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[Report and Recommendations] “Post G7 Ise-Shima Summit: Reflecting upon Japan’s National Action Plan and Addressing Next Steps for Global Antimicrobial Resistance”Meeting Summary – “Seven Recommendations for Promoting Measures Against AMR”

[Report and Recommendations] “Post G7 Ise-Shima Summit: Reflecting upon Japan’s National Action Plan and Addressing Next Steps for Global Antimicrobial Resistance”Meeting Summary – “Seven Recommendations for Promoting Measures Against AMR”
The 2nd Global Expert Meeting on AMR “Post G7 Ise-Shima Summit: Reflecting upon Japan’s National Action Plan and Addressing Next Steps for Global Antimicrobial Resistance” was convened on Friday, July 21st, 2017.
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 the public and private sectors. One year after the enactment of Japanese “National Action Plan on Antimicrobial Resistance (AMR)“, the 2nd meeting provided an opportunity for open multi-stakeholder discussions to identify key achievements after the G7 Ise-Shima Summit as well as remaining challenges and the specific policy agenda to be addressed moving forward. The meeting served as a venue for policy discussions related to the AMR countermeasure that should continue to be promoted both within Japan and abroad.
Meeting participants raised points for discussion related to the threat of AMR within the international community and the role that should be played by Japan in consideration of the history of the G7, as well as the international promotion of AMR countermeasures moving forward. This discussion highlighted the importance of Japan-US collaboration. The details of the action plan formulated for AMR countermeasures by Japan in April were clarified, and participants touched on the future initiatives of Japan as the chair of the G7.
Seven Recommendations for Promoting Measures Against AMR (Summary of Experts’ Meeting)
1. Reaffirm the importance of rapid testing in order to promote appropriate diagnoses
  • Reaffirm the importance of proper and rapid examinations and reporting of results as a measure against AMR, and further promote the adoption of technologies that are already approved for use.
  • Government authorities must consider measures to promote microbial testing – considered to be one measure against AMR – such as support for the adoption of rapid medical technology, or valuations necessary for medical reimbursement. 
  • The government must consider concrete measures for infection control (hospital-acquired infections, community-acquired infections), and evaluate medical facilities on their performance on such measures.
  • Speed up the approval of so far non-approved reagents and technological equipment that has already been shown effective against AMR. 

2. Provide concrete incentives for R&D

  • Recognize the difficulties companies face when trying to predict revenue or hedge investment risks related to AMR-related R&D. 
  • Develop basic incentive plans in addition to financial support, to create an environment that will facilitate investment into AMR-related R&D and the appropriate use of related drugs after they enter the market.

3. Promote both the cross-sectoral and international integration of examination data 

  • Promote the cross-sectoral and international integration of data collected during examinations.
  • Based on the analysis of such data, raise awareness about proper diagnoses through such activities as the distribution of diagnosis protocols that include information on diagnostic guidelines for infectious diseases. 

4. Seek concrete progress in areas of cooperation between academia, government, and industry

  • Promote cooperation between academia, government, and industry in fields that are pillars of measures against AMR, such as the promotion of proper detection and diagnoses, surveillance, and R&D.
  • Establish, within the area of academia, government, and industry cooperation, such mechanisms that go beyond agenda-setting to concretely address issues related to the harmonizing of regulatory mechanisms and sharing of standardized data.
  • Base these efforts on dialogue to promote mutual understanding and trust building.

5. Proceed with the implementation of the Action Plan while taking special care not to bring too many restrictions to bear

  • Further implement cross-sectoral and multidisciplinary action plans. In implementing such plans, care should be taken to not overly restrict the use of antimicrobials while pursuing plan objectives. 

6.  Japan must continue to assume global leadership

  • At the same time as Japan works for academia, government, and industry cooperation between itself, the countries of Europe, and the United States, Japan should also display international leadership with regard to outstanding AMR issues in Asia.

