Transatlantic Taskforce on Antimicrobial Resistance (TATFAR)

Key points

  • Antimicrobial resistance (AMR) experts from Canada, the European Union (EU), Norway, the United Kingdom (U.K.) and the United States (U.S.) collaborate and share best practices to strengthen efforts to combat AMR.
  • The Taskforce works across several key areas, including antimicrobial use, AMR surveillance, communication, and innovation, to guide collaboration and work plan goals.
Transatlantic Taskforce on Antimicrobial Resistance

Overview

The Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) was created to address the urgent, growing global threat of antimicrobial resistance after the U.S.-European Union Summit Declaration in 2009.

TATFAR's technical experts from Canada, the EU, Norway, the U.K. and the U.S. collaborate and share best practices to strengthen domestic and global efforts to combat AMR.

Operating procedures

The Taskforce is co-chaired by the Director of the European Commission Public Heath Directorate and U.S. Health and Human Services Assistant Secretary for Global Affairs. The full membership of the Taskforce will hold meetings no less than every six months by teleconference or video conference with one in-person meeting midway through this implementation period of five years. The Taskforce will review its progress annually and increase visibility by posting progress to its website.

Objectives

  • Increase the mutual understanding of TATFAR partners' activities and programs relating to the prevention and control of antimicrobial resistance.
  • Contribute to an effective global dialogue and uptake of best practices.
  • Provide opportunities for shared learning.
  • Promote information exchange, coordination and cooperation between Canada, EU, Norway, the U.K. and the U.S.
  • Provide technical and scientific statements or suggestions and neither represent nor impose a formal or binding position on the part of the TATFAR partners.

Key areas

Between fall 2021 and February 2022, TATFAR revised and launched its work plan, which identifies 18 actions across four key areas for continued collaboration through 2026:

  1. Appropriate antimicrobial use in human and veterinary medicine.
  2. Surveillance and prevention of AMR.
  3. Strategies to improve financial incentives, access, research, and development of antimicrobial drugs, diagnostics and alternatives.
  4. Cross-cutting actions to improve awareness and disseminate information from TATFAR.

Key Area 1: Appropriate antimicrobial use in human and veterinary medicine

Working together, members' work improves appropriate antimicrobial use in human health care and veterinary medicine through actions like:

  • Publishing an online report titled Data for Action: Using Available Data Sources at the Country Level to Track Antibiotic Use.
  • Publishing an article with detailed information on the reduction goals targets and corresponding metrics titled Targets for the reduction of antibiotic use in humans in the TATFAR partner countries.
  • Aligning campaigns that promote appropriate antimicrobial use, including collaboration with other partners, like the World Health Organization, to support World Antimicrobial Awareness Week (WAAW).
  • Developing a table of risk profile elements, focused on the Codex Guidelines for Risk Analysis of Foodborne AMR to streamline future risk profiles the time and data needed for those elements and considerations for which elements would be required depending on the problem.
  • Sharing information to promote antibiotic stewardship principles in veterinary communities and efforts to improve surveillance of AMR in foodborne bacteria.
Key Area 1 by Action Number, Description, and Implementation Organizations
Action Number Description Implementation Organizations
1-1 Collaborate through regular exchanges of information on actions and approaches related to the consumption and appropriate use of antimicrobials in veterinary medicine.
The group will continue ongoing collaborations among TATFAR partners from the previous implementation period on approaches to promote appropriate antimicrobial use and stewardship in veterinary medicine.		 CDC, CFIA, DG-SANTE, ECDC, EFSA EMA, FDA, HC, NVI, PHAC, USDA, VMD
1-2 Collaborate through regular exchanges of information on actions and approaches related to antimicrobial stewardship in human medicine.

As of November 2022, diagnostic stewardship (formally Action 1-3) is included in this working group (Action 1-2).

The group will exchange information on actions and approaches related to the appropriate use of antimicrobials in human medicine, as well as challenges and opportunities related to integrating laboratorians and diagnosis with antibiotic stewardship actions. The group will foster ongoing collaboration among TATFAR partners, WHO, and other non-TATFAR partners from the previous implementation period to promote appropriate antibiotic use in human medicine and accelerate the fight against AMR across the globe. Diagnostic stewardship interventions are needed to limit the incorrect diagnosis of infections with multidrug-resistant organisms, as well as to contribute to a more targeted and prudent use of antimicrobials. The group will also discuss COVID-19’s impact on appropriate antibiotic use.

