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U.S. Department of Health and Human Services

Animal & Veterinary

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International Programs: Korea by Gun-Jo Woo, Ph.D.

DR. WOO: Good afternoon, ladies and gentlemen. My name is Gun-Jo Woo from Korea University. Thank you very much for inviting me and giving me a chance to talk in NARMS meeting.

Before joining the Korea University I was the Director of National Antimicrobial Resistance Program in Korea and I also worked as a Director for the Center for Food Safety in ---, it’s a counter-part of the CFS in USFD. Okay.

This will be a good chance to communicate between NARMS in the United States and NARMP in Korea. I think this is my son, Julius, he has a duel citizenship, so he can play a role in this area. He’s a freshman in Perdue University.

(Slide)

My talk is composed of five parts. First overview and the -- let me introduce briefly the structure and how the NARMP is organizing Korea and the roadmap in a couple of areas. Let me show you. And I’ll talk about briefly the budget size and how many projects and what kind of projects is going on. And the achievements of the NARMP and finally talk of the self-evaluation of this program.

(Slide)

First let me overview of NARMP for you. Okay. Who is this person? He’s the former Director General of WHO, Doctor Lee Jong-Woo, he’s a Korean. Unfortunately he passed away one year before the WHO General Meeting. He mentioned like that, we had an emerging infectious disease just yesterday, until yesterday. If an emerging infectious disease such as SARS is an impending disaster, crisis of antimicrobial resistance is a future disaster. However, the intensity of this disaster is more serious and widely spread than we think and we imagine.

(Slide)

This is the status of antimicrobial resistance. Here -- what is the blank in this area. That is the South Korea. It’s a shame. This data is from WHO Report 10 years ago. How about Hungary, Hungary is in this data, Hungary is ranking number two and the silver medal. How about -- however in 1990 Hungary is number one. However, due to the intensity and great investment and care from the Hungarian government, they can step down from the gold medal to the silver medal.

I hope and I’m sure Korea is not anymore at the top position. Under second slide, I was invited to WHO, Western --- Regional Meeting five years ago. The South Korea is number one, I’m sorry. And the -- it’s hard to see, USA is ranking number two. So that’s the reason you invited me. And we have a meeting here between NARMS and NARMP. This is easy to remember and isn’t easy to pronounce.

(Slide)

And naturally when I worked in KFDA I organized this program with my colleagues in KFDA around eight years ago. Over 300 researchers are participating in this program every year. This is a 10 year long-term national project.

The first period is until 2012. The relevant organizations has 6 ministries, including MOAFF, MOPAS, and Ministry of Modern Affairs and Fisheries, and including 21 hospitals.

(Slide)

This is the key parts of the NARMP in Korea. First is the establishment -- I’m sorry, it’s not in front of me -- establishment of the safety system. We developed and implemented coordinated national surveillance program to control antimicrobial resistance including food, livestock, farming, aquiculture, hospital and also environmental. We did not mention about -- specifically in the environmental. I’ll talk about that.

And we assessed the risk to human health and associated antimicrobials in food and also in feed. And we also did management of the critically important antimicrobials.

Like other program in NARMP, in NARMS, in the Health Canada and the other programs, we also did the antimicrobial resistance, microorganisms monitoring program.

And also we emphasized the public campaign and education. This is my experience, education is a very important area especially in the farmers and the consumerism.

And the base research area, we standardized and harmonize methodologies to ensure the availability of reliable and comparable data. We have in Korea 116 MRLs at the present time. And also we introduce HACCP System in livestock farming. So at the present time all throughout house has a HACCP System. And we develop also guidelines. And the organization of the NARMP.

(Slide)

This is the NARMP structure until 2007. And this area is food and animal and environment. And this is a clinical area. KFDA is working at a control tower over management and budget, location, networking and information refining. We have much data however data sometimes is not so useful. The data should be refined for the information. And we have advisor community, 53 advisory community from the clinical areas and the non-clinical area. And public campaign, and international activities.

