AMR-Times Newsletter #21
December 2017
In this issue:
  • Editorial: Hurrah for Meat! 
  • Plasmids: key vehicules for AB Resistance
  • A Week of AB Awareness 
  • WHO EB: from UHC to AMR and Global Health Security 
Next issue in January:
  • Moscow TB Summit: BRICS countries on TB 
  • Report on the RICAI, Paris global meeting on anti-infectives and AB resistance 
  • Sydney to host: First World Conference on Global Health Security 

If you would like to subscribe to the newsletter please click here.You can also view the previous issue(s) of this newsletter by clicking hereYou can view WAAAR’s (World Alliance Against Antibiotic Resistance) /ACdeBMR yearly publication on AMR here: AMR Control 2015 /AMR Control 2016.

Hurrah for Meat & Turkey!

Our best wishes to all for the New Year!

The past months have seen a rise of more and more arguments in the mainstream press to cut down on meat consumption, with meat-free diets presented as both essential to combat AMR (because of antibiotics in animal feeds, presently  the greater portion of global purchase and consumption) and as a key policy to combat climat change because husbandry is a large producer of greenhouse gas emissions, with, frequently an 'anti-productivism' and 'de-growth' promotion trend. 

The argument against meat is being pushed forward now in the maintream press while petitions circulate to that effect. 

Lately the Guardian, published policy proposals to instaure taxes on meat, presenting this as probably unavoidable over the next ten years. ("Meat tax ‘inevitable’ to beat climate and health crises")  the article cites a study which "shows that increasing the price of beef by 40% would lead to a 13% drop in consumption."  and writes: "’Sin’ taxes to reverse the rapid global growth in meat eating are likely in five to 10 years, according to a report for investors managing over $4tn..."

We find bizzare these alledgedly ‘science-based’ arguments starting with humans as 'siners' (for a new 'Goddess').

Not a month goes by without a criticism leveled at the expected increase in meat production in Low and Middle Income Countries. Often enough, the argument is coupled with a 'bio only' or 'vicinity production only' argument.

We would like to point out that to stop meat production at present level would deprive the 3 billion plus poor people from access to basic proteins indefinitely, while taxes on meat in wealthy countries would further deprive the poorest half of the population from protein, to which they already have a shrinking access. It would also be harsh on most of the middle class already over-taxed because of the tendancy to decrease taxes on upper incomes while decreasing (or even forbidding) public investments in education, infrastructure, health or research. Further, it would fuel obesity, one does get fat on potatoes and noodles and slim on meat and veggies.

Even in the OECD countries going away from meat production would endanger national nutrition. An article in the Proceedings of the National Academy of Science in the US analysed the effect, just on the US population alone, if the US were to shift from a meat based to a solely plant based diet and concludes that: "This assessment suggests that removing animals from US agriculture would reduce agricultural GHG emissions, but would also create a food supply incapable of supporting the US population’s nutritional requirements. " 

We do not mean to deny that antibiotic use in husbandry is a problem The WHO is correct in demanding a more responsible management. And we agree with AMR specialist and AGISAR member Ellen Silbergeld's brilliant book "Chickensizing Farm and Food" : industrial production is essential to feed humanity, but it needs to be more respectful of human laborers, of animals and of the environment.

We note the paucity of arguments for infection prevention and control systems in husbandry globally ! There is also a paucity of demands for proper waste management, as some pharma companies have agreed to, and others need to come under regulations not to dump waste into the soil and rivers untreated.

Meat is good for the mostly carnivorous human population on this planet, meat based diet has contributed to the increase in longevity and good health of a growing population.  Everyone on this earth has a right to good nutrition, we cannot feed humanity properly without industrialized agriculture.

We believe that a while Indian vegetarian cooking is among the best in the world, (according to our taste buds) one ought to respect the diversity of the human condition and cultures. From the extensive use of glyphosate (registered as an antibiotic) to antibiotics use for bio fruits and vegetables, it would be travelling a deadend to target meat itself.

We need a campaign for containment of AMR infections with clean waste management, from the hospital to the meat plant, with a watch and a demand to insure similar containment and hygiene everywhere.

No, to combat AMR does not have to mean no meat delicacies for the New Year!

We wish our readers the best for the New Year, and may we operate together to feed the world well as soon as possible!

