Overview of the implementation of JETACAR recommendations
This chapter outlines the work undertaken by JETACAR, the initial response
to its recommendations and whether the recommendations still remain relevant
today. The effectiveness of the implementation of the JETACAR recommendations
relating to coordination and resourcing are included is this chapter. The remaining
recommendations are covered in more detail in the following chapters.
The JETACAR recommendations and initial response
JETACAR was established by the Commonwealth to review the link between
the use of antibiotics in food-producing animals and the emergence and
selection of antibiotic resistant bacteria and their spread to humans.
JETACAR brought together human, veterinary and food interests.
The 1999 JETACAR report noted that the committee had considered the
whole area of antibiotic resistance and its importance in human and veterinary
medicine. The committee concluded that there was evidence for:
- the emergence of resistant bacteria in humans and animals
following antibiotic use;
- the spread of resistant animal bacteria to humans;
- the transfer of antibiotic resistance genes from animal bacteria
to human pathogens; and
- resistant strains of animal bacteria causing human disease.
JETACAR reported that the ongoing emergence of antibiotic resistant
bacteria is causing essential, life-saving antibiotics to be less effective. As
a result, there are fewer alternative treatments and sometimes more toxic and
costly antibiotics must be used instead.
The JETACAR report proposed that Australia adopt an antibiotic resistance
management program that focussed simultaneously on both humans and animals. The
proposed program was a coordinated multidisciplinary approach with five key
elements, as follows:
- regulatory controls (recommendations 1–9);
- monitoring and surveillance (recommendations 10–11);
- infection prevention strategies and hygienic measures
- education (recommendations 15–17); and
further research (recommendations 18).
The JETACAR report stated that 'all five elements of the program must be
implemented together if there is to be any chance of reversing the trend to
increasing antibiotic resistance'.
JETACAR also made recommendations in relation to communication
(recommendations 19–20) and coordination of resistance management
The Government response to JETACAR
and subsequent actions
The Government responded to the JETACAR report in 2000 largely
supporting the intent of the recommendations and acknowledged the threat from
antibiotic resistant organisms to the health and economic prosperity of the
In responding to the JETACAR report, the Government accepted nine recommendations,
did not express an opinion on one recommendation and offered qualifying words
for the remaining recommendations, often agreeing with the intent and
principles of those recommendations.
To implement its response, the Government stated that it would establish:
- an Expert Advisory Group on Antibiotics (EAGA), under the
auspices of the NHMRC, to provide continuing advice on antibiotic resistance
and related matters; and
- an Interdepartmental JETACAR Implementation Group to oversee and
coordinate the continuing Government response to the JETACAR, to respond to the
policy advice received from the EAGA, and to seek funding for implementation
The expert advisory group was formed as the Expert Advisory Group on
Antimicrobial Resistance (EAGAR). It was responsible for providing independent
scientific and policy advice on AMR issues and worked closely with the CIJIG to
develop and implement the national AMR management program. EAGAR also provided
advice to the regulatory bodies, Australian Pesticides and Veterinary Medicines
Authority (APVMA) and the TGA. EAGAR reported through the implementation group
to ministers and the NHMRC.
EAGAR was disbanded in 2007.
The Commonwealth Interdepartmental JETACAR Implementation Group (CIJIG)
was established in November 2000 to facilitate the planning, development,
coordination and implementation of the antimicrobial risk management program as
proposed by JETACAR. The CIJIG was also to incorporate advice from EAGAR. The
CIJIG was jointly chaired by the Department of Health and Ageing (DoHA) and Department
of Agriculture, Fisheries and Forestry (DAFF). In 2003, the CIJIG progress
report provided information on actions taken in response to the JETACAR
The CIJIG was disbanded in 2004.