Korea, as you know is the host country of the task force on antimicrobial resistance and we also have asked for a meeting, collaborating with --- and FAO. And also mentoring antimicrobial resistance in retail foods, is KFDA’s job.

(Slide)

In 2008 the new Cabinet, the President Lee Yong-Ba, and the NARMP program, NARMP in Korea was promoted from the Minister’s level to Prime Minister’s level. So the Prime Minister’s Office is controlling the non-clinical area under the supervision of KFDA and under the control of KCDC, Korea CDC.

(Slide)

I would like to show you just a one roadmap. This is NARMP roadmap where we did the survey on the amount of antimicrobial use and ARM status, and also public campaign. We appeared before the 2007 host Codex ad hoc Task Force on Antimicrobial Resistance and International Collaboration.

After, as you know, this Codex ended this year. And it will be adopted in Codex hopefully next year. After that it is not decided yet, but we are considering to host the international meeting, for example, AGISAR, something like that. And we are planning for introducing the Vet Prescription System. Unfortunately we don’t have the vet prescription system but we would like to introduce in 2011.

And we would like to develop a vaccine and new antimicrobial and also including ---.

(Slide)

And budget and projects. Every year we have around $1 million project just through the NARMP. Each ministry has their own budget including the NARMP from the KFDA. For example the --- has their own project to support HACCP System and also the Ministry of the Republic has their own budget to the hospital surveillance programs.

(Slide)

And let me show you briefly the achievements of NARMP. I would like to summarize into five achievements. The first one is the policy to decrease antimicrobial resistance. And the second one is a decrease in antimicrobials for non-clinical area and also public campaign for risk communication. I emphasize this area during the last year. And develop the guidelines for international collaboration and some basic research area.

(Slide)

This is the policy to decrease antimicrobial resistance. When this program was started in 2003, before that the feed items was increased year by year. However, in 2005 we kicked out 28 feed items so the 25 items remained. And last year seven items were kicked out and 18 items remained. And next year we would like to completely ban except nine anti --- agents.

(Slide)

And this is the second step. We reduced two highly resistant tetracyclines, Chlortetracycline, Oxytetracycline Quaternary Ammonium Chloride, and five human and non-human common use of antibiotics, Zink Bacitracin, Colistin sulfate, Neomycin sulphate, and Neomycin HCI, and Penicillin.

(Slide)

This is the summary of the achievements ban on production of four zoonotic quinolones and imported items, said 133 approved items. And we introduced certification program for environment friendly agriculture safe livestock products, and we expended application of HACCP system in livestock farming.

So, during the NARMP program the number of HACCP applied livestock farms was greatly increased from 380 to 1,000. And we expanded the standard MRL from 58 to doubled, 116. And plan of introduction of vet prescription system next year.

(Slide)

And this is the result, during the NARMP program, decrease in antimicrobials for non-clinical areas. The decrease of antibiotics for livestock. It was increased until 2005 from the beginning. However, from the 2005 it is decreasing like this, from the 1,500 to the 1,000. This is the details for antibiotic use for animals.

(Slide)

This is the antimicrobial resistance rates in our livestock and also in the retail foods. I would like to focus on this area.

In Korea over 50 percent of antibiotics, tetracycline are from the 2005, the tetracycline resistance rate is decreased like this. You can compare with other country’s data this morning. The tetracycline resistance rate is not decreasing in our native countries.

(Slide)

And Vibrio parahaemolyticus is the indicator microisms in aquiculture farming. The ampicillin resistance rate was 97 percent. However, it has decreased to 32 percent. And Escherichia coli tetracycline resistance rate was 74 percent. It was decreased to 34 percent.

And the antimicrobial resistance rates in environment, Escherichia coli isolated from the environmental stream like this. The TCT resistance rate was decreased 51 percent to 25 percent last year.

