A recent report from China showing the rapid emergence of antimicrobial resistance (AMR) to colistin (the drug of last resort) in Escherichia coli and Klebsiella pneumoniae isolated from chicken and pork meat, and from patients, has prompted a sharp intake of breath from the medical community and provided a timely and worrisome reminder of the inexorable spread of AMR.1 AMR is recognised as a grave threat to public health, summed up recently in the World Health Organization Global Action Plan on AMR2: Without harmonized and immediate action on a global scale, the world is heading towards a post-antibiotic era in which common infections could once again kill. In order to respond to and contain the threat of AMR, many countries, including the UK, the US and Canada, have developed cohesive action plans, with a series of forward-looking objectives, and the recognition that AMR is a One Health issue, covering both human and animal populations. Most recently, in June 2015, the Australian Government released Australias first National Antimicrobial Resistance Strategy, incorporating the collective views of stakeholders from human and animal health, academia, and food and agricultural sectors.3 One of the common features of overseas AMR strategies is endorsement by and commitment from Government, with demonstrable leadership and accountability frameworks.New Zealand, like other countries, has suffered the consequences of the emergence of AMR. Indeed, over the past decade, a number of concerning AMR threats have emerged in New Zealand. For example, as the result of very high levels of use of topical antibiotic preparations (Bactroban\u00a9 and Foban\u00a9) in New Zealand, the rates of resistance to mupirocin and fusidic acid in Staphylococcus aureus are amongst the highest in the developed world.4 Moreover, the prevalence of resistance to commonly used antibiotics in gram-negative pathogens, such as E. coli and K. pneumoniae,continues to increase, and recent reports of the transmission of carbapenem-resistant Enterobacteriaceae within New Zealand healthcare facilities are also of significant concern.5 In addition, the emergence of livestock-associated methicillin-resistant S. aureus (MRSA) in humans,6 and the detection of resistant Campylobacter jejuni in poultry and in human populations7 raises concerns about potential animal reservoirs of AMR in New Zealand. Finally, New Zealand has high rates of human antimicrobial consumption compared with most other developed countries, exacerbating the problem of AMR, and prompting calls for improved medical and public awareness around the judicious use of antibiotics.8 Importantly, the effectiveness of antimicrobials is integral to almost all areas of human and animal health, and has an impact on all of society.Laudable efforts have already been made by several organisations in New Zealand to monitor and respond to the threat of AMR. For example, the Health Quality and Safety Commissions Infection Prevention and Control (IPC) programme has successfully implemented initiatives designed to improve IPC practices and reduce the spread of AMR in healthcare facilities,9 and the Best Practice Advocacy Centre (BPAC) provides advice to healthcare professionals on the appropriate use of antimicrobials. In addition, the Institute of Environmental Science and Research (ESR) provides surveillance data on AMR to the New Zealand Ministry of Health, with the capacity to monitor emerging and existing resistance patterns. Particularly admirable is a recent statement from the New Zealand Veterinary Association,10 stating, By 2030 New Zealand Inc. will not need antibiotics for the maintenance of animal health and wellness. It is important to recognise however, that no single individual, organisation or action will provide an effective and successful response to AMR, and that continuing to document the problem is no replacement for devising a solution.Responding to AMR is also a key component of the global health security agenda.11 This framework is increasingly being used internationally to promote a more systematic and proactive response to emerging microbial and related threats to public health. This approach has been motivated by the realisation that, while recognising and responding rapidly to pandemics and emerging problems is vital, it is also necessary to use our knowledge to prevent problems emerging in the first place. This additional focus includes strategies to reduce the overuse of antibiotics, work with animal health agencies to reduce the prevalence of and human exposure to zoonotic diseases, and increase population resilience through immunisation and other approaches. A strong motivation is the observation that our current public and private sector organisations generally appear poorly adapted to combat complex, long-term, global health problems.While there have been other major public health responses over the past few years, most notably addressing extremely high rates of rheumatic fever, and ensuring national preparedness for the distant threat of Ebola virus infection, there has been no visible and coordinated strategy around AMR in New Zealand. Importantly, the WHO has called for all member states, including New Zealand, to have a multisectoral national action plan on AMR in place by the 2017 World Assembly.2 Given the emergence and spread of AMR globally and in New Zealand, it is critical that efforts are made to promptly develop and implement a cohesive and coordinated national AMR strategy, rather than suffer a slow death by committee. This strategy should have clear objectives, include a governance framework, and identify priority areas for New Zealand. Most importantly however, there should be active participation from all relevant stakeholders, with clear and credible leadership from Government. Failure to act now will impact on the health and wellbeing of New Zealanders for generations to come.