The following table provides a summary of the significant elements
relevant to AMR issues following the Government response to JETACAR to 2013:
Table 2.1: Summary of significant elements relevant to
2000 – 2002
Australian Health Ministers'
Conference JETACAR Taskforce
- oversaw activities arising from the JETACAR report
- provided conduit for human health related issues to
2000 – 2004
Interdepartmental JETACAR Implementation Group)
- responsible for promoting implementation of JETACAR
- reported through the Australian Health Ministers'
Conference JETACAR Taskforce
Australian Infection Control
Association – National Surveillance of Healthcare Associated Infection in
- report developed in response to JETACAR
- study of surveillance activities, policies and
programs across Australia
National Summit on Antibiotic
- involved participants from human health, food and
- proposed priorities for national action
National consultation on
antibiotic resistance surveillance
- part of the post-JETACAR Report consultation
- workshops and focus groups involved all states and
territories seeking input to a antibiotic resistance surveillance plan
Strategy for Antimicrobial
Resistance Surveillance in Australia
- published in Communicable Diseases Intelligence
- proposed a comprehensive strategy to address JETACAR
recommendations relating to surveillance
2001 – 2007
EAGAR (Expert Advisory Group
on Antimicrobial Resistance)
- role of expert advisory group under the oversight of
- produced outlines of a comprehensive set of projects
to address JETACAR recommendations
Integrated Surveillance Program to Improve Australia's Response to
- contained the outlines for nine projects that would
address surveillance of antimicrobial resistance and antibiotic use
2010 – 2012
NHMRC AMRAC (Anti Microbial
Resistance Advisory Committee)
- established by NHMRC in 2010
- AMRAC’s term expired on 30 June 2012
Summit – A call to urgent action
- jointly convened by the ASID and the ASA
- a proposed plan of action was published in the Australian
Medical Association journal
Resistance Standing Committee)
- established in the review of committee structures
under the COAG Standing Council on Health
Source: Department of Health
and Ageing and portfolio bodies joint submission, Submission 32,
AMRSC was established in mid 2012 to advise the Australian Health
Protection Principal Committee (AHPPC) on matters relating to AMR; provide
expert advice and assistance on issues relating to AMR; and recommend national
priorities relating to AMR for action. AMRSC has both government members (including
DoHA, DAFF and APVMA) and non-government members (including the ASA and NPS
MedicineWise). AMRSC is to develop a national strategy to minimise AMR.
A study, The Surveillance and Reporting of Antimicrobial Resistance and
Antibiotic Usage in Australia: A National Study, was commissioned to provide an
evidence base for AMRSC's work plan.
AMRSC was funded through the Australian Commission on Safety and Quality in
Health Care (ACSQHC) until 30 June 2013.
In addition, in February 2013, DoHA and DAFF agreed to establish
strengthened governance arrangements for the oversight and coordination of
Australia's efforts to prevent and contain AMR. The Australian Antimicrobial
Resistance Prevention and Containment Steering Group (AMRPC Steering Group) will
consist of the Secretaries of each department, as well as the Commonwealth
Chief Medical Officer and the Commonwealth Chief Veterinary Officer. It will
provide governance to oversee the development and implementation of a coherent
national framework for current and future work related to AMR.
Implementation of JETACAR recommendations
DoHA noted that AMR is an important global public health priority and argued
that significant progress had been made in responding to the challenge of AMR
since the JETACAR recommendations were made. Professor Chris Baggoley, Chief
Medical Officer, DoHA, stated that AMR continued to be a priority of the
department and its portfolio agencies.
Professor Baggoley added:
Certainly it is fair to say that not all recommendations have
been enacted. But it is important to understand also that the government in its
response to JETACAR accepted unequivocally nine, I think, of the 22 recommendations,
and for the remainder it either reserved or did not express an opinion on one,
and offered qualifying words for the others, either agreeing with the intent,
the concept, the principles, the development, or 'agreed but'.
In addition, DoHA noted that 'in some instances priorities for action
may no longer directly align with the JETACAR recommendations'.
DAFF also argued that substantial progress had been made in implementing
the JETACAR recommendations:
Many of the recommendations of the JETACAR Report involving
DAFF have been and continue to be implemented. These include enhanced
antibiotic assessment processes, adopting a conservative approach to antibiotic
registration, progress in moving towards harmonised control of use legislation
between the various jurisdictions, surveillance activities, proactive
approaches to education and awareness of antimicrobial (AMR) resistance issues
and influencing research and development organisations to have a focus on AMR
DAFF noted that ongoing attention to the management of AMR risks is
needed and that this will increasingly require a collaborative approach
involving a range of stakeholders.