 APHI, APRHAI, CDC, DoD, ECDC, NHSEI, NIH, NIPH, PHAC, UKHSA
1-3 Collaboration on diagnostic stewardship actions.
As of November 2022, this working group (Action 1-3) is included in working group Action 1-2.

Key Area 2: Surveillance and prevention of AMR

Working together, members prevent infections and their spread through actions like:

  • Working on three collaborative manuscripts (pending publication) addressing point-prevalence survey (PPS) methods and PPS data use for hospitals and for long-term care facilities/nursing homes.
  • Mapping the availability of genomic information on carbapenem-resistant Enterobacterales (CRE) across TATFAR partner countries.
  • Addressing bioinformatics approaches and the need for available microbiological and epidemiological information with provisional agreement on essential information, such as the sample origin and type, date of sample collection and country.
  • Collaborating to improve communication between government agencies to alert one another of emerging and concerning AMR trends.
  • Working with Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST), international clinical breakpoint setting organizations, to harmonize breakpoints focused on bug/drug combinations.
Key Area by Action Number, Description, and Implementation Organizations
Action Number Description Implementation Organizations
2-1 Collaboration through regular exchanges of information on emerging resistance trends and novel strategies to detect and prevent AMR.
The group will communicate on emerging trends and AMR infection control and prevention strategies. The group will also discuss how resistance data and alerts are shared within countries and consider possibilities for improved sharing internationally via a secure network, and COVID-19 impact on control measures.		 APHA, CDC, DA, DoD, ECDC, EFSA, FDA, FSA, NHSEI, NIPH, NVI, PHAC, UKHSA, UKRI, USDA, VMD
2-2 Cooperate in using mathematical modeling to accelerate AMR prevention and control efforts.
The group will work to foster transatlantic collaboration to accelerate AMR prevention efforts by increasing joint scientific evaluations using transmission modeling. This group will exchange information and discuss ongoing and future national and international actions and events related to use of transmission modeling. This work contributes towards the utilization of transmission modeling evidence to accelerate prevention efforts.		 APHA, CDC, DoD, ECDC, FDA, NIPH, NVI, PHAC, UKHSA, UKRI, USDA
2-3 Exchange information on approaches to risk analysis for foodborne AMR.
The group will continue long-standing information sharing on approaches to risk analysis for foodborne AMR. The group will share ideas and expertise on how to effectively conduct risk analysis of foodborne AMR. The group will share the latest progress on risk analysis and AMR, ways to improve current framework and models, ways to best include new types of information (e.g., fitness/virulence genetic determinants and genomic data), and how to conduct dose-response modelling of foodborne AMR.		 AAFC, APHA, CDC, CEFSA, CFIA, DG-SANTE, ECDC, EFSA, EMA, FDA, FSA, HC, NVI, PHAC, USDA
2-4 Consultation and collaboration on prevalence surveys of healthcare-associated infections (HAIs) and antimicrobial use in hospitals and long-term care facilities, with a focus on burden estimation methods and how prevalence survey data are used at facility/local, national, and multinational levels.
The group will continue collaboration on point prevalence surveys and continue work planned in previous implementation period. The group will work to complete and publish the hospital point prevalence survey methods paper established in the last implementation period. The group will also work to continue efforts to produce publications related to long-term care survey methods and how survey data is used to address AR. The group will also continue communication around future surveys planned, considering COVID-19 impact on facilities and how address as part of assessments.		 CDC, DHSC, ECDC, NHSEI, NIPH, PHAC, UKHSA
2-5 Revision of the definitions for multidrug-resistant (MDR), extensively drug-resistant (XDR) and pan-drug-resistant (PDR) bacteria for human infections.
The group will discuss and agree about revisions of the current definitions for MDR, XDR and PDR bacteria. The purpose of this action is to provide clear and lasting definitions and ensure they are applied consistently and correctly.		 APRHAI, CDC, DoD, ECDC, FDA, NHSEI, NIPH, PHAC, UKHSA, UKRI, USDA
2-6 Share approaches to improve AMR surveillance across the One Health spectrum (human, animal, environment).
This group will discuss ways to improve national monitoring and detection of AMR. The group will share best approaches for One Health surveillance and AMR data from humans, animals, food, and the environment as appropriate.		 APHA, APRHAI, CDC, CEFAS, DEFRA, DoD, EA, ECDC, EFSA, FDA, FSA, NIPH, NVI, PHAC, USDA, UKHSA, UKRI, VMD
2-7 Consultation and collaboration on ways to explore sewage-based surveillance measures to monitor AMR.
The group will discuss and share information, best practices, and specific ways to describe, collect, and present data from wastewater monitoring to reveal the occurrence of antimicrobial resistance bacteria around the world.		 AAFC, APHA, CDC, CEFAS, DEFRA, DG-ENV, DG-JRC, DG-SANTE, EA, ECDC, EFSA, EPA, FDA, NIPH, PHAC, UKHSA, UKRI, USDA

