Topics Drug Resistance (AMR) Seminar" Held History and Current Status of Countermeasures against Infectious Diseases: Learning from Semmelweis

In his lecture, Dr. Kiyoshi Kurokawa, President of the Japan Health Policy Organization and Professor Emeritus of National Graduate Institute for Policy Studies, noted that Semmelweis noted differences in the incidence of postpartum fever between obstetric facilities in the era before the development of bacteriology by Pasteur and others, and the similarity of autopsy findings in patients who died from postpartum fever and other diseases. He also introduced episodes in which he encouraged hand washing with disinfectant after each delivery, noting the similarities between the incidence of postpartum fever among obstetric facilities and pathological autopsy findings in patients who died of other diseases. He also pointed out the significance of learning from Semmelweis' foresight in taking countermeasures based on the hypothesis derived from his observations when infectious diseases caused by bacteria and viruses that had become resistant due to regional and inter-national transmission suddenly became a problem in today's globalized world.

Takao Omagari, Director of the International Center for Infectious Diseases, National Center for Global Health and Medicine, presented the various measures that have been taken in Japan in response to the Action Plan for AMR control, as well as their achievements and challenges.

First, he noted that the percentage of residents in Japan who have accurate knowledge about drug resistance and antimicrobial agents is low compared to European countries, and that it is necessary to provide more opportunities for people to be exposed to correct knowledge. In addition, he stated that, in terms of local AMR measures, support for infection control and treatment in small and medium-sized hospitals and elderly care facilities is needed, guidance should be developed, and the network of additional medical institutions for infection prevention measures should be further expanded and their support extended. Regarding the proper use of antimicrobials, he noted that the practice of the common cold has improved over the years, and the antimicrobial prescription rate fell from 60% in 2015 to 30% in 2017, but this is still insufficient, and that overall antimicrobial use fell 10.6% in 2018 compared to 2013 due to the "Guide to Proper Use of Antimicrobials" and other factors On the other hand, the use of injectable drugs increased by 10.0%, which was attributed to the use of injectable drugs for elderly patients over 65 years old. In addition, he pointed out various other issues, such as the introduction of resistant bacteria from overseas, one-health measures, and insufficient supply of antimicrobial agents and stagnation in the development of new antimicrobial agents.

On the other hand, as an achievement, he introduced the establishment of the Joint Common Platform for Infection Control (J-SIPHE). He stated that the actual status of microorganism detection and antimicrobial use at each medical institution has been visualized, and comparisons with other institutions and national data have become possible, making it possible to use this information for countermeasures against resistant bacteria.

He concluded by expressing his view that while the past 15 years have been spent raising awareness of the concept of appropriate use of antimicrobial agents and meeting unmet medical needs through changes in dosage and administration and expansion of indications, the next 10 years will see Japan become a global leader in promoting AMR control together with all stakeholders in society, and contribute to the development of medicine and society. He expressed his view that it is important for Japan to become a global leader and contribute to the development of healthcare and society.

Akira Kawahara, Executive Director of the Pharmaceutical Manufacturers Association of Japan (PMAJ), began his presentation with an overview of PMAJ and the situation surrounding the pharmaceutical industry, followed by an explanation of PMAJ's efforts to combat infectious diseases, particularly AMR.

In the Action Plan for AMR control, the pharmaceutical industry is expected to make the "appropriate use of anti-microbial agents" and "research and development and drug discovery" in particular, and although it supplies medical facilities with therapeutic agents for various pathogens such as bacteria and viruses, preventive and therapeutic measures are still insufficient for some types of pathogens. However, for some types of pathogens, preventive and therapeutic measures are still inadequate.

He also introduced that the Pharmaceutical Manufacturers Association of Japan (PMAJ) is engaged in various activities to promote and raise awareness of AMR countermeasures through cooperation with domestic academic societies related to infectious diseases, medical associations and other related organizations, the Asian Pharmaceutical Associations Conference (APAC), and the Nikkei Asia-Africa Conference on Infectious Diseases. In addition, the health agenda for the 2019 G20 Osaka Summit includes the development of a sustainable environment for R&D and drug discovery, namely, pull-type incentives (1) Market Entry Reward, (2) Transferable Exclusivity Extension, (3) He also mentioned that the Leaders' Declaration includes the consideration of these incentives.

In closing, Executive Director Kawahara pointed out that there is no trump card for AMR countermeasures and that steady efforts are needed. In particular, as an R&D-oriented pharmaceutical industry, he believes that the most important thing is to introduce pull-type incentives that lead to sustainable research and development of antimicrobial agents as soon as possible, and to have industry-academia-government collaboration to materialize such incentives. He also expressed his determination to move forward while gaining public understanding.

Satoshi Shimada, Specialist, Tuberculosis and Infectious Diseases Division, Health Bureau, Ministry of Health, Labour and Welfare, began his presentation by pointing out that infectious diseases are not only a domestic problem due to the problem of tuberculosis in Japan and the increase in human traffic associated with globalization, and he discussed the need to continue to make antimicrobial agents valuable in the future.

In his speech, Dr. Shimada explained that Japan is now acting on the five pillars of the World Health Organization's Global Action Plan for AMR (awareness-raising, surveillance, infection prevention and control, appropriate use of antimicrobial agents, and promotion of research and development), as well as the Action Plan for AMR control, which includes international cooperation. He also described the results of the plan, including several case studies. For example, in the area of public awareness, he reported on activities to increase public awareness through effective use of collaborations with celebrities and animations, and in the area of surveillance, he reported on the release of a trend survey report summarizing antimicrobial use and outbreaks of resistant strains for the public awareness conference. The report also included a report on the use of antimicrobial agents and the outbreak of resistant bacteria. Furthermore, in the area of infection prevention and control, he mentioned that an additional fee was newly established for hospitals that have an antimicrobial agent proper use support team (AST). As part of the promotion of proper use, he also mentioned that the first edition of the Guide to the Proper Use of Antimicrobial Agents was published in 2017, and that a second edition is now being prepared with additional guidance for infants and young children.

As part of the R&D promotion, he reported on the support for drug discovery and development against drug-resistant bacteria, which are considered important by WHO, through the Health and Labor Sciences Research, the Japan Agency for Medical Research and Development (AMED), and the Global Health Technology Fund (GHIT Fund), among others. In addition to such push-type support, he also mentioned the need for pull-type incentives to support new drugs after their launch, and stated that in order to realize such incentives, the need for new antimicrobial agents and their development must be widely known and understood by the public.