National Action Plan to Curb Microbial Resistance (2022-2025)

All provinces, autonomous regions, municipalities directly under the Central Government, and the Xinjiang Production and Construction Corps Health Commission, Education Department (Education Commission, Education Bureau), Science and Technology Department (Committee and Bureau), competent departments of industry and information technology, Finance Department (Bureau), Ecology and Environment Department (Bureau), Agriculture and Rural Affairs (Agriculture and Animal Husbandry) Department (Committee and Bureau), Radio and Television Bureau, Medical Insurance Bureau, Traditional Chinese Medicine Bureau, Disease Control Bureau, Food and Drug Administration, and relevant military health departments:

 

In order to actively respond to the challenges posed by microbial resistance, implement the Biosecurity Law of the People's Republic of China, and better protect people's health, the National Health Commission and other 13 departments jointly formulated the National Action Plan for Curbing Microbial Resistance (2022-2025) (hereinafter referred to as the Action Plan).

It is now issued to you, and please seriously organize and implement it in light of the actual work of various localities and
departments.

 

National Health Commission Ministry of Education

 

Ministry of Science and Technology Ministry of Industry and Information Technology

 

Ministry of Finance Ministry of Ecology and Environment

 

Ministry of Agriculture and Rural Affairs State Administration of Radio, Film and Television

 

National Health Insurance Administration State Administration of Traditional Chinese Medicine

 

National Disease Control Administration State Food and Drug Administration

 

Health Bureau of the Logistics Support Department of the Central Military Commission

 

October 25, 2022

 

(Information disclosure form: active disclosure)

 

　　                   

National action plans to curb microbial resistance

 

(2022-2025)

 

Since the implementation of the National Action Plan for Curbing Bacterial Drug Resistance (2016-2020), China has adopted a comprehensive management strategy to curb drug resistance and achieved positive results, but some common microbial drug resistance problems are still intensifying, and there are differences in the level of drug resistance prevention and control between regions and institutions, and the situation is still grim
.
In order to accelerate the implementation of the Healthy China Strategy, implement the Biosecurity Law of the People's Republic of China, curb microbial resistance, and better protect people's health, this action plan
is formulated on the basis of summarizing and evaluating the previous work.

 

1.
General requirements

 

Adhere to the principle of putting prevention first, combining prevention and treatment, and comprehensive policies, focusing on the outstanding problems existing in microbial resistance, innovating institutional mechanisms and working models, and effectively controlling the situation of drug resistance of major pathogenic microorganisms of
human and animal origin 。 By 2025, the national governance system for coping with microbial resistance will be basically improved, the public's health literacy related to microbial resistance prevention and control will be greatly improved, the ability of medical and health and animal health professionals to prevent and control microbial resistance will be significantly improved, the application and drug resistance monitoring and evaluation system of human and animal antimicrobial drugs will be more sound, the level of rational application of antimicrobial drugs will be further improved, scientific and technological research on microbial resistance prevention and control will be further accelerated, and international exchanges and cooperation will be further advanced
.

 

2.
Main indicators

 

From 2022 to 2025, the following indicators will be achieved:

 

(1) The incidence of drug-resistant bacteria infection and community-acquired drug-resistant bacteria infection in medical institutions continued to decline
.

 

(2) The drug resistance rate of major pathogenic microorganisms of human and animal origin continues to decrease or the growth rate of drug resistance decreases
.

 

(3) The awareness rate of urban and rural residents about microbial resistance, infection prevention, and the correct rate of knowledge of rational application of antimicrobial drugs reached 80%, and the correct rate of use behavior reached 60%; Health education on microbial resistance, infection prevention and rational application of antimicrobials for primary and secondary school students nationwide has reached full coverage
.

 

(4) The training of medical personnel and licensed veterinary antimicrobials in large-scale farms nationwide has achieved full coverage, and the correct rate of knowledge mastery has reached more than
80%.

 

(5) The suitability rate of outpatient antimicrobial prescriptions and inpatient antimicrobial drug orders in medical institutions above the secondary level nationwide has reached more than
75%.

