Advancing Planetary Health in Australia: focus on emerging infections and antimicrobial resistance

Hill-Cawthorne, Grant; Negin, Joel; Capon, Tony; Gilbert, Gwendolyn L; Nind, Lee; Nunn, Michael; Ridgway, Patricia; Schipp, Mark; Firman, Jenny; Sorrell, Tania C; Marais, Ben J

The WHO's Antimicrobial Resistance: Global Report on Surveillance (2014) identified a policy package with broad goals that included strengthened surveillance and laboratory capacity. 47 However, without adequate funding and accountability measures, such farsighted policies will continue to fall short, especially in the Asia-Pacific region where antimicrobial use is essentially unregulated and strong financial incentives exist to retain the status quo. The WHO Western Pacific Region's Action Agenda is a step towards tackling these problems, but the agenda includes no plans for BMJ Global Health 48 Lack of funding for cross-disciplinary research was identified as a significant barrier; participants believed that this was exacerbated by the separation of the two major Australian public research funding bodies-the National Health and Medical Research Council (medical) and the Australian Research Council (non-medical). Breaking down traditional medical, veterinary and biological research silos is crucial, with dedicated funding to support cross-disciplinary initiatives. Few new antimicrobials have been developed in recent years, as antimicrobials do not deliver attractive returns on investment. 33 Private-public partnerships have been used with success to develop vaccines for neglected diseases, 49 but this requires generous philanthropic support. New economic models should reward antimicrobial discovery (or novel non-antibiotic approaches to reducing AMR) as a public good, delinking the return on investment from the volume of sales. The Association of British Pharmaceutical Industries Antibiotics Network has suggested an insurance-based model that guarantees an annual license fee, providing a more predictable return on investment. 50 While the development of new antimicrobial drugs is important in the short term, history has shown that resistance will Develop frameworks for the optimal and ethical application of new technologies, such as social network surveillance and advanced pathogen genomics. Provide leadership within the Asia Pacific region and link with international efforts â–º Strengthen linkages with and support of regional WHO offices (Western Pacific and Southeast Asia), especially the 'Health Security and Emergencies' and 'communicable diseases' sections and other regional mechanisms and forums, including the South Pacific Commission, the East Asia Summit and the Asia Pacific Economic Cooperation, as well as global initiatives such as Global Health Security Agenda and the Development Banks. â–º Encourage adequate funding of DFAT's Regional Health Security strategy. â–º Link with One/Eco/Planetary health communities in other countries, encourage a 'united front' and support international efforts *This was recently completed, 51 but many of the core elements remain to be executed. develop in response to selection pressure and spread without appropriate infection control measures. Alternative therapeutic strategies, such as bacteriophage treatment may be successful if linked to rapid and accurate pathogen identification. Attempts to reduce selection pressure fuelled by indiscriminate microbial killing, includes highly targeted bacteriophage-based approaches, modification of disease causing microbes to make them more susceptible to immune attack and developing strategies that prevent or selectively treat invasive disease only. Rapid point-of-care tests that differentiate viral and bacterial infections, and provide antimicrobial susceptibi