Key Area 3: Strategies to improve financial incentives, access, research, and development of antimicrobial drugs, diagnostics and alternatives

Working together, members strengthen the drug pipeline through actions like:

  • Engaging in regular communication and focused collaboration among funders and the research community to facilitate research and product development opportunities and enable clinical research.
  • Publishing papers that summarize economic incentives for antibacterial drug development.
  • Communicating on research and development of new pharmaceuticals, new diagnostic tests, and clinical trials.
  • Supporting drug development programs collaboratively to meet EU, Canada, and U.S. regulatory requirements more efficiently.
  • Exchanging information on approaches to authorizing alternatives underway to promote access to market for such products while ensuring appropriate levels of quality, safety, and efficacy.
Key Area 3 by Action Number, Description, and Implementation Organizations
Action Number Description Implementation Organizations
3-1 Regulatory agencies will share approaches regarding antibacterial drug development to:
  • Discuss common issues in the area of drug development and regulation.
  • Consider opportunities for convergence in the requirements and regulation of antibacterial agents.
 BARDA, EMA, FDA, HC, NIPH, NMA, VMD
3-2 Exchange information on regulatory science research approaches to antimicrobial therapies, including traditional and alternative approaches for managing bacterial infections.
The group will exchange information on actions and approaches related to the development of alternative therapies for managing bacterial infections.		 BARDA, CDC, DG-RTD, DoD, EMA, FDA, HC, NIH, NIPH, VMD
3-3 Discuss the particular challenges related to authorization of novel veterinary therapies presented as alternatives to antimicrobials.
The group will continue collaborations on discussing approaches (and challenges) related to authorization of alternatives and the initiatives already underway to promote access to market for such products while ensuring appropriate levels of quality, safety, and efficacy.		 CDC, CFIA, DG-SANTE, EMA, FDA, HC, USDA, VMD
3-4 Collaborate on research to support the development of new antimicrobials, alternative approaches, and diagnostic devices, by fostering international research and product development to address challenging problems in the management of AMR.
  • Enhanced communication between TATFAR partners on cross-cutting issues related to the area.
  • Enhanced collaboration among funders and with the research community.
  • Focus on facilitating preclinical research/product development opportunities and enabling clinical research.
 BARDA, CIHR, DoD, DG-RTD, DHSC (GAMRIF), HC, HHS-OGA, NIH, NIPH, UKRI
3-5 Communicate on incentives for antibiotic innovation and access.
The group will communicate, discuss, and examine incentives aiming to either (or both) stimulate antibiotic innovation or secure access to important antibiotics (including both old and new antibiotics). These incentives may also include alternative therapies.		 BARDA, DG-RTD, DG-SANTE, DHSC, DoD, EMA, HC, HHS-OGA, NHSEI, NICE, NIH, UKRI

Key Area 4: Cross-cutting actions to improve awareness and disseminate information from TATFAR

