On April 18, 2016, U.S.-Japan Expert Meeting on AMR “Japan’s Role in Addressing Global Antimicrobial Resistance” was convened jointly with the Washington-based Center for Strategic and International Studies (CSIS).

As AMR presents an increasingly serious threat to global public health, it is imperative that all stakeholders urgently coordinate and take necessary actions at national and international levels across both public and private sectors.

As the follow up of Tokyo Meeting of Health Ministers on AMR in Asia, this meeting provided a platform for open multi-stakeholder discussions on AMR-related policy with active participation of experts from the private, public and academic sectors.

In particular, the conference explored 6 goals and outcome indices from the National Action Plan on Antimicrobial Resistance (AMR), which was published on April 5, 2016 by the Japanese Government. In this regard, this report by HGPI will propose 14 recommendations that cover the 6 Goals of the National Action Plan on AMR by the Japanese Government. CSIS and HGPI also jointly published the report proposing recommendations to G7 group.

The following is a summary of the recommendations by HGPI. Both the HGPI report and the joint report by CSIS and HGPI can be downloaded from the right column of this page. 

 
【AMR Action Plan Field １: Public Awareness and Education】

Recommendation 1: Promote AMR Education Programs
・In addition to presenting clinical and basic medical knowledge, AMR education programs should offer increased content related to social medicine, pharmaco-economics, and other relevant areas in the social sciences. They should also reference international comparative studies to provide a wider perspective.

Recommendation2: Deepen Public Awareness about AMR
・Create a National Council on Countermeasures against AMR (tentative name) as a public awareness-raising working group. This body should be a multi-stakeholder group featuring collaboration among the private, public and academic sectors. It should comprise stakeholders, including healthcare providers, patient groups, insurers, members of the private sector, the Government, and professionals from other countries, and work to develop concrete public awareness campaigns.

【AMR Action Plan Field 2： Surveillance and Monitoring】

Recommendation 3： Establish an Isolate-based Surveillance System
・It is essential that isolate-based surveillance systems led by governments be managed in collaboration with academic associations and the private sector. 
・ Establish a system to consistently secure various resources, including funding and staff members, by clarifying the roles of the Government and academic associations.
・ Regarding the application and management of surveillance systems, it is recommended that Japan consider the establishment of a Surveillance Management Committee within institutions such as the National Center for Global Health and Medicine and the National Institute of Infectious Diseases.

Recommendation 4： Develop Surveillance Systems
・In order to accelerate the development of new drugs, data from the isolate-based surveillance system should be open to the public in principle. This would promote research and development via collaboration among the private, public and academic sectors. 
・ Promote the proper use of antibiotics by utilizing information technology to connect clinical data, strain data, and data on antibiotic use within surveillance systems. This would increase understanding of the current usage situation for each antibiotic.
・Integrate data related to the surveillance of human and animals, and then link this data with data from the U.S. surveillance system in order to promote a “One Health” approach to surveillance.

Recommendation 5: Facilitate an Understanding of the Current Situation of Antibiotic Use in Outpatient Setting
・Develop a system that collects data from pharmacies to understand antibiotic use among outpatients.

Recommendation 6: Strengthen Surveillance through Participation by Multiple Stakeholders
・ Policies aimed at strengthening surveillance, such as the establishment of the Antimicrobial Resistance Research Center (tentative name) require not only the participation of the Government, but of academic associations and the private sector, to improve cooperation.

 
【AMR Action Plan Field 3: Infection Prevention and Control】

Recommendation 7: Use of Information Technology for AMR
・ Promote the use of information technology to enable regional and institutional real-time information sharing.

【AMR Action Plan Field 4: Appropriate Use of Antimicrobials】

Recommendation 8: Promote Complex Approaches for the Appropriate Use of Antibiotics
・Promote the appropriate use of antibiotics and the benefits of this through institution-specific approaches. 
・ Reduce unnecessary prescriptions of antibiotics by developing drug pricing mechanisms that would unlink usage and sales. 
・ Promote insurance coverage for antimicrobial-resistant gene tests to further encourage the appropriate use of antibiotics.

Recommendation 9: Promote a Vaccination Strategy
・Reduce the unnecessary use of antibiotics at elderly care facilities. It is important to promote appropriate vaccination practices that take into consideration patient immune systems.
・ Promote antibiotic and vaccine usage that is appropriate in consideration of each patient’s age and their immune system.

Recommendation 10: Promotion of Outcome Indices
・ Regarding proper antibiotic usage, it is necessary to not only aim to reduce unnecessary prescriptions by volume, but also to promote evaluations that employ clinical effects and epidemiological outcomes as measures.

 
【AMR Action Plan Field 5： Research and Development】

Recommendation 11: Establish an Evaluation and Review System to Promote Research and Development
・Encourage PK/PD modeling and simulation work that can make it possible to implement clinical trials even given a limited number of patients. 
・ Establish electronic information networks to gather information on new antibiotics, including on their effectiveness, and their safety from development to the post-market period.

Recommendation 12: Create Diversified and Effective Incentives for Research and Development
・Grant various incentives regarding research and development (pull, push, cap-and-collar, etc.). 
・ Expand drug pricing policies that promote the development of drugs with high unmet medical needs.

Recommendation 13：Establish a Consortium of Organizations from the Private, Public and Academic Sectors to Promote Drug Development
・ Create a consortium in the Government, which will hold multi-stakeholder discussions involving private, public and academic sector members related to antibiotic research and development, incentive grants, review systems, and clinical usage.
 
【 AMR Action Plan Field 6：International Cooperation】

Recommendation 14： Lead on AMR in the Asia-Pacific Region
・ Looking to the Tokyo Meeting on Health Ministers on AMR in Asia as a good example, consistently promote international cooperation frameworks between international organizations and other Asian countries. 
・ Raise public awareness internationally by utilizing international trends and agenda setting efforts. 
・ Secure the resources needed for JANIS to expand into Asia and contribute to the region.