Garance Upham

(this editorial view point is entirely my sole responsibility)

Web=links: The Guardian:
Nutritional and greenhouse gas impacts of removing animals from US agriculture by M. B. Hall and R.R. White.

AGISAR and Ellen K. Silbergeld:

In AMR Control 2017, Pr Silbergeld writes with WHO Awa Aidara Kane on Agriculture and Food Production as Drivers of the Global Emergence and Dissemination of Antimicrobial Resistance, rationally.

Pr Silbergeld’s great critical book: “Chickenizing Farms and Food. How Industrial Meat Production Endangers Workers, Animals, and Consumers”

Web=link: / or check on Amazon.

Glyphosate was registered as an antibiotic in 2014. Overuse of antibiotics in plant production gives rise to drug resistant bacterial resistant infections of plants as well.

Overall we need more science and responsible behavior on the State level. No, AMR is not a lone patient’s responsibility! 

As for the trend to establish a sharp division between anti-bacterial and anti-viral, let us remember that pathogens often travel in team and that the first med used against HIV, the anti-retrovial AZT, is a powerful antibiotic!

Dear reader, if you want to react to my editorial :

Antibiotic resistance is commonly present on and spreads by conjugative plasmids

The study by Lopatkin et al. is based on the fact that antibiotic resistance is most commonly present on, and spreads by, conjugative plasmids. 

The rapid and global spread of conjugative plasmids carrying medically relevant AMR genes among bacteria, particularly Gram-negatives, is of great concern. 

Although these plasmids are arguably the biggest contributors to the spread and maintenance of resistance genes among bacteria, they are rarely considered as important targets to reduce the AMR burden.

Lopatkin et al. focused their work on trying to understand and quantify the persistence of resistance among bacterial populations due to horizontal gene transfer (conjugation). 

The first part of the study describes a mathematical model that was developed to determine the necessary plasmid transfer frequency to allow for the maintenance of the resistance genes among a population. Using their equation, the group was able to model various situations which resulted in plasmid and resistance maintenance and spread and confirmed that a plasmids will persist either due to carrying a beneficial trait and not having a metabolic burden and/or by having high transfer rates. 

These models suggest that if conjugation and/or plasmid stability would be targeted, resistance would no longer persist in bacterial populations.

In the second part of the paper, Lopatkin et al. used chemical compounds known to inhibit plasmid transfer and increase plasmid loss, but that have no effect on bacterial growth, to gather data for their model. 

Their results suggest that efficiently disrupting plasmid transfer and stability would allow for an effective loss of resistance from a particular population. 

This study further points at the necessity to consider different targets when dealing with the problem of AMR. Plasmids are ubiquitous among bacteria and are hotspots for the accumulation of resistance genes and key elements for their spread. 

Specifically developing methods to eliminate plasmids will reduce the global burden of resistance and this study provides compelling evidence that targeting individual conjugation and plasmid maintenance function will have a population wide effect.

Summary by Alessandro Lazdins, Ph.D.

Review of Lopatkin, A. J., et al. (2017). "Persistence and reversal of plasmid-mediated antibiotic resistance." Nat Commun 8(1): 1689.


Roundup for AMR awareness week campaigns 2017

Coinciding with the Antibiotic awareness week, lots of awareness campaigns have been launched, we highlight here some of the most remarkable ones:

US CDC: The Centers for Disease Control and Prevention (CDC) have launched "Be Antibiotics aware: Smart use, Best care " campaign aiming to achieve the optimum usage of antibiotics within each community member. The Campaign shows to the public the cases when Antibiotics are needed and when they are not. It has released also promotional materials that differentiate between viral and bacterial infections based on symptoms one could have.


US CDDEP: Many campaigns present bacteria as parasites, such as CDDEP:

The cartoon, otherwise funny, and well drawn:

Japan: Funny AMR campaign concerning using cartoons heroes in Japan in their campaigns:

World Health Organization, WHO: "Think Twice, Seek Advice", under this slogan, WHO has released its campaign in a simple but effective way of delivering the idea of the misuse of Antibiotics.

A poster representing that taking antibiotics as a candy will speed up bacterial resistance.

While another poster shows that we neither have much time nor reserve of effective antibiotics as a result of the antibiotics misuse.

“Antibiotics aren't always the answer. Always seek the advice of a healthcare professional before taking antibiotics."


