. Share it with us. Find us on social media. We'd love to hear you from you at CDC about the actions that everyone is going to take to combat AMR. A final word of thanks to Rob, Michael, Hebah, Hania, and Dave for being here today as panelists. We feel very thankful to be [01:22:30] partnering with you and your organizations in the work that we do here at CDC. And a final word of thanks of course to everybody on the planning team, without whom none of this would be possible today.
(01:22:43):
Our team just put a link to the post-event survey in the chat. You will also receive this link via email. We really appreciate any time you can take to complete this very brief survey. I promise it'll only take a few minutes. We do use this feedback from every Exchange [01:23:00] to make improvements before the next. We will share a recording of this webinar with everyone that's here today along with everyone who registered but may have not been able to attend. And we'll also post that on our CDC website. And finally, we would love to hear from you about topics that you would be interested in for future AMR Exchanges. Feel free to share those in response to the post-event survey or directly with our CDC AMR team. And with that, we will close [01:23:30] today's webinar and I really hope that everyone has a wonderful day or evening, depending where you are in the world. And wishing everyone a happy new year in case we don't have a chance to connect between now and then. Thanks so much and have a good one everybody. Bye.

AMR Exchange Webinar #9
Final Transcript: 03/04/25