Publication of a national action plan to contain 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, Bureau), Industry and Information Technology Department, Finance Department (Bureau), Ecology and Environment Department (Bureau), Agriculture and Rural Affairs (Agriculture and Animal Husbandry) Department (Committee, Bureau), Radio and Television Bureau, Medical Insurance Bureau, Traditional Chinese Medicine Bureau, Disease Control Bureau, Drug Administration, and relevant health departments of the military:

 

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 hereby issued to you, please seriously organize its implementation
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 Medical Insurance Administration, State Administration of Traditional Chinese Medicine

 

National Agency for Disease Control and Prevention State Food and Drug Administration

 

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

 

October 25, 2022

 

(Form of information disclosure: active disclosure)

          

 

National Action Plan to Contain Microbial Resistance

 

(2022-2025)

 

Since the implementation of the National Action Plan for Containing Bacterial Drug Resistance (2016-2020), China has adopted a comprehensive management strategy to contain 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 preliminary work.

 

1.
Overall requirements

 

Adhere to the principle of prevention first, prevention and control, and comprehensive policies, focus on the outstanding problems of microbial resistance, innovate institutional mechanisms and work models, and effectively control the situation of drug resistance in
major pathogenic microorganisms of human and animal origin 。 By 2025, the national governance system for dealing 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 rational application level of antimicrobial drugs will be further improved, the scientific and technological research on microbial resistance prevention and control will be further accelerated, and international exchanges and cooperation will be deepened
.

 

2.
Main indicators

 

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

 

(1) The incidence of drug-resistant infections and community-acquired drug-resistant infections in medical institutions continues 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 the problem of microbial resistance, the correct rate of infection prevention and the rational application of antimicrobial drugs reached 80%, and the correct rate of use behavior reached 60%; The health education of microbial resistance, infection prevention and rational application of antimicrobial drugs among 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 antibacterial drug prescription and inpatient antibacterial drug order in medical institutions above level II nationwide has reached more than
75%.

 

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

 

(7) The coverage of human and animal antimicrobial applications and drug resistance surveillance networks continues to improve; The antimicrobial application and resistance evaluation system is more sound
.

 

(8) R&D and marketing of 1-3 new antimicrobial drugs; Research and development of 5-10 new microbial diagnostic instruments and reagents
.

 

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

 

Third, the main tasks

 

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

 

1.
Strengthen infection prevention and control
in medical institutions.
Promote infection prevention and control in medical institutions and the management of the 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 infections in medical institutions, and strengthen the source classification
of medical waste.
Strengthen basic knowledge education and behavioral norm management
for infection prevention and control of non-health technicians such as cleaning and security personnel in medical institutions.
(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 according to the division of duties)

 

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 safe drinking water for
families, communities and health care facilities.
Improve public health facilities and solidly promote the rural toilet revolution
.
Promote the comprehensive management of urban and rural environmental sanitation and improve the situation 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 Agency for Disease Control and Prevention are responsible according to the division of duties)

 

3.
Strengthen the prevention and control of environmental pollution of
antimicrobials.
Strengthen the standardized treatment
of domestic sewage, medical wastewater and waste, production wastewater from pharmaceutical enterprises, aquaculture and food production wastewater.
Strictly implement the environmental impact assessment of antimicrobial drug pharmacy related industrial park planning and construction projects, strengthen the control of antimicrobial pollution emissions, and promote the reduction of
antimicrobial waste.
Pilot antimicrobial surveillance in aquatic environments
.
Strengthen the regulatory capacity building
for the prevention and control of environmental pollution of antimicrobials.
(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 vaccines related to infectious diseases, enhance the resistance of humans and animals to preventable infectious diseases, reduce the incidence of infectious diseases, and reduce the demand for
antimicrobial use.
(The National Health Commission, the Ministry of Agriculture and Rural Affairs, and the National Agency for Disease Control and Prevention are responsible according to the division of duties)

 

(2) Strengthen public health education and raise 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 understanding of the problem of microbial resistance, and improve the knowledge level
of infection prevention and rational application of antimicrobial drugs.
Promote personal hygiene protection, correct the use and treatment of over-the-counter antimicrobials, and guide the public to rationally use antimicrobials under the guidance of physicians
and pharmacists.
(Led by the National Health Commission, the State Administration of Radio, Film and Television and the Ministry of Agriculture and Rural Affairs are responsible according to the division of duties)

 

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

 

3
.
Hold regular Antimicrobial Awareness Week.
In November of each year, the Antimicrobial Awareness Week is carried out simultaneously with the World Health Organization, through shooting public welfare publicity videos, designing publicity posters, setting up public micro-signals, organizing knowledge interactive questions and answers, etc.
, to publicize infection prevention, rational application of antimicrobials and knowledge of microbial resistance, and effectively improve the level
of awareness of microbial resistance in the whole society.
(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' ability to
prevent and control.

