Speech by Princess Margriet at the McMaster Universiteit in Hamilton, Canada

It is indeed a great pleasure and joy to be back here today – in Canada and especially at McMaster University.

To be here is all the more special in the festive and commemorative year 2017.

McMaster University has a valuable partnership with Maastricht University in the NL through the Master Global Health Programme, which also includes the exchange of students and staff with Manipal University in India, University College of Southeast Norway, Rosario University, Columbia Ahfad University for Women, Sudan and Thammasat University in Thailand.

Students and staff work together either by virtual interaction or participation in joint field projects. I have been involved in this project as honorary chair and participated in several meetings of the program’s Advisory Board.

The Master Global Health Programme includes the study of the global impact of health-affecting events like epidemics, natural disasters and inequities in access to health services and the need to partner with all those concerned in these issues.

The universities share the use of Problem Based Learning as an educational method, and aim to offer innovative and international educational programs, with the object to prepare graduates for a better understanding in the domain of global health. So where can we better have this Round Table than here?

We in the Netherlands hold Canada very near in our hearts. As you know, my family found a safe haven in Ottawa during The Second World War. I was born in Canada, so somehow, quite naturally, I feel strongly attached to my place of birth. Being in Canada  gives me a sense of being home, my second home. Canada’s hospitality towards my family, Canada’s pivotal role in our liberation from the Nazis and the Dutch emigration to Canada – especially in these parts – formed the foundation for the special bonds between our two countries. In their contribution to bring us peace many of your servicemen have paid the ultimate price for our freedom. Our deep-felt gratitude has remained, won’t diminish, and will remain forever.

After our marriage, this year exactly 50 years ago, (another festive year) my husband and I visited Canada often; every visit was a welcome opportunity to commemorate and celebrate the past, but also always a new opportunity to look at the future, at our future, knowing the Canadian and the Dutch share so many important values and ideas.

In many areas, Canada and the Netherlands work together and learn from each other. My husband and I embrace every initiative to strengthen the bond between our two countries.

One of these initiatives is to stimulate our universities and research institutes to work more together. Today’s Round Table is an example and hopefully an inspiration for more programs to come.

Now to today’s subject, Antimicrobial Resistance, or AMR for short! Does an Honorary Degree entitle me to speak here once more in the presence of so many learned scholars? I am not an expert on today’s subject but I am very concerned about this topic as AMR is a growing global threat that needs a global multidisciplinary approach.

A global threat but also an individual one. I too have witnessed the effects of over use and misuse of antibiotics. Moreover we also have serious issues on food safety related to AMR.  This has prompted our interest (both my husband and mine) in the challenges and dangers AMR poses to society. We welcome this opportunity to exchange ideas and knowledge on this subject today!

In 1928 Sir Alexander Fleming discovered an active substance segregated by moulds that was able to inhibit bacterial growth. He named this substance penicillin, the first antibiotic. The introduction of penicillin took place in the 1940s, and has been recognized as one of the greatest advances in therapeutic medicine. It marked the beginning of the antibiotic era and modern medicine, which has led to a significant decrease in death from previously widespread and frequently fatal diseases.

But all these gains are now jeopardized by the increasing threat of AMR. Already as early as in 1945
Sir Fleming warned us about the danger of resistance! He was afraid that the day would come when penicillin could be bought by anybody freely and that due to under-dosage the bacteria wouldn't be killed, but would fight off the drug and become resistant.

When receiving the Nobel Price he said in his lecture: “It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body…There is the danger that the ignorant man may easily under-dose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”

During the past decades, the overuse and misuse of antibiotics in human and veterinary medicine has accelerated the natural phenomenon of AMR and the emergence and spread of resistant bacteria. This situation is worsened by the lack of investment to develop new effective antibiotics. The consequences are important. It is shocking to think that antibiotics, which have allowed us to treat previously deadly bacterial infections and save many lives, are becoming less and less effective. Current medical interventions like organ transplants, orthopaedic and other more simple surgery or cancer chemotherapy may well be in danger in the future as well as treatment of for instance tuberculosis, which could become high risk.

In addition to being a major public health threat, AMR also represents a serious economic burden for our countries. The European Centre for Disease Control and Prevention and the European Medicines Agency estimated in 2009, that AMR results each year in 25.000 unnecessary deaths – in 1,5 billion euro healthcare cost and productivity losses in the European Union alone.

Inappropriate use of antibiotics, for example, people taking antibiotics against the flu, leads to reimbursement for medicines that should not have been taken at all.

A study published in 2015 by the OECD estimated that about 700 000 deaths may be caused globally each year by AMR and that the economic impact associated with current rates of AMR may reach about USD 2.9 trillion by 2050.

Unless action is taken, the number of deaths from AMR could be estimated 10 million lives each year by 2050 and this will be higher than the expected number of deaths due to cancer.

