CIVAS 8th Anniversary: Seminar on “The Global Threat of Antimicrobial Resistance: How Should We Act?”
Sunday, 23 March 2014
Universitas Siswa Bangsa Internasional, Jakarta, Saturday, March 22, 2014
By Nofita Nurbiyanti and Erianto Nugroho
The use of antimicrobial for the treatment of infectious diseases has grown rapidly since the 19th century. Such development was followed by the increase of antimicrobial resistance. Every year 2 million people in the United State are infected by resistant bacteria resistant and at least 23.000 people die as a result of the infection (Center for Disease Control and Prevention/ CDC Report in 2013). Antimicrobial resistance has become a global health issues.
One contributor to the increase of antimicrobial resistance is the irrational use of antimicrobial in humans and animals. Fundamentally, resistance in humans could not be separated from the development of antimicrobial resistance in animals, particularly with the use of sub-therapeutic levels of antibiotic growth promoter (AGP) in feed which leads to the development of resistant bacteria populations. Therefore in 2011, WHO issued several strategies and recommendations to control antimicrobial resistance in humans. In 2012, OIE also released recommendations to control antimicrobial resistance in animal health and animal husbandry practices.
As an effort to raise awareness on this global issue and celebrate its 8th anniversary, the Center for Indonesian Veterinary Analytical Studies (CIVAS) conducted a National Seminar on “The Global Threat of Antimicrobial Resistance: How Should We Act?” on Saturday, March 22, 2014, at the Auditorium of Universitas Siswa Bangsa Internasional, Mulia Business Park Building 1st floor, Jl. M. T. Haryono No. Kav. 58-60 Pancoran, Jakarta. The seminar was aimed to increase knowledge and understanding of antimicrobial resistance and its current situation in the world, the region and in Indonesia, increase awareness on the prudent use of antimicrobials, and gather information necessary to encourage and support the making, development, use, and enforcement of rules/policies related to antimicrobial control in Indonesia. The seminar was also intended to be a forum for information exchange on antimicrobial resistance status in Indonesia and initiate and reactivate the involvement of various stakeholders from all sectors, e.g. production policies, distribution, usage and study, and control and monitoring, related to antimicrobial use in order to achieve a global health for human, animal, and the environment. This seminar was supported by The American Institute for Indonesia Studies (AIFIS), a non-government organization focused on education, particularly at university level, information exchange and issues related to science and social culture.
The seminar presented four (4) speakers, which are :
(1). Prof. Dr. Pratiwi P. Sudarmono, PhD, SpMK (K), Vice Dean of the Faculty of Medicine, University of Indonesia, with topic “Multidrug Resistant Bacteria to Antibiotics: a Global Problem”,
(2). Drh. Tri Satya Putri Naipospos, MPhil, PhD, Chair of the Directive Board of CIVAS, with topic “Antimicrobial Resistance in Animals: A Perspective on Global Livestock Production and Correlations with Antimicrobial Usage”,
(3). Drh. Akhmad Junaidi, MMA, Director of Veterinary Public Health, Directorate General of Livestock and Animal Health Services (DGLAHS), Ministry of Agriculture, with topic “The Threat of Antimicrobial Resistance: Impact of Drug Use in Food Products of Animal Origin”, and
(4). Dr. Siswanto, MPH, DTM, Head of the Center of Applied Health Technology and Clinical Epidemiology, Health Research and Development Agency, Ministry of Health, with topic “Study of Antimicrobial Resistance in Humans in Indonesia”. The seminar was led by Dr. Med. Vet. Drh. Hadri Latif, MSi, a professor of Veterinary Public Health at the Department of Animal Disease and Veterinary Public Health, Faculty of Veterinary Medicine, Bogor Agricultural University, and Member of the Directive Board of CIVAS.
The seminar was conducted from 09.00 AM until 02.00 PM, preceded with speech by the Executive Director of CIVAS, Drh. M. D. Winda Widyastuti, MSi, then followed by the Chairman of Directive Board of CIVAS, Drh. Tri Satya P. Naipospos, MPhil, PhD, and the last closed by Drh. Pudjiatmoko, PhD, the Director of Animal Health, who was representing the Director of DGLAHS, Ministry of Agriculture to officially open the seminar.