Key Area 4 by Action Number, Description, and Implementation Organizations
Action Number Description Implementation Organizations
4-1 Collaboration through regular exchanges of information on ways to best communicate on AMR to various audiences.
The group consists of communications subject matter experts from each respective member organization who will share communications actions and strategies on AMR. The group will also work to share important communications on AMR so that TATFAR can help amplify messages.		 CDC, CFIA, DA, DG-SANTE, DoD, ECDC, EMA, FDA, HC, HHS-OGA, NHSEI, NIH, NIPH, NVI, PHAC, UKHSA, USDA, VMD
4-2 Collaboration through regular exchanges of information on policy topics.
The group will present and share on current AMR policy and actions that may help inform policy discussions.		 All TATFAR agencies, core group: CDC, CFIA, DG-SANTE, DHSC, DOD, ECDC, EMA, HHS-OGA, NHSEI, NIPH, NVI, PHAC, VMD
4-3 Share successes and challenges related to the fight against AMR.
The group will work to develop a compendium (structured template) housed within a webpage folder (one page in a structure format for each described best practice). The resource will provide a “one-stop shop” where individuals in and outside of the TATFAR sphere can access information and resources that highlight successful practices (communication, policy, interventions, research, etc.) related to the fight against AMR.		 All TATFAR agencies, core group: CFIA, DHSC, DOD, ECDC, EMA, HHS-OGA, NHSEI, NIPH, NVI, UKHSA, UKRI, VMD

TATFAR actions to meet Key Areas

Canada

  • Develops and shares guidance and products for appropriate antimicrobial use and infection prevention and control (IPC) for health professionals and the public. For example:
    • With support from the Government of Canada, Choosing Wisely Canada published a toolkit addressing the management of respiratory tract infections with considerations of COVID-19 and virtual care, including when to prescribe antibiotics.
    • The Government of Canada's World AMR Awareness Week (WAAW) social media campaign reached approximately 383,000 Canadians through Facebook, Twitter and LinkedIn.
  • Collects annual reports on the sales volume of veterinary antimicrobials considered to be important in human medicine to support AMR surveillance programs and stewardship. For example:
    • Mandatory collection of annual antimicrobial sales data from manufacturers, importers and compounders of medically important antimicrobials intended for use in animals, called the Veterinary Antimicrobial Sales Reporting (VASR)
    • Publishes the 2018 Veterinary Antimicrobial Sales Highlights Report, which reflects the first year of sales data submitted through the VASR system.
  • Develops guidance to address appropriate antimicrobial use. For example:
    • Provides a comprehensive view of efforts to develop their Pan-Canadian Framework for Action to address AMR.
  • Conducts its first PPS in long-term care facilities of antibiotic-resistant organisms and antimicrobial use, with information on exposure to hospitals.
  • Conducts its second PPS in smaller, remote, and northern Canadian acute-care hospitals of HAIs, antibiotic-resistant organisms, and antimicrobial use.
  • Conducts its third PPS in large acute-care hospitals of HAIs, antibiotic-resistant organisms, and antimicrobial use.
  • Continues to be a top funder within the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) and leads the JPIAMR Virtual Research Institute (VRI) task with eight other member states.
  • Engages in several international efforts in the area of AMR and supports declarations focused on AMR and framed Canada's position at the international table of the WHO, WHA, UNGA, G7, and G20, and is developing action plans and frameworks.
  • Invested $130.7 million in AMR-related research, including $26.3 million in 2019-2020 alone.
  • Launches a challenge as part of the Innovative Solutions Canada program that provided investments to support Canadian small business in the development of point of care diagnostics to combat AMR.

