First of all, I would like to thank Sally, Kevin, Damiano and all those who organized this very important meeting on AMR in such a beautiful country like Malta. I am especially happy to be here when we have had terrible snow storm in Tokyo after I safely left Haneda Airport where people are now in a mess struggling with 10 centimeter of snow in Tokyo.
Today, we all gathered here to discuss for only one goal: how we can successfully increase the momentum of our fight against antimicrobial resistance to its highest level.
We all know that it is the political decision that ultimately decides the degree of our commitment. We can only change our policy on AMR either by changing the allocation of present budget or finding new ways to finance a new policy. Those must be ultimately decided only by politicians. And it is crucially important to create strategic evidences for action that politicians can perceive as their own critical issues.
To have a better dialogue among us, this meeting advices us not to use power point materials. I asked Damiano to supply my material on your request that includes three charts I used in 2016, the year of Ise-Shima G7 Summit and the last UN High Level Meeting on AMR. I succeeded to persuade Prime Minister Abe to include AMR as one of the three pillars of agenda on global health at the Leaders' Meeting. These charts are on ? a composition of total antimicrobial consumption in Japan which told us that human use was only about 30% and 70% was consumed in agriculture and fishery. ? Country by country statistics of use of antimicrobials on livestock, that told us Japan has only 1.7% share whereas China and US has 23%,12% share respectively meaning AMR was nothing but a global health issue. ? Country by country comparison of the antimicrobial use in health-care sector telling us that,
although Japan consumed relatively few antimicrobials, we used too much amount of three kinds of wide-spectrum antimicrobials that could have strong impact on AMR.
Although, with those charts, we were successful to convince then prime minister and the general public in Japan and the world at that time, as we are becoming more aware of the complex and serious global implication of the AMR, it is obvious that we need a paradigm shift in our way of thinking towards AMR.
The concerns of political leaders are not just the number of deaths by specific disease , but the impact on the sustainability of society itself and human being, from the point of view of the "security" and "political, economic, and social stability" of their own countries. We have to link the evidence we create with these concerns of political leaders.
Antimicrobial resistant bacteria invade the global environment and consequently undermine people's well-being. The UNEP's report last year, "Bracing for Superbugs", points to this problem. This argument must be far deepened.
Thus, I would like to propose to view antimicrobial resistance as a "sustainability issue" for the "planetary environment" and for "human survival". To this end, it is necessary to show more scientifically the impact and the transmission mechanism of antimicrobial resistance on the global environment and, in turn, on human health. Obviously, we don't have sufficient enough data and evidence yet.
The issue of "global environmental sustainability" appeals to all generations, including younger generations, and inspires people to take action. The result would be a whole-of-government initiative, not only in the medical sphere, but also in the agricultural, fisheries and environmental spheres and, consequently, involving the government's finance ministry which influences the prime ministers most.
From this perspective, I believe it is important to construct evidence on the following:
•Firstly, the irreversible effects of antimicrobial agents globally leaked into the environment through many channels such as ? the waste from antimicrobial manufacturing plants, ? leakage of antimicrobials via hospital drainage, ? effect of self-medication with antimicrobials sold without a prescription or ? leftover antimicrobials, and ? from agricultural and fishery settings.
•Secondly, the risk of outbreaks of antimicrobial resistant pathogens destabilizing social and economic stability, given the fact that bacterial infections such as anthrax and plague caused major social unrest in the past.

Now I would like to ask Dr. Ohmagari from Japan, as our leader in the clinical and research fields of AMR, to add more information about how Japan is struggling to build up such evidences.

Thank you very much.