 

(6) The proportion of pharmaceutical retail enterprises selling antimicrobial prescription drugs on prescription reaches 100%; The proportion of veterinary drug trading enterprises selling veterinary antimicrobial drugs on veterinary prescriptions has reached 80%.

 

(7) The application of human and animal antimicrobials and the coverage of drug resistance surveillance networks continue to increase; The application of antimicrobials and the evaluation system of drug resistance are more sound
.

 

(8) Develop and market 1-3 new antimicrobial drugs; Research and development of new microbial diagnostic instruments and equipment and reagents 5-10 items
.

 

(9) Initially establish a clinical antimicrobial susceptibility threshold standard system
suitable for China's actual conditions.

 

3.
Main tasks

 

(1) Adhere to prevention and reduce the incidence of
infection.

 

1.
Strengthen infection prevention and control
in medical institutions.
Promote the prevention and control of infection in medical institutions and the management of clinical application of antimicrobials, and increase investment in infection prevention and control, including the allocation of infection control professionals and the capacity building of infection control technology
.
Supervise and guide medical institutions to implement various systems, norms and standards for infection prevention and control, research and formulate evidence-based prevention and control measures for infections of important drug-resistant microorganisms, reduce the incidence of drug-resistant bacteria infection in medical institutions, and strengthen the source classification
of medical waste.
Strengthen basic knowledge education and behavioral norms for non-health technical personnel such as cleaning and security personnel in medical institutions to prevent and control infection
.
(The National Health Commission, the State Administration of Traditional Chinese Medicine, and the Health Bureau of the Logistics Support Department of the Central Military Commission are responsible for the division of labor according to their responsibilities)

 

2.
Strengthen water, sanitation and hygiene
.
Carry out in-depth patriotic health campaigns to promote the formation of civilized hygiene habits
in the whole society.
Ensure the safety
of drinking water for families, communities and health care institutions.
Improve public health facilities and solidly promote the rural toilet revolution
.
Promote comprehensive management of urban and rural environmental sanitation and improve the status of
urban and rural environmental sanitation.
Strengthen the hygiene management of breeding sites, slaughtering sites, food production workshops and other places to prevent animal diseases and ensure food safety
.
Take multiple measures to prevent and reduce community-acquired infections
.
(The National Health Commission, the Ministry of Agriculture and Rural Affairs, and the National Disease Control Administration are responsible for the division of labor according to their responsibilities)

 

3.
Strengthen the prevention and control
of environmental pollution of antimicrobials.
Strengthen the standardized treatment
of domestic sewage, medical wastewater and waste, production wastewater of pharmaceutical enterprises, aquaculture and food production wastewater.
Strictly implement the environmental impact assessment of antimicrobial pharmaceutical-related industrial park planning and construction projects, strengthen the control of antimicrobial drug pollution discharge, and promote the reduction of
antimicrobial drug waste.
Carry out pilot
monitoring of antimicrobials in aquatic environments.
Strengthen the capacity building
of antimicrobial drugs to prevent and control environmental pollution.
(The Ministry of Ecology and Environment, the National Health Commission and other departments are responsible according to the division of duties)

 

4
.
Strengthen vaccination against infectious diseases.
Further strengthen the vaccination of infectious diseases-related vaccines, enhance the resistance of humans and animals to preventable infectious diseases, reduce the incidence of infectious diseases, and reduce the need for
antimicrobials.
(The National Health Commission, the Ministry of Agriculture and Rural Affairs, and the National Disease Control Administration are responsible for the division of labor according to their responsibilities)

 

(2) Strengthen public health education and raise the level of awareness of
drug resistance.

