“Just the Beginning": UN Adopts AMR Declaration

The High-Level meeting on Antimicrobial Resistance at the 71st UN General Assembly
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Brian W. Simpson

UNITED NATIONS—To sustained applause, a high-level meeting at the 71st UN General Assembly adopted a political declaration on Wednesday that calls for a collaborative, global response to the threat of antimicrobial resistance (AMR).

The meeting—only the fourth UN General Assembly high-level meeting on a global health issue—signaled growing recognition of the critical nature of AMR, which is estimated to kill 10 million people per year by 2050 if current trends continue.

“It’s a very present reality in all parts of the world. We are losing our ability to protect people and animals from life-threatening infections,” said UN Secretary-General Ban Ki-moon. He cited 200,000 annual deaths of newborns from infections that do not respond to available antibiotics and an epidemic of drug-resistant typhoid in Africa as 2 examples of AMR’s threat.

In her address before the adoption of the political declaration, WHO Director-General Margaret Chan upped the rhetoric on AMR: “Antimicrobial resistance is a global crisis. It is bad and getting worse.”

Raising the specter of helpless doctors unable to offer treatment to patients with infections, Chan called on individuals to take action. “Consumers, you have a very important role to play. [You] have to stop demanding antibiotics when [you] have a viral infection like the cold or flu. Doctors should only prescribe on the basis of a diagnosis,” Chan said, adding that “Antibiotics listed by the World Health Organization as critical human medications should not, and I must emphasize, should not be used in animal husbandry or agriculture.” 

A succession of government ministers testified to the importance of the AMR declaration and shared national plans both envisioned and underway throughout the morning and into the afternoon. “This phenomenon has the potential for devastating the health of our global population. Strong collaborative efforts are required internationally and nationally to combat this threat,” said Carl B. Greenidge, Guyana’s vice president and minister of Foreign Affairs.

Isaac Adewole, Nigeria’s Minister of Health, warned against complacency that could follow the declaration’s adoption:We must not only talk but act. The time is now to fully implement this document.”

While the adoption of the declaration leavened the stark warnings about AMR, concerns about how to make inroads into the complex global problem persist. A paucity of new antibiotics, the fast-spreading resistance to antibiotics and other treatments, widespread usage of antibiotics for livestock, simultaneous over-prescription and lack of access to antibiotics, and a host of other issues await answers.

Sylvia Burwell, secretary of the U.S. Health and Human Services, offered a candid assessment of AMR’s effects in the US, including more than 2 million illnesses from antibiotic resistant bacteria, $35 billion in economic losses and 23,000 deaths every year. However, the country’s response to AMR is beginning to show effects, including a recent 13% reduction in MRSA cases in acute care hospitals. “We have made progress but we know there is still much work to be done,” Burwell said.

Shifting to a wider perspective, she added, “Global challenges present opportunities for global resolve. This call to action at the UN reminds us we have opportunities to work together to face this threat and to protect the health of all our peoples.”

Following the declaration’s adoption, Manica Balasegaram, director of DNDi’s Global Antibiotic R&D Partnership (GARDP), offered measured optimism. “What we have now, it’s on a piece of paper. It’s good, it’s important but it’s just the first step,” said Balasegaram. “It’s declaration, as far I am concerned, of intent. We have to see that it is translated into something more concrete [and see] how it will work at the international and national level, how different sectors are going to work together, how financing and funding for things will be done and [if they will be] sufficient on a long-term basis and what is the framework.” 

A particular challenge is how to increase access to antibiotics in low- and middle-income countries while ensuring they are used only when they are truly needed. In countries with high levels of mortality from infectious diseases, physicians often prescribe antibiotics in an effort to save lives of the most vulnerable, Balasegaram said. “Access is quite a multi-dimensional issue,” he said. “On one hand, everyone says antibiotics are made available too easily. On the other hand, we know people are not able to access antibiotics when they need them. We have to reconcile that. I think that’s a solvable problem.”

Overall Balasegaram found today’s high-level meeting to be encouraging. Working as a clinician in developing countries 10 to 15 years ago, he was more resigned to the lack of access to drugs and the lack of development of new drugs, he said. Now steps are being taken.

“I’m also saying, this is just the beginning. We have to see how this really translates to concrete, sustainable, long-term action,” he said.

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