AMR is a global public health threat and an international priority. In the last years many initiatives have been taken by countries and international organisations in order to address the growing threat of AMR; for example:

- In May 2015, the World Health Assembly unanimously adopted the Global Action Plan on AMR,
  together with the FAO and the World Organization for Animal Health;

Another example:

- During the High-Level Meeting on AMR at the General Assembly of the United Nations (last September) a political declaration on AMR was adopted. The declaration reaffirmed that that the blueprint for tackling AMR is the WHO’s “Global Action Plan on Antimicrobial Resistance”.           

At the same time, and despite all these initiatives, the resistance levels in the EU and in the world are still increasing. It is obvious that our good intentions are not enough to stop the emerge and spread of resistant bacteria. The political will is present, but we need to take concrete actions.           

The goal of the Global Action Plan is to ensure, for as long as possible, continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are used in a responsible way, and accessible to all who need them.

The Netherlands welcomed the adoption of the Global Action Plan and are fully committed to its implementation. The Netherlands adopted its National Action Plan in 2015, a plan in line with the Global Action Plan, based on the One Health approach and adapted to the specific Dutch situation.

The Global Action Plan stresses the need for an effective “One Health” approach involving coordination among numerous international sectors and actors, including human and veterinary medicine, agriculture, finance, environment and also consumers.

We will all agree that the only effective approach  to combat AMR is the One Health approach.

Resistant bacteria can spread between humans and animals, the environment and through food, highlighting the necessary link between human and veterinary medicine, and the need for coordinated action in all these sectors. So there’s no point in fighting AMR among humans – unless – we tackle the problem in livestock as well. Health care and livestock farming have to join forces in the One Health Approach to address the threat of antibiotic resistance. All involved sectors share this responsibility!           

It’s also important not to overlook the fact that none of us can stop the cross-border health threat of AMR by ourselves. Resistant bacteria don’t respect borders and can move from one country to another when people travel, or migrate, or when food and animals are handled across borders. Therefore International cooperation is key when dealing with AMR.

Collaboration with international partners is needed, for example, on research and innovation to achieve success. There is need to put research and development of new antibiotics high on the agenda, and to bring them to the market.

To have reliable tests will help doctors to decide when NOT to prescribe antibiotics, for example in case of viral infections, and to facilitate patients' acceptance for not taking antibiotics. This international cooperation is needed at all levels: at policy level, in the academic field, between universities and research institutions in the different areas.           

The Netherlands recognise the importance of the international cooperation and is joining forces with other international partners to fight AMR. Canada is very active at the international level. Canada and Netherlands are members of the Global Health Security Agenda and leading countries of the Action Package AMR.           

I’d like to share the Netherlands’ experience with you. In 2009, the use of antibiotics in livestock production became a major topic of debate in Dutch society. Our policy in health care on preventing infections and containing antibiotic resistance was in stark contrast with the widespread use of antibiotics in veterinary medicine. European statistics showed that in contrast with the low use in human patients, the Netherlands was one of the countries in the EU consuming the most antibiotics in livestock.

The outbreak of various animal diseases, including Q fever that could be transmitted from animals to humans, intensified the concerns about the risks that livestock production posed for human health concerns. 10 years ago the Netherlands developed a policy to reduce the use of antibiotics in animals.

A policy based on prevention (prevention is always better than cure) where veterinarians and farmers are primarily responsible for the prudent use of antibiotics and for the development of health plans.

The Dutch authorities formulated targets for reducing the use of antibiotics in animal husbandry by 70%.

Even if the target has not been met yet, the Dutch policy has been effective. The reduction of the use of antibiotics in the period 2009–2015 has been 58%.

The use of critically important antibiotics in animal husbandry has been drastically reduced or even phased out. More important, as a result of the reduction of use of antibiotics, also the resistance levels decreased substantially in all main livestock production sectors.

Farmers managed to maintain or even improve their economic results, while reducing their use of antibiotics, despite their investments in improving animal health and the increasing prices for feed.

As a result of the work of innovative farmers and the food industry, the Netherlands maintained the position of second exporter of agricultural goods in the world.

In the Netherlands and in Europe, the use of antibiotics as growth-promoters was banned in 2006. In some countries antibiotics are still used in animal husbandry as management tools, for non-therapeutic purposes as for example growth promoters and to mask poor hygiene practices, thereby favouring growth of resistance. Canada has not yet banned the use of antibiotics as growth promoters, although there is a Federal plan for action to do so.

The Dutch example shows that it's possible to reduce the use of antibiotics in animal husbandry, using them only for therapeutic purposes, without a negative effect on profits,  and that the achievement of the two  goals, preserving public health ánd keeping economic benefits, are not necessarily opposing.

Antibiotics are the cornerstone of modern medicine and we need to keep them effective and ensure a safe future, a future where infectious diseases can still be treated.

I wish all participants a fruitful discussion on this vitally important theme.

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