 

1.
Strengthen the cultivation of talents in
colleges and universities.
Demand-oriented, cultivate and expand the team
of professional talents in infection prevention and control, infectious diseases, pharmacy, microbiology, veterinary medicine and so on.
Support qualified institutions of higher learning to independently set up secondary disciplines or interdisciplinary disciplines related to microbial resistance under relevant first-level disciplines, and encourage multidisciplinary training 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 prevention and prevention.
Support qualified colleges and universities to open courses on microbial drug resistance, infection prevention and control, and rational application of antimicrobials in clinical medicine, veterinary medicine, pharmacy and other majors, or add corresponding teaching content
to relevant 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 a training brand
.
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 Administrative Measures for the Clinical Application of Antibacterial Drugs, regularly train and assess physicians and pharmacists, and grant the corresponding antibacterial drug prescription rights or antibacterial drug dispensing qualifications
after passing 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 antibacterial drugs" 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 the
coverage.
Incorporate veterinary antimicrobial use norms into the curriculum system
of high-quality farmer cultivation projects.
(Ministry of Agriculture and Rural Affairs responsible)

 

(4) Strengthen industry supervision and rational use of antimicrobials
.

 

1.
Improve the level of clinical application of
antimicrobials.
Medical institutions should further implement the national rules and regulations, norms and standards on the management of antimicrobials, 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 information technology, artificial intelligence and other technologies to improve supervision capabilities and efficiency
.
Strengthen the construction of infectious disease departments in general hospitals above level 2, and standardize the diagnosis and treatment of bacterial and fungal infections; Strengthen the construction of clinical microbiology rooms, and improve the ability of etiological diagnosis by participating in interlaboratory quality evaluation and promoting rapid diagnosis technology of drug-resistant bacteria; Vigorously train clinical pharmacists in the field of anti-infection, and take the lead in assigning 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 guiding principles and management methods
for the safe use of veterinary antimicrobials.
Strengthen the supervision and management of animal hospitals, animal clinics and breeding 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 use of veterinary antibacterial drugs to reduce the use of veterinary antibacterial drugs, 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 with veterinary prescriptions
.
Continue to carry out safety risk assessment and veterinary drug residue monitoring for veterinary antimicrobials to maintain food safety and public health safety
.
(Ministry of Agriculture and Rural Affairs responsible)

 

3.
Strictly supervise the sale of
antimicrobials.
Strictly implement the sale of antimicrobial prescription drugs by pharmaceutical retail enterprises by prescription, and increase the supervision
of drug circulation channels such as retail pharmacies and third-party platforms for online drug trading.
The use of automatically generated prescriptions
without diagnosis is strictly prohibited.
Strictly crack down on the sale of
counterfeit and inferior antimicrobial drugs in the pharmaceutical business sector.
(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 calculate 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 catalog, and include antimicrobial drugs with high clinical value, obvious patient benefits and excellent economic evaluation into the scope
of medical insurance payment according to procedures.
Scientifically carry out medical insurance negotiations for antimicrobials, centralized drug procurement organized by the state and reform of medical insurance payment methods, and strengthen the evaluation
of policy implementation effects.
(Led by the National Health Insurance Bureau, 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 antibacterial drugs, bacterial drug resistance, mycosis and infection in medical institutions, and expand the coverage of
surveillance.
Improve monitoring indicators and monitoring methods, improve data quality and analysis efficiency, and give full play to the supervision and guidance role
of the monitoring network in clinical diagnosis and treatment and industry management.
Strengthen data linkage between monitoring networks, and explore the establishment of a rapid early warning mechanism
for the outbreak of multidrug-resistant bacteria with real-time data on the monitoring network.
(The National Health Commission and the State Administration of Traditional Chinese Medicine are responsible according to the division of duties)

