[Source: PLoS Med., full text: (LINK). Extract, edited.]
A Call for Action: The Application of the International Health Regulations to the Global Threat of Antimicrobial Resistance


Stephen Harbarth and colleagues argue that the International Health Regulations (IHR) should be applied to the global health threat of antimicrobial resistance.
  • Didier Wernli<SUP>1</SUP>, Thomas Haustein<SUP>2</SUP>, John Conly<SUP>2</SUP>, Yehuda Carmeli<SUP>3</SUP>, Ilona Kickbusch<SUP>4</SUP>, Stephan Harbarth<SUP>2</SUP><SUP>*</SUP>

1 Division of International and Humanitarian Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland, 2 Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland, 3 Infection Control Unit, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel, 4 Global Health Programme, Graduate Institute of International and Development Studies, Geneva, Switzerland

Citation: Wernli D, Haustein T, Conly J, Carmeli Y, Kickbusch I, et al. (2011) A Call for Action: The Application of the International Health Regulations to the Global Threat of Antimicrobial Resistance. PLoS Med 8(4): e1001022. doi:10.1371/journal.pmed.1001022

Published: April 19, 2011

Copyright: ? 2011 Wernli et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The authors received no specific funding to write this paper. JC received financial support for a sabbatical leave from the University of Calgary, Calgary, Canada.

Competing interests: JC has an unpaid relationship with the World Health Organization in the Department of Global Alert and Response (Infection Prevention and Control Unit). All other authors have declared that no competing interests exist.

Abbreviations: AMR, antimicrobial resistance; CRE, carbapenem-resistant Enterobacteriaceae; IHR, International Health Regulations; KPC-Kp, Klebsiella pneumoniae harboring KPC; PHEIC, public health emergency of international concern; WHO, World Health Organization; XDR, extensively drug-resistant

* E-mail: stephan.harbarth@hcuge.ch

Provenance: Not commissioned; externally peer reviewed.
Summary Points
  • The public health threat of antimicrobial resistance (AMR) is growing and needs to be addressed urgently.
  • The International Health Regulations (IHR), a legally binding agreement between 194 States Parties, whose aim is to prevent, protect against, control, and provide a public health response to the international spread of disease, deserve critical examination with regard to their applicability to AMR.
  • We argue that the emergence and spread of antimicrobial-resistant bacteria, especially those involving new pan-resistant strains for which there are no suitable treatments, may constitute a public health emergency of international concern (PHEIC) and are notifiable to the World Health Organization under the IHR notification requirement.
  • The use of the IHR framework could considerably improve our response to emerging AMR threats like carbapenem-resistant Enterobacteriaceae (CRE).
  • As more governments start to take the threat of pan-resistant bacteria seriously, there is a window of opportunity for having a healthy debate about the applicability of the IHR to AMR.

The unrelenting rise of antimicrobial resistance (AMR) constitutes a serious threat to health worldwide. In the last decade, challenging multi-resistant bacteria have expanded while new antimicrobial drug development has lagged [1] with little coordinated containment action at the global level. Of significant concern has been the emergence of vancomycin-resistant Staphylococcus aureus, extensively drug-resistant (XDR)-tuberculosis, and carbapenem-resistant Enterobacteriaceae (CRE).

AMR in both humans and animals represents a complex global concern that must be addressed ?urgently and aggressively? [2]. The International Health Regulations (IHR), a legally binding agreement between 194 States Parties [3], deserve critical examination with regard to their applicability to AMR. Using the example of CRE as point of departure, we analyze and discuss the potential role of the IHR with respect to AMR.

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