The UN General Assembly has convened a high-level meeting on a global health issue only 3 times in its history. The meetings addressed HIV/AIDS, noncommunicable diseases and Ebola). Tomorrow, it hosts the 4th: The UN General Assembly High Level Meeting on Antimicrobial Resistance seeks to rally the resources and political will needed to stem this global threat.
The meeting and the Political Declaration to be approved by the Heads of State on Wednesday mark important progress in mobilizing global resources against antimicrobial resistance (AMR). Without global action, AMR’s toll promises to be staggering. The UK Review on Antimicrobial Resistance (AMR) suggests that by 2050 the costs will add up to $100 trillion and claim up to 10 million lives per year—more than that of cancer. Margaret Chan, WHO’s director-general, has warned of a “post-antibiotic era.”
In 2015, the World Health Assembly acted on Chan’s admonition by passing the Global Action Plan on AMR. A useful start, it charted a course to address drug resistance by calling on countries to adopt multisectoral, national action plans, aligned with the objectives outlined in the 2015 Global Action Plan (GAP), within 2 years. The GAP also sought to strengthen the collaboration among WHO, the World Organization for Animal Health (OIE) and the Food and Agriculture Organization (FAO), taking a One Health approach on AMR.
When the global network ReAct—Action on Antibiotic Resistance started down this road in 2004, few policymakers acknowledged the importance of this issue. What prompted this turnabout? Over the last decade, the rise of resistance has increasingly outpaced the development of new antimicrobials with novel mechanisms of action—particularly against more virulent Gram-negative “superbugs.” Not only this, but evidence of resistance to colistin, one of our last-line treatments, has emerged since November 2015 in 32 countries across 5 continents. Rarely used in human medicine due to its toxicity, colistin has until recently been used widely in food animal production.
As resistance to last-line antibiotics has emerged, the need for a multisectoral, One Health response has never been greater. At meetings during this week’s UN General Assembly meeting, member states are expected to approve a Political Declaration that lays out a course of action on how the UN and other stakeholders might effectively coordinate a global AMR response. The effective implementation of this Political Declaration by member states, UN agencies, and other stakeholders including civil society and industry will need to ensure resources to transform the innovation ecosystem, promote sustainable financing for novel stewardship approaches, and enable transparent monitoring and accountability on progress achieved to curb AMR in human and animal use. We believe the following 3 steps are essential for the Political Declaration to succeed in stemming the tide of AMR:
1. Implementing the Political Declaration should ensure that resources are targeted upstream in the R&D pipeline to transform the ecosystem for innovation, not just by giving incentives to one company or one drug at a time. Pharmaceutical industry data have shown that there is a ten-fold lower yield in the discovery phase of identifying promising drug leads when comparing antibiotics with all therapeutic drug areas. It’s clear that traditional pharmaceutical R&D approaches have yielded too few products over the last 3 decades and will likely not work for the future.
2. Financing should not only be mobilized for innovation of new technologies, but also for innovation of practice. Both sustainable funding as well as a coordinated research agenda are needed to effectively encourage stewardship of antimicrobials for both human and animal use. Global action on AMR should also ensure innovation of practices that encourage access, not excess in healthcare delivery. Replacing resistant drugs with novel therapies will cost billions of dollars and would take many years while investment into conservation approaches now will cost significantly less. Similarly, to curb AMR in food animal production, innovative practices that encourage sustainable agriculture are necessary in order to curb non-therapeutic use of these lifesaving drugs.
3. To inform both global and national policies to effectively address AMR, transparent monitoring of antimicrobial use, sales, prescriptions, trade, resistance, as well as access is needed. A 2014 WHO survey of 129 Member States found major gaps in national surveillance data as well as a lack of information-sharing infrastructure across countries. In order to track progress on the commitments put forward by the Political Declaration, global coordination, commitments to transparency of these data, and resources will be necessary.
The heads of state who will approve tomorrow’s Political Declaration should be congratulated but they should also be reminded that much more than words are needed. Action and accountability will be critical. Only with effective implementation will the UN General Assembly’s Political Declaration take us a step closer to a future free from the fear of untreatable infections.
Anthony D. So, MD, MPA, is the director of ReAct-Action on Antibiotic Resistance Strategic Policy Program and of the new Innovation + Design for Enabling Access (IDEA) Initiative in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. Reshma Ramachandran, MD, MPP, is an assistant scientist in the ReAct Strategic Policy Program and the Department of International Health at the Bloomberg School. ReAct is also a member of the Antibiotic Resistance Coalition, which has outlined a framework for ensuring accountability in realizing global commitments on AMR.