12/10/2017 | Title of the presentation 1

The 2017 WHO EML AB chapter

(6th June 2017)

WHO HQ, Geneva 11 October 2017

Nicola Magrini

Secretary, WHO Expert Committee on the Selection and Use of Essential Medicines,

Essential Medicines Department, WHO

The 40 years of EML (1977 – 2017)

1977 1st Model list published, approx. 200 active substances

List revised every two years by WHO Expert Committee

2002 Revised procedures approved by WHO

The first list was a major breakthrough in the history of medicine,

pharmacy and public health

Médecins sans Frontières, 2000

First EML: 1977 36 pages, 20 references

Essential Medicines List: Concept and Procedures 4 |

EML & EMLc 2015 - 2017

2015 EML: 409 medicines

– 5th EMLc (children): 294 medicines

20th EML: 433 medicines

– 6th EMLc (children): 314 medicines

586 pages, 1082 references

12/10/2017 | Title of the presentation 5

12/10/2017 6

The 2017 AB update and A-Wa-Re Index

WHO EML: why is it 'model'

• Model for process of selection

• Model list

• Model to facilitate efforts to 'improve health' of population Procurement and Supply

Regulation

Quality

Rational/responsible/optimal Use

Availability Affordability Access Equity

The 2017 AB update and A-Wa-Re Index

EML AB 2017: syndromes considered

EML 2017 applications: example/template

EML 2017: final template

EML ACCESS Group

• First and second choice AB for the 23 relevant/frequent syndromes

considered make the ACCESS Group (29 AB)

EML 2017 AB listing

ACCESS Group

each AB: by indication

EML AB (not just) listing: ACCESS

EML AB (not just) listing: ACCESS

EML AB (not just) listing: ACCESS

EML WATCH Group

CIA List: Critically Important Antimicrobials

First developed in 2005, last revision 5th 2016

Intended to help preserve the effectiveness of

antimicrobials

Reference to help formulate and prioritize risk

assessment and risk management strategies for

containing resistance coming from the food chain

(non-human use)

http://www.who.int/foodborne_disease/resistance/cia/en/

Antimicrobial agents are ranked as

Critically important

Highly important

Important

Highest priority agents

Fluoroquinolones

3rd and 4th generation cephalosporins

Macrolides

Glycopeptides

Polymyxin (colistin)

Recommends not to use in animals or plants classes not currently used in food

producing animals (such as carbapenems) & new classes developed for humans

Ranking of Antimicrobials

EML AB (not just simple) listing: ACCESS & WATCH GROUP

AB RESERVE Group: implications for policies

12/10/2017 | Title of the presentation 24

Mike Sharland,

personal

communication

Penta-id.org

EML A-WA-RE index uses in DU PPS in >20.000 patients

The ABC of implementation

Implementation:

Dissemination

Adoption

Education

Change

WHO EML AB: A-WA-RE implications

• AB progressive change of status (AB are different, the more you use, the more

you lose them)

• The great potential: OneHealth common goals in human health, agriculture and

food producing animals

• The difficult (long-term) part: implementing optimal uses

Back to basics on implementation

Where am I?

You’re 30 metres above the ground

in a balloon

You must be a researcher

Yes. How did you know?

Because what you told me is absolutely

correct but completely useless

You must be a policy maker

Yes, how did you know?

Because you don’t know where you are, you don’t know where you’re going, and now you’re blaming

me

J Lomas, 2007

We need to look to non-traditional stewards, such as community

health workers and members of the public, in settings where health-

care professionals are a scarce resource.

Goff and Mendelson, Lancet ID, 2017

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Global implementation/stewardship

Effect size: moderate though higher than average Quality Improvement studies

February 2017

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Contents of the presentation

• The 2017 WHO EML AB chapter (6th June 2017)

The Expert Committee recommended the appointment of a standing EML working group to:

• consider reviewing additional clinical syndromes

• adapt the current clinical synopsis to produce short structured documents;

• coordinate the development for the EML and EMLc of a guidance document on

optimal dose and duration of antibiotic;

• review the differential effect of antibiotic classes on the selection of resistance;

• Define key stewardship messages associated with the new categorization and

develop more detailed guidance to assist with the implementation of

recommendations

12/10/2017 | Title of the presentation 33

EML 2017-2019: a standing AB WG

Public Awareness

Campaigns: - Key messages

- Privilege contents

based on evidence

3 Priority Pathogens List

- R&D

6

Research Priorities &

GARDP new AB

7

Essential Diagnostics 8

Drug Utilization

- Hospital pps

- Community use

- Across sectors

(animals and

agricolture)

9

Animals & Agriculture

One Health

- CIA List (EML bridges)

10

Stewardship &

Education & audit

WHO package based

on new EML and 21

syndromes guidances

4

Implementation: context dependent and

research oriented

Health System

programs: monitoring

5

EML AB listing (3+) 1

Syndromes guidances

Comprehensive

Review of optimal use

2

5 Paediatric

Syndromes and STI

indications

New EML website: - database., new

format

- New App?

EML AB

strategy

2017

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