Resistance Fighter: A Q&A with Keiji Fukuda

Delegates to last week’s 69th World Health Assembly heard copious reasons for the global community to fear the rising tide of antimicrobial resistance. However, Keiji Fukuda, WHO’s Special Representative on the issue, finds at least one reason for some cautious optimism: The world is finally waking up to the threat posed by AMR. Following a May 26 side event on global AMR research and innovation, the assistant Director-General took a few minutes to talk about AMR and prospects for global action with Brian W. Simpson, editor-in-chief of Global Health NOW.

Is the world now reacting sufficiently to AMR—are things moving forward enough?
We have the best chance now in our lifetimes to really move on this issue. You know, the people working in medicine and in science have really been working on AMR for decades. It’s clearly not a new issue, but what’s changing right now is it’s transitioning from being a scientific issue which you read about in medical journals to something which you can now hear on the radio, when you walk down and see sandwich shops saying that that they have antibiotic-free meats for example, you suddenly realize that we’re transitioning into something which is much more of a societal concern.  Because of that, that brings the potential to make a level of change which we could not have imagined 10 years ago. Of course, we’re not there yet but we are definitely off to the best start which we have had in our lifetimes. And we have the most potential to actually put in place what’s needed to deal with the issue.

Is there one mechanism that is actually going to be most successful? Should it be these public-private partnerships? Should it be the incentives for pharmaceutical companies?
I think that, again, to step back for a second, if we are going to deal with this issue, we are going to have to deal with at least 3 main problems. One of them is how do we get antibiotics whether they are existing ones or future ones used in the right way both in human health and in agriculture. The second thing though it’s clear that in much of the world, especially in developing countries, they simply don’t have the capacities do deal with this as an issue, and we have to come to grips with that. The third aspect is that, you know, we simply don’t have the right approach right now to making the technologies we need but also using them in the right way. And so I think that it’s going to be partly a question of what’s the right economic incentives, which in part is reducing risks, making them manageable, making sure that we have the right financial incentives so there’s a push aspect to it but there also has to be ability of companies to recoup what they put in—there needs to be the pull part of it. But again, there also has to be a level of understanding among people in general, and in the medical community, and in the agriculture community that using them in the right way is really in their interest. And so I think it goes beyond just these mechanisms that we’re talking about.

AMR will be discussed in a heads of state meeting at the UN General Assembly in September. Are you optimistic that it will accelerate things in terms of finding new solutions and new funding mechanisms?
I think there’s a couple things that it will clearly do. One of them, by having a meeting at that level, it is going to ensure that the highest level in many countries will begin to understand that we have an issue called AMR. And so it’s going to remove it from a “what is this?” to a “what are we going to do about it?” issue. That by itself is huge. The second thing is that if the meeting is successful, it will be seen as an issue in which the highest-level decision makers can play a prominent role in bringing sectors together. This is one of the most difficult issues in global anything—is getting sectors to work together. But also to recognize there is a strong developmental component to it. And the implications of that are you need to think about financing, you need to think what is the role of richer countries and poorer countries—again, a really important component. And so I think that it will do that for sure. And then the third part of it is that level of attention is really needed to, in many ways, enable the planning to go forward. You know there’s no end of technical plans—there’s a global action plan—but in many instances, they’re hard to get moving. There’s not enough money. There’s not enough buy-in. And so here I am hopeful that that level of attention will begin to free up those actions and so on. We’ll have to see, but I am hopeful.

Are you surprised that there’s not a great public outcry and demand on this issue?
No, I think that up until now, very few people would have heard about it. And even now when people hear about it, words like “antimicrobial resistance” completely confuses people. What do  these words mean? In fact, we have done a survey of about 10,000 people at WHO, and also Wellcome Trust has done another large survey, and many people simply believe they are becoming immune to the medicines and don’t understand that it really refers to microbes becoming resistant. So there’s a huge amount of either misinformation or lack of understanding but it’s very confusing for most people so I’m not surprised at all.

Brian W. Simpson, Global Health NOW editor-in-chief, reported from Geneva on the World Health Assembly from May 23 to 28, 2016. Visit this page for more GHN stories from the 69th World Health Assembly

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