7.  Promote further awareness-raising activities 

  • Promote further awareness-raising activities targeting the media and general public to help patients understand the problem themselves and discourage them from seeking antimicrobials when they do not need them.  
Welcoming Remarks
Kiyoshi Kurokawa (Chairman, HGPI) video message
A year has passed since the enactment of the National Action Plan on AMR by the Japanese Government. In relation to specific efforts within Japan, Dr. Kurokawa emphasized the importance of having relevant governmental ministries and agencies, as well as companies, work together to clarify policy issues. Dr. Kurokawa commented on key events and movement around AMR, such as a UN high level meeting and discussion at the G20 summit. He also highlighted the policy agenda for AMR that now requires discussion at the global level.
Keynote Address 1
Kuniaki Miyake (Director, Tuberculosis and Infectious Diseases Control
Division, Ministry of Health, Labour and Welfare (MHLW))
Mr. Miyake described the way forward from the National Action Plan, based on discussions from domestic and international meetings on AMR. He touched on the importance of developing an integrated surveillance system, as well as the provision of support for antimicrobial development, in order for Japan to take leadership in this area and to meet the six goals formulated in the National Action Plan. 
Keynote Address 2
Kazuhiro Tateda (President, The Japanese Association for Infectious Diseases/
Professor, Department of Microbiology and Infectious Diseases, Toho University)
Professor Tateda gave a keynote address on the future direction of infectious diseases treatments in the AMR Era. He emphasized the goal of promoting the appropriate use of antimicrobials, rather than just aiming to meet numerical targets and figures. He also pointed out the importance of education and efforts to spread knowledge among primary care physicians in order to enable them to practice the appropriate use of antimicrobials.

Panel Discussion 1 
“G7 Ise-Shima Summit’s Achievements and Further Role to Combat AMR”
The discussion in Session 1 reflected on the changes made during the past year following the G7 Ise-Shima summit both globally and locally. The Panel elaborated on the complicated issue of the new framework for public-private partnerships (PPP) needed for AMR R&D policies.
The panel had a thorough discussion on R&D and the appropriate use of antimicrobials, touching upon the incentives needed to facilitate R&D from various perspectives. Insights were also shared regarding the re-establishment of insurance reimbursement systems to promote appropriate antimicrobial use. The audience joined the lively discussion with many questions and comments on the formulation of frameworks for international cooperation.
• Gary M. Cohen (Executive Vice President and President, Global Health and Development, Becton, Dickinson and Company)
• Jayasree K. Iyer (Executive Director, Access to Medicine Foundation)
• Paul Schaper (Executive Director, Global Public Policy, Merck & Co., Inc., Kenilworth, N.J., U.S.A.)
• Naoko Yamamoto (Senior Assistant Minister for Global Health, MHLW)
Mayuka Yamazaki (Project Assistant Professor, Global Health Policy, Faculty of Medicine, The University of Tokyo)
Panel Discussion 2  
“Challenges and Next Agendas in Japan’s National Action Plan”

In this session, experts had a focused discussion on the remaining challenges and future agenda related to Japan’s National Action Plan, including incentives to foster antimicrobial development as well as possible frameworks for the government-industry-academia partnerships critical to that process.
A wide range of issues were addressed, including systems for rapid diagnostic testing, new mechanisms for drug development within Japan, and the utilization of active surveillance. Open discussions were held among the experts from the public, private and academic sectors, followed by a number of ideas and questions raised by the audience such as establishment of platforms for public-private partnerships and the importance of evaluating the quality of diagnostic methods and technology.
 Norio Ohmagari (Vice Director, National Center for Global Health and Medicine / Director, Disease Control and Prevention Center(DCC) / Director, International Health Care Center at DCC)
• Takuko Sawada (Director of the Board, Senior Executive Officer, Senior Vice President, Corporate Strategy Division, Shionogi & Co., Ltd.)
• Kazuhiko Mori (Director, Evaluation and Licensing Division, MHLW)
• Katsunori Yanagihara (Professor, Department of Laboratory Medicine, Graduate School of Biomedical Sciences, Nagasaki University)
Ryoji Noritake
President, Health and Global Policy Institute (HGPI)
Closing Remarks
Keizo Takemi (Member of the House of Councillors)
Building off of his long history of work in the global health field, including on AMR, Mr. Takemi spoke about the complex and pressing issue of AMR, including the importance of working to resolve issues related to the development and creation of new antimicrobials specifically to address AMR, through collaborations among the Cabinet Secretariat (including the Coordination Office of Measures on Emerging Infectious Diseases, and the Healthcare Policy Office), MHLW, the Ministry of Foreign Affairs (MOFA), the private sector, and academia. 
(No particular order and title omitted)
(Photographed by: Kazunori Izawa)

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