A recent report from China showing the rapid emergence of antimicrobial resistance (AMR) to colistin (the drug of last resort) in Escherichia coli and Klebsiella pneumoniae isolated from chicken and pork meat, and from patients, has prompted a sharp intake of breath from the medical community and provided a timely and worrisome reminder of the inexorable spread of AMR.1 AMR is recognised as a grave threat to public health, summed up recently in the World Health Organization Global Action Plan on AMR2: Without harmonized and immediate action on a global scale, the world is heading towards a post-antibiotic era in which common infections could once again kill. In order to respond to and contain the threat of AMR, many countries, including the UK, the US and Canada, have developed cohesive action plans, with a series of forward-looking objectives, and the recognition that AMR is a One Health issue, covering both human and animal populations. Most recently, in June 2015, the Australian Government released Australias first National Antimicrobial Resistance Strategy, incorporating the collective views of stakeholders from human and animal health, academia, and food and agricultural sectors.3 One of the common features of overseas AMR strategies is endorsement by and commitment from Government, with demonstrable leadership and accountability frameworks.New Zealand, like other countries, has suffered the consequences of the emergence of AMR. Indeed, over the past decade, a number of concerning AMR threats have emerged in New Zealand. For example, as the result of very high levels of use of topical antibiotic preparations (Bactroban\u00a9 and Foban\u00a9) in New Zealand, the rates of resistance to mupirocin and fusidic acid in Staphylococcus aureus are amongst the highest in the developed world.4 Moreover, the prevalence of resistance to commonly used antibiotics in gram-negative pathogens, such as E. coli and K. pneumoniae,continues to increase, and recent reports of the transmission of carbapenem-resistant Enterobacteriaceae within New Zealand healthcare facilities are also of significant concern.5 In addition, the emergence of livestock-associated methicillin-resistant S. aureus (MRSA) in humans,6 and the detection of resistant Campylobacter jejuni in poultry and in human populations7 raises concerns about potential animal reservoirs of AMR in New Zealand. Finally, New Zealand has high rates of human antimicrobial consumption compared with most other developed countries, exacerbating the problem of AMR, and prompting calls for improved medical and public awareness around the judicious use of antibiotics.8 Importantly, the effectiveness of antimicrobials is integral to almost all areas of human and animal health, and has an impact on all of society.Laudable efforts have already been made by several organisations in New Zealand to monitor and respond to the threat of AMR. For example, the Health Quality and Safety Commissions Infection Prevention and Control (IPC) programme has successfully implemented initiatives designed to improve IPC practices and reduce the spread of AMR in healthcare facilities,9 and the Best Practice Advocacy Centre (BPAC) provides advice to healthcare professionals on the appropriate use of antimicrobials. In addition, the Institute of Environmental Science and Research (ESR) provides surveillance data on AMR to the New Zealand Ministry of Health, with the capacity to monitor emerging and existing resistance patterns. Particularly admirable is a recent statement from the New Zealand Veterinary Association,10 stating, By 2030 New Zealand Inc. will not need antibiotics for the maintenance of animal health and wellness. It is important to recognise however, that no single individual, organisation or action will provide an effective and successful response to AMR, and that continuing to document the problem is no replacement for devising a solution.Responding to AMR is also a key component of the global health security agenda.11 This framework is increasingly being used internationally to promote a more systematic and proactive response to emerging microbial and related threats to public health. This approach has been motivated by the realisation that, while recognising and responding rapidly to pandemics and emerging problems is vital, it is also necessary to use our knowledge to prevent problems emerging in the first place. This additional focus includes strategies to reduce the overuse of antibiotics, work with animal health agencies to reduce the prevalence of and human exposure to zoonotic diseases, and increase population resilience through immunisation and other approaches. A strong motivation is the observation that our current public and private sector organisations generally appear poorly adapted to combat complex, long-term, global health problems.While there have been other major public health responses over the past few years, most notably addressing extremely high rates of rheumatic fever, and ensuring national preparedness for the distant threat of Ebola virus infection, there has been no visible and coordinated strategy around AMR in New Zealand. Importantly, the WHO has called for all member states, including New Zealand, to have a multisectoral national action plan on AMR in place by the 2017 World Assembly.2 Given the emergence and spread of AMR globally and in New Zealand, it is critical that efforts are made to promptly develop and implement a cohesive and coordinated national AMR strategy, rather than suffer a slow death by committee. This strategy should have clear objectives, include a governance framework, and identify priority areas for New Zealand. Most importantly however, there should be active participation from all relevant stakeholders, with clear and credible leadership from Government. Failure to act now will impact on the health and wellbeing of New Zealanders for generations to come.