On the other hand, WHO, Targeting social media with its different platforms, has released attractive animated posters and cartoons notifying about the best practice of Antibiotics in various means

Help prevent infection through good hygiene and never share antibiotics

Always seek the advice of a qualified health care professional before taking antibiotics

Here, we see a ‘Gender’ conscious poster as the doctor is a WHITE woman, but the ‘patient’ is  a BLACK (sic) guy. Beware of racial or anti-immigrant undertones.

Antibiotics do not treat viral infections, like colds and flu

The rise of Antibiotic Resistance is leading to untreatable infections which can affect anyone, of any age, in any country

 It is the bacteria itself, not the person or the animal, that becomes resistant to antibiotics. Without urgent action, we are heading for a future in which infections and minor injuries could once again kill.

Effective waste treatment can protect the environment and reduce antibiotic resistance

Anti-racism organization in Switzerland deplored the racial undertones of the WHO posters Think Twice which has a ‘black’ hand of a patient wanting to use antibiotics as candy and then adopting the proper behavior:  seeking a prescription from a ‘white’ hand of a doctor.

We strongly suggest that the WHO should abandon the blame the patient, and drop the blame the ‘colored person’ approach to responsible AB use.

We also need a better understanding of the microbiota, of the fact that we humans are made up of bacteria, and improper use of antibiotics can disturb the microbiota with bad side effects, rather than mis-understand the battle against AMR as the individual fighting THE BACTERIA as the enemy intruder...

Overall, we note that the issue of TRANSMISSION of AMR infections is not well communicated: antibiotic resistance has always existed. While it were very important to reduce AB use and consumption in human and animal health, emphasis needs to be placed on CONTAINMENT: Infection prevention and Control / Hygiene in health centers, in communities, in meat production, in the ENVIRONMENT. 

Otherwise the risk exists of an easy path towards a ‘blame strategy’, blaming the individual patient and the individual doctor, (with the easy slide into anti-migrant overtones) while it is the lack of HYGIENE AND CONTAINMENT which is the main cause of antibiotic resistance spread.

Report by Amr El-Ateek, and additional comments by editor in chief.

AMR-Times would very much enjoy the collaboration of a cartoon artist, as a volunteer, but some remuneration possible depending on talents and capacity to produce images, starting end of February when our E-Journal will be up on line. Write to

WHO: From 3 by 5 to 3 billion, emergency, security, and AMR?

The Executive Board  met Nov 22-23 at WHO headquarters. We saw there WHO director general Dr Tedros riding on a high horse with a 3 billion people objective at the core of the new program: one billion people covered by UHC (Universal Health Coverage). 

One is strongly reminded of Dr Jim Kim initiating the 3 by 5 program at the WHO: the idea of placing 3 million People Living with HIV (PLWH) under antiretroviral treatment by 2005 appeared overly ambitious then (in 2003), and it met with cynicism on the part of the leadership at the Global Fund, the later questionning whether Dr J. W. Lee (WHO director general) was in his  right mind and 'hadn't had a drink too much' to launch such 3X5 initiative! It did not have the support of the World Bank then either.

In fact the 3x5 'worked', even if it took more time to get off the ground, because many NGOs jumped in the fray, including some of us at the NGO Forum for Health with the World Council of Churches, organized support meetings, helped with advocacy, in popularizing the objectives, supported by WHO staff (often deployed into the field), and the outcome was way beyond expectations.

Years have passed, and many more PLWH are today under treatment while Dr Jim Kim is no longer a 'mere' head of HIV at the WHO, but the DG of the World Bank (named by Obama in 2012).

Today the '3 billion' target of the new WHO GPW (Global Program of Work) is similarly met with a lot of shoulder shrugs. 

Did it get Kim's support in backrooms? It is a reasonable hunch and Peter Sands' nomination at the Global Fund could, ironically, mean support (while both institutions were hostile to the WHO plan in 2003), in view of Sands' role as Chair of the post-Ebola "Commission on a Global Health Risk Framework for the Future, and its document: "The Neglected Dimension of Global Security: A Framework to Counter Infectious Disease Crises". 

