Reflections from a week where stakeholders took the stage in New York

2024-05-30

A few days before the zero draft of the political declaration of the High-Level Meeting on antimicrobial resistance (AMR) in September this year was released, stakeholders from around the world were invited to a hearing at the UN building in New York to share perspectives, expectations and recommendations. ReAct was represented both on a panel and from the floor by ReAct Africa Director, Professor Mirfin Mpundu, and ReAct Europe Director, Ms. Anna Sjöblom. Here we share our reflections on what the hearings offered and the dynamics around the process.

1. In the bubble of the already converted there may be a false sense of consensus!

The international AMR discussions are very much led by experts and during the Hearing these groups presented a rich number of good suggestions on important aspects of the way forward. The main areas discussed included strengthening global and national governance, need for ambitious indicators, financing, One Health collaborations including the examination of what went wrong with the earlier political declaration and what needs to be done differently.

One could get the impression that there is consensus around the need for ambitious commitments that will meet all nations and peoples’ needs and priorities. A similar sentiment was there during several side events.  But are we talking within a bubble of the already converted? During the hearing some statements from member states and other voices from the Global South expressed a worry of lack of global solidarity indicating that the desired consensus might not be as easy to reach when it comes to the actual negotiations. The starting points between the Global North or Global South are often different.

So will member states be able to overcome the geopolitical tensions and major inequities in global health that were accentuated around Covid-19 and has become an infected wound during the lengthy negotiations on the pandemic treaty? Will Equity be one word out of many embedded in the declaration or will it be a light house principle that shapes action and decisions? And are decision makers aware of what is at stake here?

2. Where is the money?

One could argue that a political declaration is mainly words on paper and expressed intentions, and in itself does not lead to actions or change. The current challenge many low- and middle-income countries and some high-income countries have faced is moving paper to action regarding their AMR National Action Plans. One problem has been that funding is rarely committed in a declaration, other than with vague aspirational phrases.

Antibiotic resistance is a global threat and a financial orphan, and requires key interventions such as strengthening infection prevention and control (IPC), provision of water sanitation and hygiene (WASH), improving vaccinations for and stewardship programmes, all of which are major challenges in most low- and middle-income countries.

The fact that only 11% of National action plans are funded, was raised multiple times during the Hearing. But still no new commitments have been done by any country or financial institutions to change this. Is the plan to continue to create more and more ambitious and inclusive plans and commitments, but without any financing linked to them?

3. AMR is TB, but TB is not AMR

One thing that ReAct has strived for over many years is the engagement of many key stakeholders in the work to contain antibiotic resistance, especially civil society organizations whose role is so critical. Therefore it was very good to see the increased diversity of voices including from communities and patients being heard in New York.

One example is cancer associations who raised the important message that the emergence of drug-resistant pathogens is seriously affecting cancer care outcomes and that without strong concerted action, all the progress made in cancer care will be undermined. It was likewise really good to see that the TB community had a strong presence during the Hearing.

As civil society acting on antibiotic resistance we have a lot to learn from advocates for specific diseases. It was also noted in the meeting that End TB may be possible – but we cannot end AMR, and our approach to address the issue and the policies required to change practice must reflect this ongoing nature of the problem.

Finally

The COVID-19 pandemic showed in a very cruel way the flaws in the current global (health) systems and how solidarity can fail when faced with a new threat. Vaccines were not distributed according to need but according to financial capacity to pre-pay for them.

But we don’t need to use recent history to prove the point that equity needs to be at the center in all the discussions ahead. It’s sufficient to look at the data on where is the burden of disease the highest, what patient groups are affected and compare with where the financial resources are invested.

While writing this text the zero draft declaration has landed in our inboxes and we have already suggested revisions to the text. We will do as we always do, come with concrete proposals of improvement, raise perspectives from the realities where the ReAct network is present and make the case for equity and sustainable access to effective antibiotics.

And for the high-level meeting to become the leap forward there needs to be a realization at ALL levels that that business as usual is not working. From ReAct we want to send a strong signal of urgency and an urge to members states take stronger ownership of the process and to involve people and communities as well as the decision makers at the highest political level.