Speech at “Evidence for Action(E4A) Dialogue on Antimicrobial
Resistance”
February 6th, 2024, Valletta Campas, University of Malta
Yasuhisa ShiozakiFirst of all, I would like to thank Sally, Kevin, Damiano and all those whoorganized this very important meeting on AMR in such a beautiful country likeMalta.

I am especially happy to be here when we have had terrible snow

storm in Tokyo after I safely left Haneda Airport where people are now in amess struggling with 10 centimeter of snow in Tokyo.
Today, we all gathered here to discuss for only one goal: how we cansuccessfully increase the momentum of our fight against antimicrobial
resistance to its highest level.
We all know that it is the political decision that ultimately decides the degreeof our commitment.

We can only change our policy on AMR either bychanging the allocation of present budget or finding new ways to finance a newpolicy.

Those must be ultimately decided only by politicians.

And it is

crucially important to create strategic evidences for action that politicians canperceive as their own critical issues.
To have a better dialogue among us, this meeting advices us not to use
power point materials. I asked Damiano to supply my material on your requestthat includes three charts I used in 2016, the year of Ise-Shima G7 Summit andthe last UN High Level Meeting on AMR. I succeeded to persuade Prime
Minister Abe to include AMR as one of the three pillars of agenda on global
health at the Leaders’ Meeting.

These charts are on ① a composition of total

antimicrobial consumption in Japan which told us that human use was only
about 30% and 70% was consumed in agriculture and fishery. ② Country bycountry statistics of use of antimicrobials on livestock, that told us Japan has
only 1.7% share whereas China and US has 23%,12% share respectively
meaning AMR was nothing but a global health issue. ③ Country by country
comparison of the antimicrobial use in health-care sector telling us that,1although Japan consumed relatively few antimicrobials, we used too muchamount of three kinds of wide-spectrum antimicrobials that could have strong
impact on AMR.
Although, with those charts, we were successful to convince then prime
minister and the general public in Japan and the world at that time, as we arebecoming more aware of the complex and serious global implication of theAMR, it is obvious that we need a paradigm shift in our way of thinking towards
AMR.
The concerns of political leaders are not just the number of deaths by specificdisease , but the impact on the sustainability of society itself and human being,from the point of view of the “security” and “political, economic, and socialstability” of their own countries. We have to link the evidence we create withthese concerns of political leaders.
Antimicrobial resistant bacteria invade the global environment andconsequently undermine people's well-being. The UNEP's report last year,“Bracing for Superbugs”, points to this problem.

This argument must be far

deepened.
Thus, I would like to propose to view antimicrobial resistance as a“sustainability issue” for the “planetary environment” and for “human survival”.
To this end, it is necessary to show more scientifically the impact and thetransmission mechanism of antimicrobial resistance on the global environment
and, in turn, on human health.

Obviously, we don’t have sufficient enoughdata and evidence yet.
The issue of “global environmental sustainability” appeals to all generations,
including younger generations, and inspires people to take action. The result
would be a whole-of-government initiative, not only in the medical sphere, butalso in the agricultural, fisheries and environmental spheres and, consequently,involving the government's finance ministry which influences the prime ministers
most.
From this perspective, I believe it is important to construct evidence on thefollowing:2•Firstly, the irreversible effects of antimicrobial agents globally leaked into theenvironment through many channels such as ① the waste from
antimicrobial manufacturing plants, ② leakage of antimicrobials via hospitaldrainage, ③ effect of self-medication with antimicrobials sold without aprescription or ④ leftover antimicrobials, and ⑤ from agricultural andfishery settings.

•Secondly, the risk of outbreaks of antimicrobial resistant pathogens
destabilizing social and economic stability, given the fact that bacterial
infections such as anthrax and plague caused major social unrest in thepast.
Now I would like to ask Dr. Ohmagari from Japan, as our leader in the clinicaland research fields of AMR, to add more information about how Japan isstruggling to build up such evidences.
Thank you very much.

3

Antimicrobial Resistance (AMR): Current Status and Efforts for the Future(2017)

Concerns about AMR○ With the widespread use of antimicrobial agents, pathogens mutate in various ways, acquiring resistance to antimicrobials (AMR:
Antimicrobial Resistance), and spreading. It was suggested that if no action is taken, the number of deaths worldwide will reach 10 million
by 2050, exceeding the number of deaths from cancer. (the review committee on antimicrobial resistance (AMR) in United Kingdom(O'Neill Commission)), First Report (December 2014))○ Research and development of antimicrobials has been stagnant due to low profitability, and the international community has expressed
concern that the further spread of drug-resistant bacteria will lead to a return to the “World Without Antimicrobials" that existed before
the development of penicillin.