Focussing on achieving notably a one billion people covered by UHC, the program as described by Dr Bernhard Schwartländer (head of Tedros' cabinet, and a UN career man with experience in UNAIDS) means, first of all, recognizing that "health objectives are central to the SDGs" (the Sustainable Development Goals adopted at the UN), as Schwartländer said,  it demands a number of shifts to succeed, he basically said: better and tighter coordination in the organization of the WHO (which has already started with regular meetings with WHO Region Directors all attending this special session and clearly very much in support of Tedros), more technically competent WHO staff in countries (eg less political), and above all a bigger place and a bigger role for health ministries, more often than not neglected and deprived of power (says Schwartländer) in national governmental settings.

For the 3 billion program to work, it will need the mobilized power of civil society.

Dr Tedros' Global Program of Work, GPW has enlisted Pr Ilona Kickbush to assist, and we will have the new DDG Pr Soumya Swaminathan to implement.

Both AMR and Global Health Security have been selected as priorities alongside the main task of implementing UHC. It seems to us that these priorities fit together since only patient centered modern health care delivery, with sufficient personel, well paid, and large public investments in health combined with new technologies can achieve these worthy tasks.

We need E-Health, space technologies – as envisioned by the WHO over the past two years – new ambulatory delivery systems using internet et proper motor vehicules. 

The GPW will be further discussed this January 2018 during the Executive Board meeting. We will keep you posted.

Upcoming AMR-related events


Jan. 26-28, 2018, France
Congrès de Pneumologie de Langue Française (CPLF), Lyon Centre de Congrès


Jan 29 – Feb 3, 2018 Thailand
Prince Mahidol Award Conference Secretariat Institute for Population and Social Research
Mahidol University 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand
Tel: (66) 2441-0203 to 4 ext 627 or 628

February 15 -16, 2018, Dublin, Republic of Ireland
23rd International Symposium On Infections In The Critically Ill Patients; The aim of this two-day symposium is to review current concepts, technology and present advances in infections in critically ill patients. Sepsis, Pulmonary Infections, Basic Research, Pulmonary Infections Treatment and Prophylaxis Therapy of severe infections will be the topics of the main sessions presented by experts who will review and update the new advances on infections in the critically ill patient. At the end of each session a Clinical Controversy, Panel Discussion or Case Report Discussion will be organized.

Organized by: 
  • Antonio Artigas, MD Critical Care Center, Sabadell Hospital, University Institute Parc Taulí, Autonomous University of Barcelona, Ciberes, Spain
  • Jean Carlet, MD Consultant, President of the World Alliance Against Antibiotic Resistance (WAAAR)
  • I. Martin-Loeches, MD, St James's Hospital. Trinity Centre for Health Sciences. HRB-Welcome Trust St James's Hospital, Dublin, Ireland
  • Antoni Torres, MD, Pulmonology Department, Clinic Hospital of Barcelona, Ciberes, Spain
  • Michael Niederman, MD, Division of Pulmonary and Critical Care Medicine, New York Presbyterian Hospital, Weill Cornell Medical College, USA

May. 2-4, 2018, Amsterdam, The Netherlands
The International Forum on Quality and Safety in Healthcare (BMJ) , taking place in Amsterdam on 2-4 May 2018

This newsletter is published by the not-for-profit NGOs ACdeBMR/WAAAR and SOI.
Disclaimer: The named authors alone are responsible for the views expressed in this publication. The content does not commit the WAAAR or SOI associations.
The Editorial Board: 
-Garance Fannie Upham, Editor in Chief (;
-Mostafa El Yamany (Egypt and the Netherlands), pharmacist and Ph.D. Candidate on AMR (
-Caterina Floriani Mussolini (Graduate Institute, Switzerland), Editor and Associate Researcher (
-Hervé Jacqueson, Associate Editor and Reporter, French Edition (
-Amr El-Ateek, Pharm.D., researcher, translator (Arabic), and collaborator
-Nora Mahfouf, (Algeria) Ph.D. student on AMR, journalist, and translator 
-Jean-Jacques Monot, (France) Computer Engineer, database, and edition
-Aletha Wallace (Belgium/Liberia) Biotechnologist, MSc Health Sc. Management, contributor
-Christy Mulhall (Graduate Institute, Switzerland), Associate Researcher & Reporter

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AMR CONTROL 2015 / 2016: WAAAR publishes a yearly book AMR CONTROL with over 30 world renown experts for each edition (2015 and 2016 and soon 2017) which can be freely downloaded or printed copies requested by postal mail by
filling in the form on the London publisher's website.
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