Toespraak tijdens de World Health Assembly

Toespraak | 20-05-2014

Ladies and gentlemen,

Thank you for joining us today. And thank you Ms Davies and mr Fukuda for this meeting and for your inspirational view on the topic of this meeting: antibiotic resistance.

Ladies and gentlemen:

Whether you live in poverty in the slums of a big city or receive an expensive cosmetic treatment in a top of the bill hospital - resistant bugs are everywhere and their number is growing fast. They know no borders. They don’t discriminate.

The worst: they don’t respond to drugs.

So whoever you are. Wherever you live: this concerns us all.

The toll of antibiotic resistance has been calculated: thousands of additional deaths due to infections with resistant bacteria, billions of avoidable costs in healthcare.

The numbers and figures are impressive but anonymous. Behind them are people like you and me, people with children, people with grandchildren, getting seriously ill or even dying from common infections. A bladder infection, diarrhea, a skin infection.

It does not stop there.

Even common surgeries like getting an appendix removed or a knee replaced will become impossible or life threatening. By which ongoing resistance will be the end of what we know as regular healthcare.

Or: as the WHO states in its last surveillance report: a post-antibiotic era - in which common infections and minor injuries can kill - is not an apocalyptic fantasy but a very real possibility for the 21st century.

So we are facing a global problem. Similar to climate change, nucleair security and international terrorism.

The message is clear: We have to act now and we have to act together.

Three steps are necessary:

First: we have to stop the overuse and abuse of antibiotics in healthcare and agriculture.

Second: we have to prevent infectious diseases – and thereby the use of antibiotics - by stepping up hygienic measures. Again: both in health care and in the veterinarian sector.

Third: we need new drugs. No new class of antibiotics has been discovered since 1987.

Simply because they are not lucrative – the aim is not using them at all or as less as possible. So you can imagine: this is not a good business case.

These three steps require an enormous effort. A joint effort. An international effort. But at the same time: we shouldn’t make the mistake to wait for each other. We all have to start in our own countries. National action is the corner stone of international results.

National action works. I know from experience in my own country.

Human consumption of antibiotics in the Netherlands is subject to a stringent national policy.

It is based on professional guidelines for infection prevention and prudent and restrictive use of antibiotics. As well as a search and destroy policy for unwanted resistant bacteria, mainly MRSA.

And it works.

In my country – as in the Scandinavian countries – the percentage of MRSA is about 1%. The lowest in Europe. The average in the rest of Europe is 25%.

Ladies and gentlemen, I already mentioned the livestock industry. Which has – worldwide – become far too dependent on the use of antibiotics, contributing to resistant strains that occur everywhere in the environment – also in our daily food. Antibiotics are even used for preventive use and to boost growth.

Let’s take a look at my own country again, this time at our livestock. In 2007 we were the number 1 heavy user of antibiotics in the European Union. So nothing to be proud of.

This had to stop. In 2009 we agreed with the industry to reduce the use of antibiotics in veterinary medicine by 50% within three years. A goal we reached in 2012. It moved us from place 1 to place 10 of the 25 countries that register  their veterinary use of antibiotics. Research shows resistance in animals is recently reducing as well.

Encouraging, but still: we can do better. Our next goal is a reduction of 70% by the end of next year.

This progress was mainly based on political will and courage, dedication and effort by the livestock sector and government supervision.

National action can make a difference!

Step two, is that we have to prevent infections. The simple truth is: Infections that do not occur, don’t need treatment.

An example: In the Netherlands we have two million hospitalisations per year. A third with the use of antibiotic treatment. But about 50% of these treatments is due to hospital acquired infections.

So imagine what we could achieve if the number of hospital infections goes down.

Infection prevention is no rocket-science. Relatively simple measures render great effect. Washing your hands in the right way, risk assessment of specific patients. A search and destroy policy to prevent resistant bacteria to enter our health care systems.

If this is true, why then do we still accept doctors and nurses to ignore basic hygiene principles? How can we, each in our own situation, reduce the occurrence of healthcare related infections? It is just one out of many questions we have to ask ourselves.

Infections in livestock industry also often result from the way in which animals are kept. Preventive use of antibiotics is supposed to be necessary. Well, it isn’t. And I believe it should be banned. It is possible to break the dependency of antibiotics and breed animals in a different way. We have done so and it did not ruin the industry.

Ladies and gentlemen, the point of all this is of course not to ban the use of antibiotics completely. We need them, both in animal and human medicine. Critically ill patients need cure, diseases that easily spread in stables need to be stopped.

However, when we use them, we have to use them in a prudent and restrictive way. We have to use them wisely.

•          Not for viral infections – they don’t work there.

•          Only with proper diagnosis

•          Under national surveillance and with peer systems for medical professionals.

But yes, we should ban the growth and preventive use in animal husbandry. And we should ban the use of our last resort antibiotics in animal husbandry all together.

It won’t be enough. In spite of all our efforts we still need new antibiotics and antibiotic strategies.

At this point in time, there is no incentive for the industry to invest the money and dedicate time needed.

Only an international approach, collaborative action between governments and industry can break this vicious circle. We have to find new and innovative business models, we have to find push and pull mechanisms. Like public private partnerships. There is serious effort and money involved.

Political courage at the global scale is crucial to tackle this situation.

And there is no time to waste. The first completely resistant bacteria, for instance in people with tuberculosis, are being found right now. Remember: they know no borders. They don’t discriminate.

So besides doing our own homework, we need to join forces!

We need collaboration. Between the human and veterinary world, between neighboring countries, with private partners and at the global scale. And we need it now!

The Netherlands is more than willing to do so.

Next month, on the request of Director General Chan, we will host a ministerial meeting in the Netherlands. This ministerial meeting, co-sponsored by The World Health Organization, has the objective to speed up political commitment and to give input for the Global Action Plan.

And it won’t be just the ministers of health that are invited. We need the ministers of agriculture as well.

Ladies and Gentlemen,

The bugs are smart and they are fast. We need to outsmart them and we need to be even faster. Let’s tackle them together.

Thank you for listening.