Trends in the international society
World Health Assembly: adoption of the Global Action Plan on AMR (May 2015)○ A resolution was passed "for all countries to develop and act on National Action Plans within two years of the adoption of the GlobalAction Plan.” *In WHO, Assistant Director-General, Special Representative of the Director-General for AMR, Dr. Hajime Inoue (from theMinistry of Health, Labour and Welfare) was responsible for AMR measures since November 2016.
G7 Elmau Summit Leaders' Declaration (June 8, 2015)○ The policy to tackle drug-resistant bacteria was included in the Statement on the Health Sector and AMR measures were addressed in Berlin
Health Ministers’ Communique (October 8, 2015).
Tokyo Meeting of Health Ministers on AMR in Asia (April 16, 2016)○ The First Ministerial-Level Meeting held in Asia to share experiences of Asian countries’ efforts and discuss future AMR countermeasures.
G7 Ise-Shima Summit (May 26-27, 2016)○ G7 Ise-Shima Vision for Global Health included strengthening the response to AMR and promoting research and development. Kobe
Health Ministers Meeting (September 11-12, 2016) further elaborated on the discussion of strengthening the AMR response andpromoting R&D, and adopted the Kobe Communique.
High-level meeting on AMR in the 71st United Nations General Assembly (September 21, 2016)○ A political declaration on AMR was adopted; an Interagency Coordination Group (IACG) on AMR was established and its first meeting wasscheduled for May 2017.
World Economic Forum (Davos) (January 19, 2017)○ Coalition for Epidemic Preparedness Innovations (CEPI) was launched to promote the development of vaccines for infectious diseases withsignificant global impact such as Ebola.
(Ministry of Health, Labour and Welfare of Japan) 1

Antimicrobial use in Japan and other countries of the world
Antimicrobial use in Japan by intendeduse (2011)

Antimicrobial use in livestock (cattle, swineand poultry) by country (2010)

Pesticides
148 tons
(9%)

China
23%

Human Drugs
578 tons(33%)
Veterinarydrugs
787 tons(45%)

Others51.3%
Feedadditives
234 tons
(13%)

US
12%
Brazil9%
India 3%Use for animals accounts
for 58 % of the total.
Source: Agriculture, Forestry and Fisheries
Statistics, Pesticide Handbook, IMS
Pharmaceutical Sales Statistics

Japan 1.7%

Germany 3%

Source: Van Boeckel TP, Proc. Natl Acad Sci . 2015; 112: 5649–5654.
* For Japan, estimates were based on 2011 data from theMinistry of Agriculture, Forestry and Fisheries statistics, which
does not mean that the amount used is the sixth largest.

2

Key points of Japan’s National Action Plan on AMR (April 5, 2016)
Current situation and challenges

Japan's unique and advanced
approaches

Difficulty in analysis due to Lack of surveillance dataon animal and non-human factors (food,environment, etc.) or lack of coordination.

Establishment of a One Health Surveillance
Network that integrates AMR information frommultiple field including humans, animals, and theenvironment.

No data available on the incidence of resistantbacteria in humans and the relationship with theamount of antimicrobials used.

Understanding nationwide trends in antimicrobial
use and promoting prudent use of antimicrobials by
utilizing the National Database of Health Insurance
Claims.

In the case of aquatic animals with small production
volume, even if the development of vaccines isdesired, the development is not promoted due tothe small market size, etc.

Ensure prudent use of antimicrobial agents forveterinary use and promote development ofvaccines for animals (including fisheries).
Set numerical targets for both humans and animals.

No other G7 Action Plan sets numerical targets forboth human and animal sectors.

for animals are set in the future, along with specificaction plans.
Promote international cooperation with a focus on
Asia through Tokyo Meeting of Health Ministers on
AMR in Asia, etc.

Lack of surveillance and other systems for AMR
control in Asia.

3Numerical Targets in Japan’s National Action Plan on AMR
Reduce the use of oral cephalosporins, fluoroquinolones and macrolides by half,with reducing overall use by 33%.
Antimicrobial use in the health-care sector by country
セファロスポリン、その他のβラクタム
Cephalosporins, other β-lactams

キノロン
Quinolones

GreeceRomania
Belgium
CyprusFranceLuxembourg
Italy
Ireland
Portugal
Malta
Iceland
Croatia
Spain
United Kingdom
Slovakia
PolandFinland
Bulgaria
Czech Rep.
NorwayDenmark
Lithuania
Germany
Slovenia
SwedenAustria
Hungary
LatviaEstonia
Netherlands
Japan

Othersその他

ペニシリン
Penicillin

マクロライド等
Macrolides

Antimicrobial use is an indicator of
Antimicrobial Stewardship (AMS).
Although the amount used itself is not high in Japan, theusage rate of cephalosporins, quinolones and macrolides(many of which are effective against a wide range ofbacteria) is extremely high.

15.8
05

10

15

It is important to reduce the amount used and the usage
rate by promoting prudent use.
20

Average daily antibiotic use per 1,000 population

25

30

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