Submitters agreed that some progress has been made in implementing a
range of JETACAR recommendations. Goat Veterinary Consultancies, for example,
stated that the 'Australian Government response to the JETACAR review was very
thorough and many actions were promised. Most, but not all, have been completed
in the intervening years.'
The ASA provided details of the initiatives undertaken through the CIJIG and EAGAR
including the review of all antimicrobials in the human, veterinary and
agricultural sectors by the National Drugs and Poisons Scheduling Committee. As
a result, all but one class of antimicrobials remained or were converted to
prescription only by medical practitioner or veterinarian.
The ASID also noted that the ACSQHC was addressing improvements to
infection control programs and that they are now mandated in all healthcare
facilities through accreditation standards. State-based healthcare associated
infection surveillance programs have also been developed across the country and
are collecting a substantial volume of data. ASCQHC has also funded the
National Hand Hygiene Initiative for healthcare facilities and infection
control indicators are published on the MyHospitals website. ASID went on to
Similarly, the ACQSHC has adopted antibiotic stewardship as a
major part of their hospital infection program and the presence of an effective
stewardship program is now a mandatory part of achieving satisfactory
accreditation. The efficacy of this initiative in reducing antimicrobial usage
and consequently resistance is as yet unknown.
Evidence was also provided that, following JETACAR, there was improved
engagement across relevant groups and experts, such as the medical and animal
agricultural communities, through bodies such as EAGAR. Professor Rood, Past
President, Australian Society for Microbiology, commented that EAGAR was a very
representative body. The Cattle Council of Australia and Sheepmeat
Council of Australia also noted improved collaboration:
The result of improved understanding of antibiotics
resistance issues, behaviours and communication since the JETACAR report have
led to the medical and animal agriculture communities having a better
understanding of each other's position and a respect not previously
experienced. A recent 'debate' in the Medical Journal of Australia, presented a
'yes' and 'no' case for the significance of use of antibiotics in animal
agriculture to resistance in human infections. The two positions, one written
by a human infectious diseases expert and the other written by a veterinary
pharmacologist, when directed to the effectiveness of control exerted in
Australian agriculture, were not far apart.
Concerns about the implementation
While some significant outcomes were achieved following the JETACAR
report, submitters and witnesses also pointed to considerable flaws in the
implementation of the recommendations. In particular, it was argued that key
recommendations have not been actioned. Professor Peter Collignon, infectious
disease physician and a member of JETACAR, stated that while there had been
many very good recommendations 'a lot of them have been done only partially or
not at all'.
As a consequence, Professor Collignon commented that 'what we have now more
than 10 years later is much better data showing how this problem is
Professor Cooper stated that he was of the view that 'it is clear that
most of the recommendations have been minimally implemented or been given
The ASA provided the committee with a list of recommendations which it
considered had been only partially addressed or not at all. These included:
- an initiative to have formal resistance risk assessment as part
of the registration of new antimicrobials and extension of their indication,
similar to the process introduced by the APVMA, was commenced by the
Therapeutic Goods Administration, but never completed;
- a review of streptogramin (virginiamycin) use in the food animal
sector was completed and recommendations were made for restricted use. The
proposals were then the subject of appeal by the sponsor. The Administrative
Appeals Tribunal heard the appeal, and set aside the decision. The agent
remains on the market under its pre-JETACAR license;
- attempts were made to harmonise veterinary prescribing
legislation across states by the Primary Industries Standing Committee, but met
with only partial success. The recommendation to make it an offence to
prescribe and/or use a veterinary chemical product contrary to a label
constraint was not implemented;
the proposal for comprehensive antimicrobial resistance and usage
surveillance across all sectors was developed by EAGAR but this was never
- there was no implementation of coordinated policies to minimise the
use of antibiotics in humans and animals, and no licensing and monitoring process
for antimicrobial importers;
- the requirement for the TGA to provide resistance rate data in
the human product label was not followed up, largely due to the lack of comprehensive
national resistance surveillance; and
- an attempt to establish a targeted antimicrobial resistance
management research agenda by the NHMRC was unsuccessful.
