Opinion: The world’s response to antibiotic resistance is still too weak

2024-08-29

Antibiotic resistance is a global leading cause of death — but the world's response is still too weak and narrow.

By Otto Cars, Martha Gyansa-Lutterodt, Stefan Swartling Peterson

Antibiotic resistance is one of the greatest and most urgent cross-border challenges of our time, and it is rapidly threatening to reverse century-long progress in global public health and modern medicine. When governments convene again at a high-level meeting on antimicrobial resistance, or AMR, during the U.N. General Assembly in September to take stock of the problem and make new commitments, it should be an urgent priority to bring the global AMR governance system together in a way that can address the insufficient attention it is getting.

More lives are today lost from antibiotic resistance than from both HIV and malaria combined. Infections caused by antibiotic-resistant bacteria claimed 1.27 million lives in 2019. One-fifth of these deaths were children under the age of 5. At the same time, millions of people die every year from preventable common bacterial infections due to the lack of access to antibiotics.

Yet the world’s response to antibiotic resistance remains vastly insufficient to mitigate the consequences of this crisis for people, animals, the global economy, and for global development. Antibiotic resistance jeopardizes the achievement of several Sustainable Development Goals such as SDG 3 on good health and well-being, SDG 2 on zero hunger, and SDG 6 on clean water and sanitation.

It also negatively affects SDG 1 on poverty alleviation; SDG 10 on reduced inequalities; SDG 5 on gender equality; SDG 8 on economic growth; SDG 12 on responsible consumption and production, and SDG 14 life below water. Tackling such a complex, multisectoral problem requires coordinated, broad, and decisive actions by national governments, separately and collectively, as well as by international organizations.

In 2016, a political declaration on AMR was adopted by the U.N. General Assembly calling for the creation of an interagency coordination group on AMR, or IACG-AMR, tasked with providing practical guidance on how to ensure sustained effective global action to address AMR.

The IACG-AMR consisted of members representing several U.N. agencies and a group of independent experts to which we belonged, and delivered the final report “No Time To Wait: Securing the Future From Drug Resistant Infections” to the U.N. secretary-general in April 2019. Its recommendations are grouped in five thematic areas: progress acceleration, innovation, collaboration, investment, and strengthening accountability and global governance.

Although numerous initiatives to tackle AMR have been launched since 2019, there are still major gaps in all the above areas. Although 178 countries have a national action plan to address AMR, as requested by the World Health Organization, only 11% of them have a budget for its implementation.

Regular reports from WHO visualizes the critical gaps in the pipeline for new antibiotics. Support for a broader civil society engagement is weak. Financial commitments made in the 2016 declaration have not been delivered on. While some progress has been made on building a global governance structure, lack of clear mechanisms for holding governments and international organizations accountable for their actions, and lack thereof, is a major challenge and real obstacle to progress.

The following are some very tangible ways the international community can act to come together in the wake of the upcoming U.N. General Assembly.

At the national level, countries should commit to put in place a strong focal point for implementation of the national action plan on AMR. Such a focal point should have a broad mandate to mobilize resources across sector specific ministries, have a full overview of national SDG implementation efforts, as well as all relevant AMR-work across sectors. Importantly it should be reporting to the highest level in the government.

Is the fight against antimicrobial resistance finally gaining traction?

Often considered a neglected issue, antimicrobial resistance played a prominent role in this year’s World Health Assembly, in the lead-up to a high-level meeting on the issue in September.

At the global level, leveraging a whole-of-U.N. response will be key and strategic. An analysis of the roles, responsibilities and remit of U.N. organizations developed for the IACG-AMR already in 2019 showed there is “enormous potential and willingness … across the UN system to take on the AMR challenge. There is significant capacity, expertise, and knowledge in the UN family and among its key partners.”

Today, three U.N. organizations — the World Health Organization, Food and Agriculture Organization, and the U.N. Environment Programme — together with the World Organisation for Animal Health are the technical, normative, and standard setting agencies supporting the global response across their respective mandates, known as the Quadripartite.

However, given the negative and worrisome impact of antibiotic resistance on the sustainable development and Agenda 2030, it is evident that many other U.N. agencies such as U.N. Development Programme, UNICEF, UNESCO, the World Bank, U.N. Population Fund, to name a few, could be requested to contribute far more to the global response to AMR.

This requires making it a transversal priority issue. The standing Quadripartite Joint Secretariat could be formalized as the central coordinating mechanism with adequate resources and mandated to develop a collaboration framework in which all relevant U.N agencies contribute to the global efforts to tackle AMR by developing and implementing coordinated actions.

The forthcoming high-level meeting on AMR at the U.N. General Assembly in September must become a turning point in the global response to antibiotic resistance. Drastically elevating the priority given to the problem in countries and across the U.N. system will be necessary to succeed with the major transformation of systems across sectors that are needed to move towards more sustainable access to and use of antibiotics. Antibiotic resistance cannot be eradicated — but it can be managed through a truly coordinated collective global action.