 

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

 

3.
Realize the comprehensive application
of monitoring results in different fields.
Accelerate the establishment of a coordination mechanism for the rational application of antimicrobial drugs and microbial resistance monitoring in the fields of human medicine, 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.
(National Health Commission and Ministry of Agriculture and Rural Affairs are responsible)

 

4.
Establish and improve the monitoring, assessment and early warning system
for the risk of microbial resistance.
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, regularly organize and carry out investigation and assessment of microbial 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 new drugs and medical device products urgently needed in clinical practice
.
For new drugs, vaccines, innovative medical devices, etc.
that are urgently needed clinically related to the prevention, diagnosis and treatment of drug-resistant infections, priority will be given to review and approval
according to 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 the upstream and downstream enterprises and scientific research of 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, and 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 biological transformation, strengthen the automation and closed transformation of production processes, improve the comprehensive disposal level of "three wastes", and promote the green, large-scale and intensive development of
antimicrobial API production.
(Ministry of Industry and Information Technology responsible)

 

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

 

1.
Promote the research and development and transformation and application of new antimicrobials, diagnostic tools, vaccines, and
antimicrobial alternatives.
Establish a joint research mechanism for multidisciplinary collaborative innovation, and promote the output and transformation and application
of core key technologies and major products for microbial drug resistance prevention and control.
Encourage the development of rapid diagnostic equipment and reagents for drug-resistant bacterial infections, and support the development of inexpensive and easy-to-promote drug concentration monitoring technologies
.
Support research on the diagnosis, treatment, prevention and control of drug-resistant bacterial infections, including new treatment options, prevention and control strategies for drug-resistant bacterial infections, and post-marketing evaluation of antimicrobials
.
Carry out clinical antimicrobial susceptibility vertex research 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 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 according to the division of duties)

 

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 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 formulating drug resistance prevention and control strategies and researching and developing new drugs and new technologies.
(The National Health Commission, the Ministry of Science and Technology, the Ministry of Agriculture and Rural Affairs, etc.
are responsible according to the division of duties)

 

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

 

(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 community of
human health.
Strengthen exchanges and cooperation with relevant international organizations and countries around the world, learn from advanced concepts, high and new technologies and experience in the field of microbial resistance, and actively provide "Chinese solutions" and "Chinese experience"
for the prevention and control of microbial resistance globally.
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, talent training, and thematic seminars.
Under the cooperation frameworks of "One Belt/One Road" and "Health Silk Road", we will focus on promoting international drug resistance monitoring and coordination, 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
.
(Led by the National Health Commission, the Ministry of Agriculture and Rural Affairs, the Ministry of Science and Technology, etc.
are responsible according to the division of duties)

 

4.
Safeguards

 

(1) Strengthen organizational leadership
.
Establish and improve the coordination and contact mechanism between relevant departments to deal with microbial resistance, strengthen normalized information communication, give full play to the role of overall 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 synergy, and achieve each work goal
on schedule.
All localities should study and formulate specific implementation plans and submit them in writing to the National Health Commission
by the end of December 2022.
(The National Health Commission takes the lead, and all relevant departments are responsible according to their responsibilities and division of labor)

 

(2) Carry out monitoring and assessment
.
Establish mechanisms
for monitoring and evaluating the results of the implementation of the action plan at the national level.
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, timely issue special reports on the progress of the implementation of the action plan, actively promote good experience and practices, and promptly study and solve
problems encountered.
Each province (autonomous region, municipality) is to carry out monitoring and evaluation 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 their responsibilities and division of labor)

 

(3) Give play to the strength of
experts.
Establish and improve the National Advisory Committee on Containing Microbial Drug Resistance, promote communication and exchange of experts in different fields and multidisciples, provide decision-making consultation for strategic research and policy formulation, provide technical support for the implementation of action plans, timely put forward suggestions for action plan adjustments, and promote the improvement of relevant guidelines and technical specifications
.
Each region may set up its own regional advisory committee on microbial resistance containment to strengthen technical support
.
(The National Health Commission takes the lead, and all relevant departments are responsible according to their responsibilities and division of labor)