 

1.
Increase the intensity of
education for urban and rural residents.
Combined with the "Health Knowledge Popularization Action" in the "Healthy China Action (2019-2030)", it will further enhance the public's awareness of the problem of microbial resistance and improve the knowledge level
of infection prevention and rational application of antimicrobials.
Promote personal hygiene protection, correct the use of prescription antimicrobials, and guide the public to rationally apply antimicrobials under the guidance of physicians
and pharmacists.
(The National Health Commission takes the lead, and the State Administration of Radio, Film and Television and the Ministry of Agriculture and Rural Affairs are responsible for the division of labor according to their responsibilities)

 

2.
Widely carry out science popularization publicity
for primary and secondary school students.
Carry out scientific popularization activities on the rational application of antimicrobial drugs and microbial resistance in primary and secondary schools, guide students to establish the concept of disease prevention and rational application of antimicrobial drugs from an early age, and develop good hygiene habits and rational drug use behavior
.
(Led by the Ministry of Education, with the participation of the National Health Commission and the State Administration of Radio, Film and Television)

 

3
.
Regularly hold antimicrobial awareness weeks.
In November of each year, the Antimicrobial Awareness Week is carried out simultaneously with the World Health Organization, and through various methods such as shooting public service propaganda videos, designing publicity posters, opening public WeChat signals, and organizing knowledge interactive questions and answers, publicity prevention and knowledge prevention, rational application of antimicrobial drugs and microbial resistance are effectively improved, and the level of
awareness of microbial resistance in the whole society is effectively improved.
(Led by the National Health Commission and the Ministry of Agriculture and Rural Affairs, with the participation of the State Administration of Radio, Film and Television)

 

(3) Strengthen training and improve professionals' prevention and control capabilities
.

 

1.
Strengthen the cultivation
of talents in colleges and universities.
Demand-oriented, cultivate and strengthen professional talent teams such as infection prevention and control, infectious diseases, pharmacy, microbiology, veterinary medicine and so on
.
Support institutions of higher learning with the capacity to independently set up second-level or interdisciplinary disciplines related to microbial resistance under relevant first-level disciplines, and encourage the interdisciplinary cultivation of high-level compound talents
in biology, medicine, pharmacy, agriculture, environmental science, and other disciplines.
Strengthen the training of compound talents in public health and clinical medicine, and promote the integration
of medical and prevention.
Support colleges and universities with the capacity to open courses on microbial resistance, infection prevention and control, and rational application of antimicrobial drugs in clinical medicine, veterinary medicine, pharmacy and other majors, or add corresponding teaching content
to related courses.
(Led by the Ministry of Education, with the participation of the National Health Commission and the Ministry of Agriculture and Rural Affairs)

 

2.
Strengthen the training
of medical personnel.
Strengthen the daily training of medical personnel on the rational application of antimicrobials and the prevention and control of drug resistance, encourage relevant professional organizations and academic associations to carry out high-quality training, and establish training brands
.
Make full use of online and offline education methods to improve the theoretical knowledge and practical skills
of medical staff related to the prevention and control of microbial resistance.
Implement the Measures for the Administration of the Clinical Application of Antimicrobial Drugs, conduct regular training and assessment of physicians and pharmacists, and grant corresponding antibacterial drug prescription rights or antibacterial drug dispensing qualifications
if they pass the assessment.
(The National Health Commission and the State Administration of Traditional Chinese Medicine are responsible according to the division of duties)

 

3.
Strengthen the education
of aquaculture and veterinary practitioners.
Further promote the "scientific use of veterinary antimicrobials" public welfare publicity relay action
.
Increase the training of veterinarians and breeding practitioners in the prevention and control of animal diseases and the rational application of antimicrobials, and continuously expand coverage
.
Incorporate the norms for the use of veterinary antimicrobials into the curriculum system
of high-quality farmer cultivation projects.
(Ministry of Agriculture and Rural Affairs is responsible)

 

(4) Strengthen industry supervision and rationally apply antimicrobials
.