Reasons for the failure to
implement the JETACAR recommendations
The committee considered whether the lack of progress could be a result
of the JETACAR recommendations being flawed or no longer relevant. However,
this appears not to be the case with many witnesses and submitters noting the
continuing relevance of the JETACAR recommendations.
For example, Professor Grayson submitted that:
The report was a national and international milestone in
terms of its vision. ...Unfortunately barely any of the 22 JETACAR
recommendations have been implemented during the past 13 years, yet they remain
just as relevant to finding a solution in 2013 as they were in 1999.
Professor Grayson went on to state that, in fact, the report was 'too
far ahead of its time and as a consequence it did not result in policy change:
The JETACAR report was too far ahead of its time. It really
did not resonate with people. It had a lot of foresight in identifying what was
going to become a problem, but it did not translate into genuine awareness in
the community and among policy makers as to the fact that an ounce of prevention
was worth a lot of cure. I think that underappreciation was one thing.
The ASA stated that JETACAR was a 'blueprint for tackling antibiotic
resistance which is still relevant and even more cogent today'. The ASA noted
that its recommendations were in line with those of the World Health
Organisation and programs of other developed countries in Europe and North
Indeed, the committee was informed that Canada was initially inspired by the
JETACAR report to conduct its own review. The NSW Government Department of
Primary Industries stated that, as a result, Canada now has a well-integrated
system, that includes quality surveillance:
A comparison of implementation of JETACAR with the equivalent
program in Canada is worth noting. The Canadian Integrated Program for
Antimicrobial Resistance Surveillance (CIPARS) evolved from a review by the
Canadian Government similar in nature to JETACAR. The Canadian review was in
fact subsequent to and inspired by JETACAR. In contrast to the JETACAR
implementation, the Canadian response was well funded, well resourced, and well
managed by an identifiable team of professionals having a strong overarching
(truly integrated) understanding of antimicrobial resistance and antimicrobial
use in animals, food and man. As a result, the Canadians have produced good
quality surveillance that has provided critically important intelligence used
to improve both human and animal health.
Lack of a coordinated response
Witnesses were critical of the lack of commitment to AMR issues by
Professor Grayson stated:
The reality is that both state and federal governments of all
persuasions have not taken the issues of emerging resistance seriously enough
or have not understood the fact that it really is here, it is present and it is
happening now. 
Submitters noted that JETACAR concluded that coordination across
government, human medicine, veterinary medicine and the animal food production
sectors was required to address AMR and made recommendations accordingly. The JETACAR
report also encouraged the appropriate resourcing of the actions to implement
In its response, the Government supported the general concepts and
intent of recommendations relating to coordination and resourcing while taking
a slightly different path to implementation. The Government created EAGAR with
a balance of expertise reflecting human and veterinary usage of antibiotics.
The CIJIG was also created. However, as noted above, the CIJIG was disbanded in
2004 and EAGAR was disbanded in 2007. Other bodies created included the Expert
Panel on Health Advice under the NHMRC. This operated from 2008 to mid 2009.
In 2010, the NHMRC established the Anti Microbial Resistance Advisory Committee
(AMRAC) to provide advice to the Chief Executive Officer of NHMRC on issues
relating to antimicrobial resistance. AMRAC's term expired on 30 June 2012.
Evidence provided to the committee suggests that initially there was a
coordinated response to the JETACAR recommendations. The Australia Institute
noted that, following JETACAR, the EAGAR and CIJIG had been established.
However, both those bodies were disbanded by 2007 and submitters argued that,
as a result, no coordinated approach existed to address AMR.
Professor Cooper also commented on the fragmented approach to the
implementation of the JETACAR recommendations and stated 'unfortunately
responsibilities for prioritisation and implementation of the 22 JETACAR recommendations
concerned dozens of departments and governmental agencies. This meant that no
one agency, or minister was responsible or accountable.'