Number of participants who attended in this seminar were 114 people that consisting of various institutions. They were including: : Health Research and Development Agency (Balitbangkes), Sub-Directorate of Zoonosis – Directorate of Disease Control with Animal Sourced – Directorate General of Diseases Control and Environmental Health, Directorate of Pharmaceutics Development Services and Health Tools (Bina Yanfar dan Alkes), Directorate of Medical Support Services, Directorate General of Health Efforts Ministry of Health Republic of Indonesia, Quarantine Agency, Center of Social Economic and Agricultural Policy (PSEKP), Directorate of Veterinary Public Health and Post Harvest, Directorate of Animal Health, National Veterinary Drug Assay Laboratory (BBPMSOH), Center for Veterinary Research, Center for Quality Test and Animal Products Certification (BPMSPH), Diseases Investigation Center Wates, Diseases Investigation Center Denpasar, Diseases Investigation Center Bandar Lampung, Diseases Investigation Center Subang, Diseases Investigation Center Banjarbaru, Center for Livestock Research Ciawi – Bogor from Ministry of Agriculture RI, Marine and Agriculture Office Services of DKI Jakarta Province, Sub Livestock and Fishery Office Services of East Jakarta, Sub Livestock and Fishery Office Services of South Jakarta, Livestock and Fishery Office Services of Bogor District, Livestock Office Services of Bogor, Agriculture Office Services of Tangerang City, Agriculture and Livestock Office Services of Tangerang District, Livestock and Animal Health Office Services of Central Java Province, Poltekes Banten, Indonesia Young Entrepreneurs – Moderator Anggota Jaringan Komunikasi Masyarakat Peduli Perikanan, Pertanian dan Peternakan (JKMP4), Transfarma Medica, PT. Agri Trading Investment, Japfa Santori, PT. Sehat Cerah Indonesia, Zen Pet Clinic, Sumber Unggas, graduate, , postgraduate students, and professional program from FKH IPB, USBI students, and partners from media information, which were Trobos Magazine and Agrina Tabloid.
The result of seminar was manifested into the formulation as well as become seminar recommendation, and it was prepared by the drafting team who consisting of Dr. Drh. Anak Agung Gde Putra, SH, MSc, PhD, Drh. Pebi Purwo Suseno dan Drh. Imron Suandy, MVPH. These results and its recommendation have been presented in the last session of the seminar for getting inputs from participants. The finalization of this document had been done by drafting team with the final inputs and comments from speakers and other key source – person who also attending the seminar, then disseminated to all stakeholders.
The comprehensive seminar results and its recommendations are below:
1. Antimicrobial resistance is a threat to public health, animal, and environment.
2. Antimicrobial resistance can occur naturally and acquired that were caused or influenced by risk factors.
3. The factors that contribute and cause for increasing antimicrobial resistance are:
- Implementations of guidelines for antimicrobial usage not yet optimal.
- The lack of control in sale and distribution of antimicrobial both in number and distribution arrangements, and also in antimicrobial usage.
- The absence of national surveillance program for antimicrobial resistance.
- The lack of antimicrobial resistance test and its data analysis.
- The lack of laboratory quality assurance for antimicrobial resistance testing
4. In the livestock sector, antimicrobial resistance is driven by the increasing of animal products demand due to government program in increasing community protein consumption through livestock industrialization program, which give an impact on the extensive usage of veterinary drugs for treatment and uncontrolled usage of growth promoters as feed additive to increase livestock productivities
5. In human, the other important factors that urge to the antimicrobial resistance are inappropriate use of antibiotics (out of the rules or guidelines), free access for obtaining antibiotics, inappropriate of self medication, and irrational use of antibiotics.
6. On the environment, increasing environmental pollution by the remnants of antibiotic usage that caused by bad practices on the sanitary and other biosecurity aspects, or as a result of contamination from antibiotic residues, will cause the bacteria to become resistant in the environment. The resistant bacteria can carry and transmit its resistant genetic material to other bacteria, both of commensal and pathogen.
7. Antimicrobial resistance can give impacts especially in the failure of implementation of standards therapy/ treatment, increasing treatment or caring cost, and risk of death.
8. Antimicrobial resistance is the problem for human, animal, and environment health, therefore it is need to implement multi-sector strategies and approach for its prevention and control program.
9. Particularly in animal health sector, the recommendations of World Organization for Animal Health (OIE) for antimicrobial usage are below:
- Enforcement of rules and guidelines or standards, and also government regulation that related to the prudent use of antimicrobials and for better control system in production, registration, distribution, and use of antimicrobials.
- Good knowledge and monitoring on antimicrobial quantity usage in livestock production.
- Harmonization of national surveillance programs and incidence monitoring of antimicrobial resistance in animals, human and environment, and the implementation of international coordination and solidarity programs for developing countries.
- Implementation of permanent risk assessment measure.
- Prevention on hazardous practices.
- Imposition of legal punishment on the part of marketing activities and usage of false antimicrobial products.
10. The strategy and action plan which must be done together to prevent and reduce the occurrence of antimicrobial resistance are:
- Development and or refinement guidelines and regulations for the use of antimicrobials.
- Strengthening and increasing capacity building of laboratory testing.
- Development and strengthening of the antibiotic surveillance network in each area and between animal and human health aspects; including between laboratories and other related technical units, in the public and private sectors, and also in educational institutions or universities.
- Determination of better plan and its sustainability for monitoring and evaluation programs on the permitting process, distribution and antimicrobial usage.
- Joint research between animal health and human health, optimalization on implementation of monitoring research program, and increasing the collaboration on result dissemination program from various studies to encourage update information and knowledge exchange, through workshop, conferences, establishment of communication forum and cross-sectoral working groups.
- Dissemination of information and increasing better understanding and awareness of various stakeholders on the importance of the rational use of antimicrobials to encourage better thinking and behavior change.
- The development of national roadmap on antimicrobials resistance control program which is involving multi sector.
11. The implementation of the national strategy to control antimicrobial resistance must involve the participation and commitment of all stakeholders (government, farmers, drug companies, drug importers, livestock associations, employers of drug association, and other stakeholders), for the success of law enforcement.