European Union

Norway

  • Collaborates with healthcare personnel to promote antibiotic stewardship and ensure that the necessary tools are available. For example:
    • Publishes an AMR action plan in 2017 focused on disease prevention and prudent use of antibiotics.
    • Facilitates use of vaccines and diagnostics (e.g., C-reactive protein (CRP) in primary care), including reimbursement.
    • Provides antibiotic prescribing guidelines (both primary care and secondary) as an app for mobile devices.
    • Actively engages with the public in antibiotic awareness campaigns, especially during European Antibiotic Awareness Week.
  • Informs and assists in activities that promote prudent use of antimicrobials in animals. For example:
    • Publishes an AMR action plan focused on disease prevention and prudent use of antibiotics, 2017.
    • Restricts the use in animals of certain human antibiotics because of the potential consequences to public health of AMR to these antibiotics.
    • Publishes guidelines for prudent use of antibiotics in horses, 2019.
  • Conducts and extends use of national PPS for HAIs and antimicrobial use twice annually in long-term care facilities .
  • Conducts national PPS for HAIs and antimicrobial use in all acute care hospitals. The surveys are mandatory twice a year.
  • Publishes a National Action Plan for IPC in health care as part of the overall strategy for AMR and HAI.
  • Re-establishes a Nordic training in IPC in collaboration with Sweden and Denmark.
  • Continues to invest in AMR-related research both through national funders and JPIAMR, Europe's Innovative Medicines Initiative, and others, calculated at a Norwegian krone 537 million (€53 million) annual investment in 2017.
  • Performs leadership roles in multiple initiatives focused on stimulating antibiotic innovation and improving access, including DRIVE-AB and the EU Joint Action on AMR and Healthcare-Associated Infections (EU-JAMRAI).
  • Actively engages in UN, WHO, Global AMR R&D Hub, and other forums related to AMR.

United States

  • Improves antimicrobial use by increasing education and awareness among providers and the public and driving enhancements to prevent infections. For example:
    • CDC had more than 5,000 downloads of its Be Antibiotics Aware print materials during WAAW 2020, and more than 350 participants attended a continuing education webinar on antibiotic use in hospitals.
  • Develops and shares products for appropriate antimicrobial use in food-producing animals. For example:
  • Worked with the Emerging Infections Program (EIP) to complete a second, full-scale PPS in hospitals focused on antimicrobial use and HAIs in hospitals.
  • Completed its first full-scale PPS in nursing homes focused on HAIs and antimicrobial use in nursing homes.
  • Established CARB-X, an international public-private partnership focused on supporting the preclinical development of therapeutics, preventatives, and diagnostics. CARB-X has received $303M from funders and has supported 86 antibacterial therapeutics, prevention, and diagnostics programs, including new classes of compounds, compounds that reach new targets or have new mechanisms of action, and non-traditional approaches. Seven programs have advanced into Phase 1 clinical development.
  • Invested over $1.5 billion in antimicrobial development both through CARB-X and the Advanced Research and Development (ARD) portfolio since its inception in 2010, to bring 3 new antibacterials to market. The portfolio stands at 13 partnerships developing 16 drug candidates/product candidates that address a majority of the drug-resistant pathogens identified by the CDC as "urgent" and "serious" threats.
  • Awarded a Project BioShield contract to Paratek Pharmaceuticals to support the advanced clinical development and procurement of Omadacycline.
  • Announced the Antimicrobial Resistance Diagnostic Challenge competition for $20 million and in August 2020, awarded the prize Visby Medical, Inc. for an innovative, rapid, point-of-need diagnostic test capable of accurately and reliably detecting gonorrhea and determining antibiotic susceptibility in less than 30 minutes.

Future direction

  • Identify ways to improve communication on AMR and help amplify TATFAR partner messaging through the Taskforce.
  • Prioritize a One Health focus.
  • Continue to share:
    • Methodologies for reporting consumption of antimicrobials by animal species, summarizing the various methods used by TATFAR partners.
    • Approaches for risk analysis for foodborne AMR, including ideas and expertise on how to effectively conduct risk analysis of foodborne AMR.
    • Ways to promote antimicrobial stewardship principles in veterinary communities and efforts to improve surveillance of AMR in foodborne bacteria.
  • Collaborate on new areas including wastewater surveillance of AMR, modeling strategies, communications, and policy.
  • Discuss the challenges related to authorization of novel veterinary therapies presented as alternatives to antimicrobials.
  • Consider impacts of COVID-19 on AMR.
  • Communicate on incentives for antibiotic innovation and access.
  • Collaborate on research to support the development of new antimicrobials, alternative approaches, and diagnostic devices by fostering international research and product development to address challenging problems in the management of AMR.
  • Discuss antibacterial drug development programs, clinical trial designs for studying new antibacterial drugs, emerging safety issues and coordinated efforts on scientific meetings to facilitate antibacterial drug development.
  • Continue to coordinate around the World AMR Awareness Week campaign for the next five-year implementation period.