 

1.
Improve the level of clinical application of
antimicrobials.
Medical institutions should further implement the national rules and regulations on the management of antimicrobials, normative standards, etc.
, with the goal of improving the outcome of infectious diseases and improving the quality of medical care, innovate management models, and make full use of technologies such as informatization and artificial intelligence to improve regulatory capabilities and efficiency
.
Strengthen the construction of infectious disease departments in general hospitals above the second level, and standardize the diagnosis and treatment of bacterial fungal infections; Strengthen the construction of clinical microbiology rooms, and improve the ability of etiological diagnosis by participating in interlaboratory quality assessment and promoting rapid diagnosis technology of drug-resistant bacteria; Vigorously train clinical pharmacists in the field of anti-infection, and take the lead in appointing full-time pharmacists
in key departments such as pediatrics.
Strengthen technical support and supervision of private hospitals, township health centers, community health service centers, private clinics and other medical institutions, and urge them to continuously improve the level of rational application of
antimicrobials.
(The National Health Commission and the State Administration of Traditional Chinese Medicine are responsible according to the division of duties)

 

2.
Strengthen the supervision and management
of veterinary antimicrobials.
Promote the development of guidelines and management methods
for the safe use of veterinary antimicrobials.
Strengthen the supervision and management of animal hospitals, animal clinics, and farms, and further standardize the use
of veterinary antimicrobials.
Focusing on the implementation of rural revitalization and food safety strategies, promote the green development of the aquaculture industry, continue to promote the reduction of the use of veterinary antimicrobials, and promote the use of safe, efficient and low-residue veterinary traditional Chinese medicine and other veterinary antibacterial alternative products
.
Strictly implement the withdrawal plan
of antibacterial feed additives for growth promotion.
Promote the sale and use of veterinary antimicrobials on the basis of veterinary prescriptions
.
Continue to carry out veterinary antimicrobial safety risk assessment and veterinary drug residue monitoring to maintain food safety and public health safety
.
(Ministry of Agriculture and Rural Affairs is responsible)

 

3.
Strict supervision
of the sales of antimicrobials.
Strictly implement the sale of antimicrobial prescription drugs by pharmaceutical retail enterprises on prescription, and increase the supervision of drug distribution channels such as retail pharmacies and third-party platforms for online drug transactions
.
It is strictly forbidden to use prescriptions that are automatically generated without diagnosis
.
Strictly crack down on the sale of counterfeit and substandard antimicrobial drugs in the field of pharmaceutical trading
.
(NMPA responsible)

 

4.
Give play to the role
of medical insurance payment in promoting rational drug use.
Deepen the reform of medical insurance payment methods, and reasonably measure the costs
related to the diagnosis and treatment of infectious diseases.
According to clinical needs and medical insurance funds, dynamically adjust the medical insurance drug list, and include antimicrobial drugs with high clinical value, obvious patient benefits and excellent economic evaluation into the scope of
medical insurance payment according to the procedure.
Scientifically carry out medical insurance negotiations on antimicrobial drugs, organize centralized drug procurement by the state and reform of medical insurance payment methods, and strengthen the evaluation
of the effect of policy implementation.
(Led by the National Health Insurance Administration, with the cooperation of the National Health Commission)

 

(5) Improve monitoring and evaluation systems to provide a basis
for scientific decision-making.

 

1.
Improve the clinical monitoring system
of antimicrobials.
Strengthen the construction of monitoring networks for the clinical application of antimicrobial drugs, bacterial drug resistance surveillance networks, mycosis surveillance networks, and infection surveillance networks in medical institutions, and expand surveillance coverage
.
Improve monitoring indicators and monitoring methods, improve data quality and analysis efficiency, and give full play to the supervision and guidance role
of monitoring networks in clinical diagnosis and treatment and industry management.
Strengthen data linkage between surveillance networks, and explore the establishment of a rapid early warning mechanism
for outbreaks of multidrug-resistant bacteria with real-time data from surveillance networks.
(The National Health Commission and the State Administration of Traditional Chinese Medicine are responsible according to the division of duties)

 

2.
Establish and improve the monitoring network
in the field of animal diagnosis and treatment and breeding.
Promote the establishment and improvement of veterinary antimicrobial drug application monitoring networks and animal-derived microbial resistance monitoring networks, improve animal-derived bacterial drug resistance monitoring networks, gradually cover breeding farms, animal hospitals, animal clinics, livestock and poultry slaughtering sites, and obtain veterinary antimicrobial drug use data and animal-derived microbial resistance data
.
Actively carry out general surveillance, active monitoring and target surveillance, pay attention to key animal pathogens, zoonotic and related symbiotic isolates, and strengthen quality control
in monitoring laboratories.
(Ministry of Agriculture and Rural Affairs is responsible)