Specifically in relation to EAGAR, Professor Rood, Australian Society
for Microbiology, noted that as EAGAR had been established under the NHMRC, its
focus shifted over time:
...where it went wrong...is where EAGAR was located within the
NHMRC. It was a problem. Gradually, as EAGAR developed its brief it became more
regulatory in nature and more risk assessment-type in nature. I will stand
corrected on this by others who are more knowledgeable than me: I think that
probably did not sit well within the framework of the National Health and
Medical Research Council at the time. There was a lack of will—I am not sure
where that good will came from—to really push this to the next level. That is the
point where I think it fell over.
A more critical view of the lack of implementation of a coordinated
approach was provided by Professor Mary Barton. Professor Barton stated that
DoHA was 'totally unresponsive and disinterested for all the time EAGAR was
active'. In relation to CIJIG, Professor Barton commented that it 'rarely met
and did nothing' and concluded that 'any actions arising from JETACAR were
carried largely by EAGAR with cooperation from APVMA, the then [National Drugs
and Poisons Schedule Committee] and TGA'.
In response to the lack of coordination in addressing AMR, other
organisations have sought tackle AMR issues. For example, the ASA and ASID
convened the Antimicrobial Resistance Summit in February 2011. The aim of the
Summit was to update the work generated in the first JETACAR report, and with
discussion and consensus, to help determine future strategies for control. The
ASA commented that the meeting was organised as a result of concern that 'the
important recommendations of JETACAR had failed to be implemented and by the
recognition of increasing antimicrobial use and spread of antimicrobial
resistance worldwide and in Australia, affecting the medical, veterinary and
agricultural sectors'. In addition, it was recognised that 'unlike other
countries, Australia had no overall coordinated approach to this major problem,
and that the response to this threat was disparate, under resourced and
therefore likely to be ineffective'.
The Summit made recommendations in five main areas including
surveillance, education and stewardship. The Summit concluded that:
The threat to multiresistant bacteria is a critical public
health issue that requires a coordinated, multifaceted response.
The Australia Institute also commented that Australia performed poorly
in relation to the factors identified by the WHO as contributing to AMR. The
...inadequate national commitment to a comprehensive and
coordinated response; ill-defined accountability and insufficient engagement of
communities; weak or absent surveillance and monitoring systems; potentially
inappropriate and irrational use of medicines, including in animal husbandry; a
need for improvement in infection prevention and control practices, as well as
insufficient research and development on new products.
National management body
The Summit proposed the establishment of national AMR management body
comprising a wide range of stakeholders. The role of the body would include
implementing a comprehensive approach to monitoring, research and upgrading of
the current regulatory system applying to antibiotics.
The PHAA argued that an Australian Centre for Disease Control should be
established along similar lines to the Canadian centre, suggesting that it:
be adequately resourced to examine and define the underlying
epidemiology of antibiotic resistant organisms
be adequately resourced to examine and define best-practice
control and prevention interventions in hospitals and other healthcare settings
and the community.
The ASA favoured a body similar to the Swedish Strategic Programme
against Antibiotic Resistance (STRAMA). This body advises the Swedish Institute
for Infectious Diseases Control in:
- matters regarding antibiotic use and containment of antibiotic
- facilitating an interdisciplinary and locally approved working
model, ensuring involvement by concerned authorities, counties, municipalities
and non-profit organizations.
The ASA concluded that 'any such authority should extend beyond an
advisory role to governments, and instead would formally co-ordinate and fund
the multiple strategies required to control antibiotic resistance in both the
health and non-human sectors and help develop public policy and enable
A key aspect of any national system would be to ensure that it is
implemented through a whole of government response with the states and
territories, because of the shared responsibilities for health. Professor
Grayson commented that the national system for hand hygiene that had been
rolled out through the ACSQHC may be a good example to follow. Professor Grayson
noted that there is now 'a greater sense of collaboration between the
jurisdictions and federal bodies'.
Response to concerns
DoHA provided additional information on the disbanding of EAGAR and
CIJIG and recent initiatives in providing a more coordinated approach to
addressing AMR in Australia.
