Experts hope UN meeting on antimicrobial resistance yields action

UN headquarters
UN headquarters

UN, Mark Garten / Flickr cc

For those who've been sounding the alarm about the worrisome rise in drug-resistant bacteria, the upcoming United Nations (UN) General Assembly meeting on antimicrobial resistance (AMR) is a welcome recognition of the gravity of the problem and the need for action. But for many observers, the question that lingers is what that action will look like.

When global leaders meet on Wednesday to discuss AMR, the primary objective will be to "summon and maintain strong national, regional and international political commitment in addressing antimicrobial resistance comprehensively and multi-sectorally," according to a UN press release. What that translates into remains to be seen.

Will the UN set global targets for reduced antibiotic consumption in humans and animals? Commit money to fund the development of novel antibiotics and diagnostic tests? Establish an infrastructure to coordinate these efforts and mobilize governments into action? Or will international leaders simply acknowledge the issue is a serious threat to global health and say that more discussion is needed?

Call for concrete steps

The scope of the threat posed by antibiotic resistance has become clear. In the past year, antibiotic resistance caused more than 700,000 deaths worldwide. The emergence of the MCR-1 gene, which can make bacteria resistant to the last-resort antibiotic colistin, threatens to make some bacterial infections exceedingly difficult to treat. One estimate suggests that the death toll from infections that are currently treatable could rise to 10 million by 2050 if antimicrobial resistance isn't addressed.

That's why many global health and infectious disease experts are hoping the meeting will produce more actions than words.

"The world is full of declarations now," Marcos Espinal, MD, DrPH, of the World Health Organization's (WHO's) Pan American Health Organization said at a recent AMR conference. "The key issue is action."

A commentary a month ago in Science argued that targets, money, and infrastructure should be on the UN agenda. In the commentary, the authors proposed that no country should consume more than the current median global level of antibiotics (8.54 defined daily doses per capita per year), and that nations should completely phase out the use of antimicrobial growth promoters in farm animals over the next 5 years. The international group of experts also called for the creation of a High-Level Coordinating Mechanism to oversee this global effort, and estimated that that $5 billion annually would be needed for the development of new antibiotics and diagnostic tests.

Lead author Ramanan Laxminarayan, PhD, MPH, director of the Washington, DC–based Center for Disease Dynamics, Economics & Policy, said that setting targets is the only way public health officials will be able to measure progress. "There's no point in just saying you want to respond to an issue," he said.

But setting targets, and enforcing them, will require all countries to be on board. According to Espinal, fewer than half of all nations are even working on an action plan for antimicrobial resistance. Any targets set by the UN, he said, will require all states to commit to creating and implementing action plans. Many countries, especially low-income nations, have more pressing issues. The job of groups such as the UN and WHO, he said, will be to "keep pushing countries to do their part."

Stewardship and surveillance

For some, any global effort needs to begin with getting people to use fewer antibiotics.

Debbie Goff, PharmD, an infectious disease specialist at The Ohio State University, said her hope is that leaders will commit to creating greater public awareness about antibiotic resistance and educating doctors and patients about how to use antibiotics more responsibly. "I will be disappointed if the UN meeting just generates more discussion but no real action," Goff said. "Every day we wait means more people die from antibiotic resistant infections."

One way to aid stewardship efforts could be establishing guidelines for antibiotic use and improving surveillance, said Gail Hansen, DVM, a consultant on public health and animal medicine. "I'd like to see some guidelines, for all countries, of what's considered appropriate use," Hansen told CIDRAP News. "And guidelines on how to do surveillance, so that you know what is being used…and how much is being used."

Hansen recognizes that this will be more difficult for low-income countries. "Some of these nations don't have the funds to do what you can do in the US," Hansen said. "But do what you can do."

The issue of resources was also noted by Espinal, who said AMR action plans will need to be tailored to each country.

What can the UN meeting achieve?

This is only the fourth time that the UN has called on world leaders to address a health issue. The previous meetings were held in 2001 to address the HIV/AIDS crisis, in 2011 to discuss non-communicable diseases, and in 2014 to tackle the Ebola epidemic. Such meetings, it's argued, not only raise awareness but also help forge a common purpose among nations and help governments justify allocating resources to address these issues. But do they really have any tangible impact?

Count Brad Spellberg, MD, an infectious disease specialist at the University of Southern California Keck School of Medicine, among the skeptics. "Honestly, I have no idea what the point or purpose of the UNGA meeting is," Spellberg said. "I have very little expectations that anything substantive will come out of such a meeting."

Jonathan Kaplan, director of the food and agriculture at the Natural Resources Defense Council, also has low expectations. "I think we're going to be disappointed by any tangible outcomes at this meeting," he said, adding that he suspects that no targets will be proposed. "I think that's a big missed opportunity."

But for Michael Osterholm, PhD, MPH, the meeting is a critical first step. "If the world is going to come to grips with the inevitability of antimicrobial resistance, we need a new game plan to deal with it," said Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, publisher of CIDRAP News. "This meeting represents the first critical step in any journey moving forward."

These meetings are important, Osterholm explained, because while they don't guarantee success they show that the international community understands you can't address global health threats like AMR in a piecemeal fashion. "It's really critical that we have this global approach," he said.

Another challenge is that AMR is a different type of crisis than HIV/AIDS and Ebola, which were acute events that Osterholm compares to tornadoes that strike quickly and with little warning. The devastation caused by those epidemics caught the world's attention. AMR is more like a hurricane, and right now the world is watching it develop. But over time, says Osterholm, the devastation will accumulate.

The question is whether Wednesday's meeting will result in actions that reduce the storm's impact.

See also:

Sep 21 Press release on UN high-level meeting on antimicrobial resistance

Aug 19 CIDRAP News story "Experts propose global targets for cutting antibiotic use"

This week's top reads

Our underwriters