Latest version of UN High-Level Meeting Political Declaration disappoints in crucial places

2024-08-29

Expectations were high when receiving the recent version of the draft political declaration that was put under silence procedure by negotiators in New York on August 9. Previous versions that had circulated contained a number of strong and promising suggestions in areas such as governance, target setting, accountability and financing. The feeling, however, after reading through this last version which emerged after weeks of retracted inter-governmental negotiations – deflated!

Up until the previous version, which was circulated in mid-July, external input had clearly been considered and was, in many places, reflected in the draft declaration text. However, the draft text that emerges now a month later is unfortunately very watered down.

The disconnect between the urgency by which the problem is described in the document and the actual commitments made – in particular on financing, accountability, R&D, access and reducing objectively wasteful and unnecessary use of antibiotics – such as use for growth promotion in animals – leaves us deeply disappointed.

With the unraveling effect that antibiotic resistance has on many of the global development goals, health and food production systems worldwide, the global economy and the health of humans and animals, the litmus test of a successful UN HLM would surely be that a number of decisive actions are taken to break all (or at least some) of these dynamics. Unlike the 2016 HLM, people worldwide have started paying far closer attention to what the outcome will be. At this moment in time more than 150 communities, social movements and civil society groups from over 50 countries around the world have mobilized and jointly call on leaders to act decisively now across sectors to save our antibiotics!

Yet the declaration text in its current shape and form signals that governments are still not willing to do what it takes.

Financing

Most disappointing is the lack of commitments on financing of the global response. National action plans are the backbone of global efforts to reverse the trend on all of the drivers mentioned above. However, just 11% of countries today have money to back their national action plan implementation. And plans without financing have a tendency to remain just plans.

In 2015 governments set the global target for climate change financing to US$ 100 billion a year to be reached by 2020 (in 2024 that actually materialized). The global HIV response mobilized US$ 8,2 Billion in 2023. Antibiotic resistance today claims far more lives than HIV, and managing it requires similar large-scale practice and systems changes as is needed to address climate change. Yet the current draft declaration sets out to mobilize a meager US$ 100 million by 2030. Beyond that, ambitions only stretch to “…promote the voluntary expansion of the donor base of the Antimicrobial Resistance Multi-partner Trust Fund”.

With these commitments governments hope to catalyze that at least 60% of countries have achieved funded national action plans; and reduce global deaths from antibiotic resistance by 10 per cent by 2030, which of course is wholly unrealistic.

Coming off the stalled negotiations of the pandemic treaty, where zero financial commitments have been made by the global north, it is perhaps not surprising that commitments in this declaration are so benign. However, it does create major cracks in the credibility of actors like the European Union, who otherwise claims to be a champion of the issue and wants to be a best practice region, that financing of the global response apparently is not something they feel obligated to contribute meaningfully to.

For a cross-border problem like antibiotic resistance, it is of course very much in their own interest to dramatically increase investments to strengthen the global response.

Let us also not forget that high income countries, with their higher consumption of antibiotics per person than the rest of the world, remain a net contributor to the problem.

Curbing unnecessary use in animals

Another area where the language has been diluted is on curbing unnecessary use of antibiotics in livestock and in food production. Ever since the zero draft the text has mirrored the targets of reducing antibiotics use for growth promotion by 30% as they are written in the Muscat Declaration, which was adopted by a subset of governments participating in the Ministerial meeting in Oman in 2022.

Now just two years later governments backtrack on these commitments, and are only willing to “strive to meaningfully reduce by 2030 the quantity of antimicrobials used globally in food production…”. What ‘meaningful reduction’ means is left undefined.

While ReAct has been less prescriptive in our engagements with governments on how targets on animal and food-production should look like, and have also argued that commitments on access and financing should be made equally strong to ensure a balance in the declaration, we are taken aback that governments in this final stretch backtrack this much.

Surely countries must realize – even those with big meat and food production sectors and industries – that business as usual is untenable, and that the withering away of antibiotics’ ability to treat diseases, is also a threat to the these sectors and industries?

The required large-scale systems transformation that can lead to more sustainable practices and use of antibiotics, can obviously not be done overnight, yet decisive incremental steps towards far more ambitious and measurable targets are necessary.

Developing new antibiotics

While the declaration text never contained strong commitments on reforming the global research and development (R&D) system to reinvigorate the antibiotic pipeline, previous versions of the declaration did introduce good language on describing the various challenges, as well as the end-to-end approach that is required to get better and more equitable R&D outcomes.

The current text, however, leaves us with a gross overemphasis on the role of the private sector in antibiotic R&D, which has very little grounding in reality. It is quite disheartening to see how little acknowledgement the text offers to the academic, public-private and non-for-profit actors who have managed to keep the antibiotic R&D space alive over the last decades, while big multinational pharmaceutical companies left the space one by one.

The current R&D section has a lot of “nice to have language” but is really thin on ‘need to have’ commitments and language that will tackle the actual barriers in antibiotic R&D. There is nothing in the text that can initiate the unprecedented global collaborations that are needed to overcome the significant scientific challenges that have impeded progress for decades. There are no real commitments on increasing financing and no measurable targets on what R&D interventions should deliver. Finally, the removal of the landmark recognition of the principle “delinkage”, which was included in the 2016 Declaration remains a major step backwards, and it is completely out of tune with the alignment of the large majority of actors in the field around this principle as the way forward.

It is clear that those in the negotiating room has not fully appreciated what it will mean that all our current antibiotics are losing their effect at an ever-increasing speed, and that there is close to nothing underway to replace them.

Ensuring sustainable and equitable access

The commitments to improving access to effective antibiotics have fallen short since the zero draft. ReAct has consistently made the points to governments that lack of access to effective antibiotic is not only causing millions of unnecessary deaths, it is also a driver of resistance. When alternative, and sometimes sub-optimal, treatment is provided to a patient instead of the recommended treatment, resistance to the alternative drug can develop. Moreover, when bacteria are left unchecked to circulate in society resistance can develop by chance, and can spread. Ensuring sustainable and equitable access to effective antibiotics (both new and existing) for everyone everywhere is very much a cornerstone of managing the resistance problem.

ReAct has advocated for a package of commitments to improve access, including reform of the R&D system to develop new antibiotics, increased financial support for actors who works with LMICs to develop introductory pathways and sustainable uptake and use of new and existing antibiotics, and improved data collection to better capture the access gap in countries. None of these have materialized.

Follow-up and accountability

Despite attempts to move the next HLM from 2029 forward to 2027, governments now seem set on keeping it in 2029. This rhymes poorly with the overall goal to reduce deaths from antibiotic resistance by 10% in 2030. Indeed, there will not be much time left to change course, if by 2029 it turns out that the global response is wholly off track.

In a previous version of the text there was a suggestion to have the UNSG report back halfway on the progress towards achieving the 10% mortality reduction goal. That has now been removed, and replaced with more general language requiring the UNSG to only report back on progress on implementing the declaration. But with most measurable targets having become immeasurable, and no strong follow-up and accountability mechanism finding the necessary support, governments are sending a clear message of just how little appetite they have for being held accountable to the commitments made in the declaration.

When ReAct visited country missions in New York back in February, we were in fact warned that we would likely be disappointed with the final outcome. We did not however, expect it to fall so short of what is needed to start making a dent in the actual problem.

With the little time that is left in negotiations, we strongly urge governments to find renewed energy and courage to reintroduce several of the stronger and more ambitious proposals that was in fact on the table just a few weeks ago.