 

3.
Realize the comprehensive application
of monitoring results in different fields.
Accelerate the establishment of a collaborative mechanism for the rational application of antimicrobial drugs and the monitoring of microbial resistance in the fields of human medical treatment, animal diagnosis and treatment, and breeding, and research and establish a scientific and reasonable evaluation index system to provide a basis
for strengthening the application and management of antimicrobial drugs in the medical and breeding fields.
Establish a national microbial resistance reference laboratory and biological specimen bank
.
Establish a technical standard system for drug resistance research and monitoring, collect and preserve various drug-resistant microorganisms isolated, and provide standard strains
required for clinical and research purposes.
(The National Health Commission and the Ministry of Agriculture and Rural Affairs are responsible)

 

4.
Establish and complete monitoring, assessment and early warning systems
for microbial resistance risks.
Strengthen the monitoring of microbial resistance biosecurity risks, and improve the ability to
identify and analyze microbial resistance biosecurity risks.
Based on risk monitoring data, materials and other information, periodically organize and carry out investigation and assessment of microbial drug resistance biosecurity risks, and establish an early warning system
.
(The National Health Commission and the Ministry of Agriculture and Rural Affairs are responsible according to the division of duties)

 

(6) Strengthen the supply guarantee
of relevant drugs and devices.

 

1.
Accelerate the launch of
urgently needed clinical drugs and medical device products.
New drugs, vaccines, innovative medical devices, etc.
urgently needed for the prevention, diagnosis and treatment of drug-resistant infections shall be reviewed and approved
in accordance with the procedures.
Strengthen the monitoring and evaluation of adverse reactions of antimicrobial drugs
.
(NMPA responsible)

 

2.
Promote the development of industries related to the prevention and control of
microbial resistance.
Promote upstream and downstream enterprises and scientific research in the antimicrobial drug industry chain to strengthen collaboration, focus on key links of the industrial chain such as raw and auxiliary materials, new pharmaceutical equipment, etc.
, carry out technical product research, and make up for the shortcomings of the industrial chain
.
Encourage enterprises to develop and apply green production processes such as continuous synthesis and biotransformation, strengthen the automation and closed transformation of the production process, improve the comprehensive disposal level of "three wastes", and promote the green, large-scale and intensive development
of the production of APIs of antimicrobials.
(Ministry of Industry and Information Technology is responsible)

 

(7) Strengthen scientific and technological research and development for the prevention and
control of microbial resistance.

 

1.
Promote the research and development and transformation application
of new antimicrobial drugs, diagnostic tools, vaccines, and antimicrobial drug substitutes.
Establish a joint research mechanism for multidisciplinary collaborative innovation to promote the output and transformation and application of core key technologies and major products for the prevention and
control of microbial resistance.
Encourage the development of rapid diagnostic equipment and reagents for drug-resistant infections, and support the development of inexpensive and easily promoted drug concentration monitoring technologies
.
Support research on the diagnosis, treatment, prevention and control of drug-resistant infections, including new treatment regimens, prevention and control strategies for drug-resistant infections, and post-marketing evaluation of antimicrobials
.
Conduct clinical antimicrobial susceptibility cut-off studies and standard development
.
Focus on strengthening the research and development of antimicrobial drugs suitable for special groups such as pregnant women, children, and the elderly, and further strengthen the research and development
of alternative antimicrobial drugs such as proprietary Chinese medicines.
Promote the research and development
of animal-specific antimicrobials and veterinary antimicrobial alternatives.
(The National Health Commission, the State Administration of Traditional Chinese Medicine, the Ministry of Science and Technology, the State Food and Drug Administration, the Ministry of Agriculture and Rural Affairs, etc.
are responsible for the division of labor according to their responsibilities)

 