DoHA indicated that EAGAR and CIJIG had been wound up 'as they had
essentially done their job and as a result of other emerging health protection
priorities'. The work of the original committees was not handed on and DoHA
stated that it had been able to use ongoing expert committees such as the
Communicable Disease Network Australia and the Public Health Laboratory Network
for advice on AMR related matters when required.
In relation to animal health, AVPMA considers AMR when evaluating
applications for the registration of new antibiotics and major extensions of
use for existing antibiotics. APVMA also collects voluntarily supplied
information from registrants on the quantity of veterinary antimicrobial
products sold in Australia.
Two bodies have recently been established: the AMRSC in April 2012; and,
AMRPC Steering Group in February 2013 (see paragraphs 2.12 –2.13 above). DAFF
stated that 'while this group is still in the early stages of its work, its
formation is viewed as a key initiative in the Australian context'.
In relation to the Steering Group, Professor Baggoley commented:
This initiative will allow us to connect all the dots from a national
policy perspective and address the full spectrum of AMR issues that impact on
human and animal health and agriculture.
The Royal Australasian College of Physicians and the ASA supported the
establishment of AMRSC.
The ASA stated that it 'finally provides a great opportunity to bring together
the many segments of this mosaic and to co-ordinate a plan for action and a
co-ordinated national response' to AMR.
The ASA concluded:
The establishment of the AMRSC must provide the impetus and
guidance for a co-ordinated approach to address antimicrobial resistance in
humans and animals. The establishment of the AMRSC is an early, but very
positive step. We need it to continue to fulfil its promise by being provided
with sufficient ongoing funding and authority.
ASID commented that the establishment of AMRSC has begun to address AMR.
However, a substantial increase in resources is urgently required to coordinate
and implement the coordinated approach envisaged by the Antimicrobial
Professor Grayson commented that the Steering Group is 'an incredibly
welcome development'. However, he went on to comment that in the past, similar
committees have been formed but no real action has been undertaken and that we
need to be sure that they are there to make sure things get done, not to just
talk about doing them.
The evidence provided to the committee points to continued growth in the
prevalence of AMR in human medicine. Of deep concern are the trends in the
growth of resistant infections in not only hospital settings, but also in the
community. There is also ample evidence that multiresistance is emerging as a
significant problem and that resistance is now been found to 'last-line'
antibiotics. The Australian community could face the prospect of returning to a
pre-antibiotic era where minor, common infections lead to significant adverse
health outcomes. In addition, governments face increased healthcare costs with
patients needing longer hospitalisation and more expensive medications and
hospitals needing to implement more expensive patient management programs and
infection control programs.
The committee considers that the recommendations put forward by JETACAR
remain highly relevant. Although there have been some important changes and
additions to the AMR landscape since JETACAR, in many cases these changes only
increase the importance and urgency of the pursuing the core themes of the
Unfortunately, it appears that the preventative measures recommended by
JETACAR were not sufficiently implemented. The committee notes the comments
made by Professor Grayson in this regard:
I think a number of things have changed since the JETACAR
report. In many ways the cat is now out of the bag. The JETACAR report was
excellent and, as I have put in my submission, was really a milestone, but many
of the things that it was predicting were going to happen in terms of emergence
of resistance are now happening.
The evidence received during the inquiry pointed to a promising initial
response to the recommendations, in particular the establishment of the
JETACAR-related bodies EAGER and CIJIG. However, both these bodies had been
disbanded by 2007 with the result that the JETACAR recommendations were only
implemented in part. The committee notes DoHA's comments that these bodies had
'essentially done their job'. However, the committee is not convinced that this
is a sufficient explanation. The committee addresses specific issues in
implementing the JETACAR recommendations in the following chapters.
The committee acknowledges that AMR matters, following the disbanding of
the JETACAR related bodies, continued to be addressed by DoHA with advice from bodies
such as Communicable Disease Network Australia and the Public Health Laboratory
Network and that APVMA continued its work in relation to animal health.
However, given that AMR was recognised by the WHO as a significant health issue
in the late 1990s as well as the far-sighted and ground breaking work of
JETACAR, the committee considers that the apparent lack of commitment to a
response to AMR in Australia to date is of significant concern.