(Slide)

And this is the public campaign for risk communication with the stakeholders, farmers, consumers, --- and other stakeholders. This is an education in public series, “Prudent Use of Antibiotics.” This is a CD. We distributed 10,000 these CDs to the elementary school and middle school. In Korea we have 9,300 elementary schools and middle schools. We are educating second generation.

And this is the “Prudent Use of Antibiotics in Food Animals.” This is a cartoon booklet. This one. As you see, this is a cartoon for the farmers. And the Educational Public Series, there are many Educational Public Series.

(Slide)

And this is the very impacting tool for the risk communication with the consumers. This is an environmental counter-attack, conditions for future happiness. With this program they got the SBS as a Win Excellence Award at the 31st Korea Broadcasting Award.

And KBS Environmental system, is a AMR, warning from super bacteria. Mr. Jong, the producer spend half a year, six months, to make this documentary. And he -- I recommended him to the Prime Minister and he got the Prime Minister’s prize.

And the 2006 project to protect our table, 2nd series of “Warning from the farm.” Okay.

(Slide)

We have the “Guideline for the Antimicrobial Free Environment of Livestock Farming.” We have a PFGE manual and guideline for the storage of antimicrobial resistance bacteria.

(Slide)

And this is a very unique and interesting data. When we started this program, only less than 30 percent of the people understand what antimicrobial resistance. However, last year, 2009, over 70 percent, less than 30 percent doesn’t know, over 70 percent know what antimicrobial resistance. This is the great result from the NARMP program in Korea, like this, like this. This is a good results for the public education.

(Slide)

And many people mentioned about the Codex Task Force. And we hosted the Codex Task Force for four years. Collaborating with the WHO, FAO and OIE.

(Slide)

And this is the final draft. The Commission agreed to make a Codex Task Force. The Head Secretary and the Chairperson and Vice-Chairperson, ---, she is the current Chairperson.

(Slide)

And this is the Codex Alimentarius Commission. So creates the whole span of the this task force.

(Slide)

And I was the Chairperson of the first Task Force on antimicrobial resistance, and so they did mention -- who knows better than me about MoJu. Our first meeting will be held in Jeju. And so we have a first and second meeting in Seoul. We have a training summit meeting this October in Seoul.

(Slide)

And this is the last part, the base standardization of antimicrobial resistance test methods and identification and characterization of molecular mechanisms of resistance development and gene transfer.

(Slide)

And we have around 6,500 microorganisms through the NARMP project.

(Slide)

And evaluation. We would like to mention the --- our project. To Establishment of regulatory approach for the decrease in antimicrobial resistance and antibiotic use and we need to monitor a more status after 2005, when the year beginning antibiotic use declined.

And we would like to reinforce national status in international society. And we need to further research on pathways and mechanisms of genetic transfer.

(Slide)

Thank you very much.

(Applause)

DR. CHILLER: Great. So we’ll have time for maybe one quick question or -- if there is anyone.

DR. WONG: Hello.

DR. CHILLER: I think it’s on.

DR. WONG: --- from the World Health Organization, Food Safety Zoonoses Department. I just want to -- hello, this is better. Okay. Danilo Lo Fo Wong from the World Health Organization, Food Safety Zoonoses Department.

I just want to congratulate you on a very, very, nice presentation and what I think for me particularly was very interesting is to show how you made all this highly technical content available for people and children in schools and people on the farm.

And we are doing similar things together with Member States for just a safer -- safer food, and I think this material would be very interesting also to have translated and maybe disseminated to other countries. So, I would like to talk to you about that later. Thank you.

DR. WOO: If this is something I will translate this one. Okay. I think we can do that.

DR. WONG: Okay. Great.

DR. CHILLER: Thank you very much. Okay. I would like to bring up Doctor Ran, from China. Doctor Ran is well known to us. She’s Deputy Director currently of the Branch of Enteric Infection Disease at the China CDC. And look forward to hearing Doctor Ran. Thank you.