2.
Support research on the molecular epidemiology, drug resistance mechanism and transmission mechanism of
microbial resistance.
Timely grasp the epidemiological characteristics and development trends of microbial drug resistance in different regions, populations, medical institutions, animals, and the environment in China, clarify the pathogenesis, drug resistance and transmission mechanism of microorganisms, and provide scientific data
for the formulation of drug resistance prevention and control strategies and the research and development of new drugs and technologies.
(The National Health Commission, the Ministry of Science and Technology, the Ministry of Agriculture and Rural Affairs, etc.
are responsible for the division of labor according to their responsibilities)

 

3.
Carry out research
on the prevention and control of environmental pollution of antimicrobials.
Research and development of environmental antimicrobial analysis technology, and research on the possible ecological environmental impact of residual antimicrobial drugs in the environment
.
(The Ministry of Science and Technology and the Ministry of Ecology and Environment are responsible for the division of labor according to their responsibilities)

 

(8) Extensively carry out international exchanges and cooperation
.

 

Actively participate in global health governance, carry out multi-level exchanges and cooperation around the problems and challenges faced by global microbial resistance, and promote the construction of a human health community
.
Strengthen exchanges and cooperation with relevant international organizations and other countries in the world, draw on advanced concepts, high technologies and experience in the field of microbial resistance, and actively provide "Chinese solutions" and "Chinese experience"
for global microbial resistance prevention and control.
Combined with the development of work and the advantages of scientific and technological development, we will continue to promote bilateral and multilateral scientific and technological cooperation
with other countries in the formulation of prevention and control strategies and technical standards, monitoring and evaluation, research and development, technology promotion, personnel training, and thematic seminars.
Under the cooperation framework of the "One Belt, One Road" and the "Healthy Silk Road", we will focus on promoting international drug resistance surveillance cooperation and controlling the cross-regional and cross-border spread of drug-resistant bacteria
.
Actively support countries and regions in need to carry out drug resistance prevention and control activities
.
(The National Health Commission takes the lead, and the Ministry of Agriculture and Rural Affairs, the Ministry of Science and Technology, etc.
are responsible for the division of labor according to their responsibilities)

 

4.
Safeguard measures

 

(1) Strengthen organizational leadership
.
Establish and improve coordination and liaison mechanisms between relevant departments to deal with microbial resistance, strengthen regular information communication, give full play to the role of overall planning and coordination, increase support for relevant work, and ensure the sustainability
of work.
According to this action plan, formulate annual work priorities, and decompose work tasks and measures into specific departments, promote each to perform its own duties, form a joint force, and achieve all work goals
on schedule.
All localities should study and formulate specific implementation plans and submit them to the National Health Commission
in writing before the end of December 2022.
(The National Health Commission takes the lead, and all relevant departments are responsible according to the division of duties)

 

(2) Carry out monitoring and assessment
.
Establish mechanisms
at the national level to monitor the implementation of action plans and evaluate results.
Focusing on work objectives and tasks, improve the evaluation index system, clarify the subject and content of evaluation, and carry out annual work evaluation and quality improvement research
on the implementation of specific measures.
According to the monitoring and evaluation situation, issue a special report on the progress of the implementation of the action plan in a timely manner, actively promote good experience and practices, and study and solve
the problems encountered in a timely manner.
Each province (autonomous region, municipality) shall carry out monitoring and assessment in its own region as required, and promote the implementation of
tasks.
(The National Health Commission takes the lead, and all relevant departments are responsible according to the division of duties)

 

(3) Give play to the power of
experts.
Establish and improve the National Advisory Expert Committee on Curbing Microbial Resistance, promote communication and exchanges between experts in different fields and across disciplines, provide decision-making consultation for strategic research and policy formulation, provide technical support for the implementation of action plans, promptly put forward suggestions for action plan adjustments, and promote the improvement of relevant guidelines and technical specifications
.
All localities may establish their own advisory committees on curbing microbial resistance to strengthen technical support
.
(The National Health Commission takes the lead, and all relevant departments are responsible according to the division of duties)