The committee acknowledges the establishment of the AMRSC in mid 2012
and the AMRPC Steering Group in February 2013. It was explained to the
committee that AMRSC 'provides the science and the clinical expertise
understanding policy and governance, and the [Steering Group] really looks to
policy and governance understanding science and clinical'.
First, in relation to AMRSC, its purpose is to develop a national
strategy to minimise AMR. The national strategy is to encompass most of the
matters identified in evidence to the committee as being critically important
for a comprehensive and coordinated response to AMR. However, the committee notes
that the AMRSC's work focusses on human health and does not encompass animal
health. The reporting pathway for AMRSC is essentially health focussed, that is
it will report to the AHPPC which is a committee of the Health Ministers
Advisory Council. The Advisory Council reports to the Council of Australian
Governments (COAG) Standing Council on Health. From the evidence received, it
is clear that addressing only part of antibiotic use is not a sufficiently
comprehensive approach to AMR prevention and containment.
Initially, funding for AMRSC was provided until 30 June 2013. DoHA has
indicated AMRSC will continue its role including providing advice to AHPPC and
advice to the Steering Group to inform the development of the national AMR
In relation to the AMRPC Steering Group, the committee notes that its
role is to oversee the development and implementation of a coherent national
framework for current and future work related to AMR. The terms of reference
are extensive and wide ranging. The membership consists of the secretaries of
DoHA and DAFF and the Chief Medical Officer and the Chief Veterinary Officer,
thus bring together human and animal health. It is to meet at least four times
The Budget 2013–14 Portfolio Budget Statement for the Department of
Health and Ageing states that:
The Australian Government will develop a National
Antimicrobial Resistance (AMR) Prevention and Containment Strategy for Australia,
to provide national and international leadership on this significant global health
priority. The Strategy will also coordinate Australia's efforts across human
and animal health to reduce, monitor and respond to AMR. The Government will
expand surveillance of AMR and antibiotic usage; implement infection prevention
and control activities to reduce the spread of infection in general and of
resistant infections in particular; and implement antimicrobial stewardship
programs to provide a systematic approach to optimising the use of antibiotics
in primary health care, residential aged care facilities and hospitals.
The Steering Group will oversee the development of the National Antimicrobial
Resistance Prevention and Containment Strategy. The committee welcomes
the focus being given to the development of a Strategy, but is concerned that
there appears to be no publicly available information on the time table for
finalisation of the Strategy.
The committee believes that the risk is not simply ongoing increases in
AMR. Rather, it is that the focus of establishing an AMR strategy will be diverted
through yet another set of committees. The evidence provided by DoHA on
27 significant elements relevant to addressing antimicrobial resistance
issues between 1998 and 2013 is a case in point.
The committee notes that the list of significant elements, only contained
tasks, roles and outputs and lacked information on outcomes and evaluation of
the almost 15 years of actions. In particular, the committee notes that in
2003 the Strategy for Antimicrobial Resistance Surveillance in Australia
was developed by EAGAR but it appears that it has not been fully implemented.
The committee considers that an urgent, comprehensive and robust
national strategy that is specifically focused on timelines and outcomes, is
needed to address AMR. The committee therefore believes that an independent, national
body should be established to deliver the national AMR resistance strategy. Such
a body should seek to draw and coordinate officials and experts from State and
Commonwealth Governments. In this way human, animal and animal-derived AMR
issues can be addressed in a consistent manner and programs effectively
coordinated and delivered. Such a body should have the authority and capacity
to collect and analyse data on AMR and be suitably resourced. In addition, an
independent body with clear accountability and reporting requirements will encourage
a continued focus on tackling AMR issues.
The committee recommends that the Commonwealth establish an
independent body or national centre, to develop a strategy, report publicly on
resistance data and measures taken to combat antimicrobial resistance and to
manage the response to antimicrobial resistance in Australia.
The committee recommends that the independent body be resourced
to implement a rigorous monitoring and reporting regime of antibiotic use in
humans and animals and of multiple drug resistant infections in humans and
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