UN meeting calls for more action, less talk, on antimicrobial resistance

UN flags and logo
UN flags and logo

United Nations / Flickr cc

Global health officials, scientists, members of nongovernmental organizations, and leaders from United Nations (UN) member states met today to reaffirm their commitment to tackling antimicrobial resistance (AMR).

The High-Level Interactive Dialogue on AMR, originally scheduled for April 2020 but postponed due to the COVID-19 pandemic, comes 5 years after the UN General Assembly held a high-level meeting to address AMR. That meeting concluded with commitments from UN member states to develop and implement national AMR action plans, as called for by the World Health Organization (WHO).

While today's meeting partially focused on the progress that has been made since then, the major theme was that both the global community and individual countries have not done enough to slow the spread of AMR nor mitigate its threat to human and animal health and food safety and security. Speakers stressed the need for countries to accelerate holistic strategies to address AMR, to educate the public about drug-resistant infections, to invest in surveillance and antibiotic development, and to apply lessons from the COVID-19 pandemic.

"As a global community, we have been shaken to the core by the COVID-19 pandemic," UN Deputy Secretary-General Amina Mohammed said in opening remarks. "We have witnessed firsthand the devastating impact of hard-to-treat infections, and the ease with which they can spread and threaten global health. If no action is taken, the fallout from the silent pandemic of antimicrobial resistance could be of the same or greater magnitude."

"I would like to take this opportunity to call on all leaders globally to be champions of AMR," said Barbados Prime Minister Mia Mottley, who co-chairs the One Health Global Leaders Group, a body created to provide political leadership on AMR. "We have all experienced the health, the social, and the economic impact of this awful COVID-19 pandemic, but we can also see the opportunity it presents to address the issue of antimicrobial resistance."

'Time to act is now'

In a series of panel discussions featuring various stakeholders, speakers frequently circled back to the urgency that COVID-19 has added to the conversation around AMR. Making infection prevention and control a focus of pandemic preparedness, they implied, was imperative to help stave off the likelihood of another pandemic.

"It will happen again…so we need to dramatically strengthen pandemic preparedness, and we need to do so together, across sectors, and as a global community," said Henrietta Fore, executive director of UNICEF. "This means building political will towards a One Health approach, underpinned by policies and budgets that put preparedness first."

The One Health concept views the health of humans, animals, and the environment as intrinsically linked. Speakers throughout the day made it clear that any national strategies to combat AMR must address how antibiotics are used in human and veterinary medicine and in agriculture.

 "All sectors of the society must be involved, active and held accountable for the spread of AMR," said Lena Holmgren, Sweden's minister of health and social affairs.

Wellcome Trust Director Jeremy Farrar, MD, PhD, noted that while there have been many warnings and discussions about AMR's effects on public health and the economy since the 2016 UN meeting, global efforts "have not matched the scale of the threat."

 "We've not seen the investment, the innovation, or indeed the political prioritization that is indeed really required, and the time to act is now," Farrar said. "Let us act now, rather than continue to talk."

More equitable progress needed

The latest global survey conducted by the WHO, the Food and Agriculture Organization of the UN, and the World Organization for Animal Health shows that countries have been making progress on addressing AMR in recent years but much work remains. The survey of 134 out of 196 WHO member states found that an increasing number of countries have implemented national AMR action plans and infection prevention and control programs that are aligned with WHO guidelines.

But the survey also found that fewer than 54% of countries had national monitoring systems for antibiotic consumption, and that much of the progress is occurring in higher income countries. This gap between richer and poorer nations is a significant challenge, given that rising antibiotic use in humans and food-producing animals, along with a higher burden of disease, is fueling high levels of AMR in low- and middle-income countries. And as many speakers pointed out, drug-resistant pathogens, like viruses, do not respect borders.

 "If we make gains in the high income countries and we don't in the low- and middle-income countries, we know what will happen: It will be far worse in the next 10 years, and we will come back and have the same discussion," said Mirfin Mpundu, DrPH, director of ReAct Africa.

Spotlight on One Health, insufficient pipelines

In a panel focusing on the progress that has been made, UK Special Envoy on AMR Professor Dame Sally Davies highlighted the efforts of the One Health Global Leaders Group and said she believes there is now a much greater recognition of the One Health impacts of AMR, as well as a greater understanding of the need for responsible and sustainable use of antibiotics.

Even so, she also noted that more tangible action is needed from governments. "Not enough has happened in countries, and we have lost some momentum," Davies said.

Farrar also warned of the dangers of hiding behind the complexity of AMR. "We mustn't be intimidated into inaction by thinking things are too complex to solve," he said. "They can be solved if we put our collective minds to it."

The dearth of new antibiotics in development, highlighted in a recent WHO report, was also a topic of discussion. Speakers warned that the combination of growing resistance to current antibiotics and the lack of new antibiotics to replace them could lead to a "post-antibiotic" future where common infections can no longer be treated. If this happens, procedures that rely on antibiotics—such as organ transplants—could become too dangerous.

"Developing new antibiotics is an urgent need, and I would urge the UN to not ignore this aspect of things and to find out how we can find ways of improving the supply of antibiotics," said Ramanan Laxminarayan, PhD, MPH, director of the Center for Disease Dynamics, Economics and Policy.

Call to action

The meeting concluded with the presentation of a "Call to Action" on AMR that was agreed to by UN member states beforehand. Among the actions listed in the document, member states agreed to keep AMR high on the political agenda, accelerate implementation of previous commitments, strengthen political leadership and coordination, encourage all member states to have multisectoral AMR action plans, and make AMR an integral part of pandemic preparedness.

The document also calls for ongoing evaluation of global and national AMR commitments.

"We must take this moment to consider the early warning we have been granted, and place AMR high on the agenda," said Zweli Lawrence Mkhize, MBChB, South Africa's minister of health. "We have the tools, the expertise, the cooperation; now we need to strengthen our resolve to stem the tide and eliminate the threat."

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