TATFAR successes

Working together during the past five-year implementation period, TATFAR member agencies continued valuable technical engagement to address AMR by:

  • Publishing an online report, Data for Action: Using Available Data Sources at the Country Level to Track Antibiotic Use.
  • Publishing resources summarizing data sources to quantify antibiotic use in human health care and on antibiotic use targets in TATFAR partner countries. This resource is for public health agencies, governments and other stakeholders interested in assessing antibiotic use.
  • Leading and coordinating annual observances to raise awareness about appropriate use of antibiotics and AMR.
  • Working on three collaborative manuscripts (pending publication) addressing point-prevalence survey (PPS) methods and PPS data use for hospitals and for long-term care facilities/nursing homes.
  • Publishing papers summarizing economic incentives for antibacterial drug development. Fostered transatlantic communication on research and development of new pharmaceuticals, new diagnostic tests and clinical trials.

Consultation, external interaction and workshops

The members of the Taskforce will seek to obtain input from the public, interested experts, likeminded groups and other stakeholders, in accordance with each members' respective process for obtaining public comment, on the specific activities within the framework of the Declaration where member collaboration can be most fruitful. As feasible, meetings to which public participation is invited will be conducted. Where possible, TATFAR will exchange information on progress with corresponding initiatives run by other international organizations working in the same area.

Contacts

Antimicrobial Resistance Coordination and Strategy Unit
Centers for Disease Control and Prevention
1600 Clifton Road NE, MS C-12
Phone: 800-CDC-INFO – (800-232-4636)
Email: TATFAR@cdc.gov

Resources

Keep Reading: New Fact Sheets

Implementation organizations:

AAFC: Agriculture and Agri-Food Canada

AMR: Antimicrobial resistance (the acronym AR is used in the U.S., and AMR is used elsewhere)

APHA: Animal and Plant Health Agency

APHIS: Animal and Plant Health Inspection Service

APRHAI: Advisory Committee on Antimicrobial Prescribing, Resistance and Healthcare Associated Infection

ARD: Advanced Research and Development

BARDA: Biomedical Advanced Research and Development Authority

BBSRC: Biotechnology and Biological Sciences Research Council

CDC: U.S. Centers for Disease Control and Prevention

CEFAS: Centre for Environment, Fisheries and Aquaculture Science

CFIA: Canadian Food Inspection Agency

CIHR: Canadian Institutes of Health Research

CLSI: Clinical & Laboratory Standards Institute

DA: Devolved Administrations (of Scotland, Northern Ireland and Wales)

DEFRA: Department for Environment, Food and Rural Affairs

DG-ENV: Directorate-General for Environment

DG-JRC: Directorate-General for Joint Research Centre

DG-RTD: Directorate-General for Research and Innovation

DG-SANTE: Directorate-General for Health and Consumers

DHSC: Department for Health and Social Care

DoD: Department of Defense

EA: Environment Agency

EC: European Commission

ECDC: European Centre for Disease Prevention and Control

EFSA: European Food Safety Authority

EMA: European Medicines Agency

EPA: U.S. Environmental Protection Agency

EU: European Union

EUCAST: European Committee on Antimicrobial Susceptibility Testing

FDA: U.S. Food and Drug Administration

FSA: Food Standards Agency

GLASS: Global Antimicrobial Resistance Surveillance System

HAI: Healthcare-associated infections

HC: Health Canada

HHS: Department of Health and Human Services

IMI: European Innovative Medicines Initiative

ISED: Innovation Science and Economic Development Canada

JPIAMMR: Joint Programming Initiative on Antimicrobial Resistance

MRC: Medical Research Council

NHSEI: NHS England and NHS Improvement

NICE: National Institute for Health and Care Excellence

NIH: National Institutes of Health

NIPH: Norwegian Institute of Public Health

NVI: Norwegian Veterinary Institute

OGA: Office of Global Affairs

PHAC: Public Health Agency of Canada

PPS: Point prevalence survey

TATFAR: Transatlantic Taskforce for Antimicrobial Resistance

USDA: United States Department of Agriculture

UKHSA: UK Health Security Agency

UKRI: UK Research and Innovation

VMD: Veterinary Medicines Directorate

WAAW: World Antimicrobial Awareness Week

WGS: Whole genome sequencing

WHO: World Health Organization

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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)