Mechanisms for intersectoral collaboration
| Acronym of the organisation | Main mandate |
| Human health, animal health, agriculture and food | |
| CAC (FAO and WHO) | The CAC adopts guidelines and standards regarding the conservation of antimicrobials and the containment of AMR in food products and animal husbandry.20 The main standards on AMR are the 1993 ‘International Code of Practice for Control of the Use of Veterinary Drugs’,69 the 2005 ‘Code of Practice to Minimize and Contain Antimicrobial Resistance’,70 and the 2011 ‘Guidelines for Risk Analysis of Foodborne AMR’.71 These standards are recognised by the Sanitary and Phytosanitary (SPS) Agreement at the WTO. While collaboration was mainly between WHO and FAO through the CAC, OIE was also included in the discussion. The work has been conducted by the ‘Ad hoc Codex Intergovernmental Task Force on AMR’ from 2007 to 2011 and since 2017. |
| Tripartite collaboration 2010 (FAO, OIE and WHO) | The Tripartite FAO/OIE/WHO Collaboration was created in 2010 and entails a common recognition of the role and functions of each organisation. For example, the standards published for terrestrial and aquatic animals are recognised by WHO.43 Efforts have been done towards better integration between the IHR and PVS instruments, regarding the assessment of national capacities to detect and respond to global health threats.72 In recent years, AMR has become one of the main areas for action of the Tripartite. In 2017, the FAO/OIE/WHO Tripartite Collaboration on AMR renewed their commitment to work together.73In 2019, the Tripartite established a standing Tripartite Joint Secretariat with special governance arrangements. |
| AGISAR (WHO) | The WHO AGISAR is an expert-based intersectoral AMR-specific mechanism that mainly addresses AMR in food-producing animals. The mission of AGISAR is to support WHO’s effort ‘to minimise the public health impact of AMR associated with the use of antimicrobial agents in all food-producing animals’.74 AGISAR covers surveillance but is also responsible for some aspect of conservation, for example, by establishing the list of critically important antimicrobials. |
| INFOSAN (WHO and FAO) | Created in 2005 by FAO and WHO, the INFOSAN shares food safety information between human and animal health sectors. INFOSAN has reported on AMR. |
| Human/animal health, food and trade | |
| SPS Agreement (WTO) | The need to manage the interface between trade and animal health resulted in the adoption of an agreement in 1998 ‘to act in collaboration and to consult each other on questions of mutual interest, in particular those concerning the sanitary aspect of international trade in animals and products of animal origin and zoonoses’.75 The standards adopted by OIE, FAO and the CAC are non-binding but ‘are specifically identified in the WTO Agreement on the Application of Sanitary and Phytosanitary Measures as the international benchmark texts for food’.76 There is no specific mechanism for AMR, but FAO and WTO prepared a joint publication on ‘Trade and food standards’ in which AMR is briefly mentioned.77 |
| Public health, intellectual property and trade | |
| Trilateral Cooperation on Public Health, Intellectual Property and Trade (WHO, WIPO and WTO) | WHO has a health mandate regarding both access and innovation, which are situated at the interface between the human rights and intellectual property regimes. Following the adoption of the ‘Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property’, WHO, WTO and the WIPO created the ‘Trilateral Cooperation on Public Health, Intellectual Property and Trade’.25 The topic of AMR has been covered during a technical symposium held in 2016.78 The scope of formal participation remains limited as the WTO Secretariat participates ‘as observers in the WHO Intergovernmental Working Group on Public Health, Innovation and Intellectual Property and in the WHO’s International Medical Products Anti-Counterfeiting Task Force (IMPACT), as well as in the field of technical cooperation’.79 |
| Overall coordination mechanism | |
| IACG-AMR (Convened by the UN Secretariat) | The adoption of the 2016 Political Declaration by the UNGA led to the creation of the ad hoc IACG-AMR to provide advice on how to make the global AMR agenda move forward.5 IACG-AMR, which is co-chaired by WHO and the UN Secretariat, has a broad membership of IOs and other global health actors. Four objectives have been laid out in its working plan for 2017–2019 and the work has been divided in six subgroups.80 In 2017 and 2018, IACG-AMR commissioned works in several areas and produced its own framework of action which put emphasis on innovation. The final recommendation of IACG-AMR stressed the need for countries’ progress, collaboration, sustainable response and innovation, and mechanisms for global governance (eg, the creation of a Global Leaders Group on Antimicrobial Resistance and an Independent Panel on Evidence for Action Against Antimicrobial Resistance).81 |
| Global framework (WHO, FAO and OIE) | Following the adoption of WHO Resolution WHA 68.7, and further supported by the 2016 UNGA Political Declaration, an ongoing effort by the FAO/OIE/WHO Tripartite Collaboration on AMR to design an overarching intersectoral mechanism to tackle AMR is the ‘global development and stewardship framework’.76 As the framework aims to balance innovation, access and conservation, ‘[it] is envisaged to form an ‘umbrella’ uniting different instruments’,76 but its legal form still needs to be defined. Several rounds of consultations have been organised with Member States, but it is yet unclear whether this initiative has so far garnered enough support to move to the WHA. |
AGISAR, Advisory Group on Integrated Surveillance of Antimicrobial Resistance; AMR, antimicrobial resistance; CAC, Codex Alimentarius Commission; FAO, Food and Agriculture Organization; IACG, Interagency Coordination Group; IHR, International Health Regulations; INFOSAN, International Food Safety Authorities Network; IOs, international organisations; OIE, World Organization for Animal Health; PVS, Performance of Veterinary Services; UN, United Nations; UNGA, United Nations General Assembly; WHA, World Health Assembly; WIPO, World Intellectual Property Organization; WTO, World Trade Organization.