Rocky start for the UN High level meeting on AMR

2024-03-27

At the end of February ReAct’s Otto Cars and Helle Aagaard travelled to New York to meet a number of country UN missions, UN agencies and civil society actors to discuss ReAct’s United Nations High-Level Meeting on AMR Policy Brief. Here we share our key reflections from a week of conversations and discussions at the epicenter of global politics about the prospects for the forthcoming High-Level Meeting on AMR in September.

1. The world is not same as it was in 2016

This will likely not come as a surprise to anyone. However, while there seems to be broad scientific consensus on the urgency of addressing antibiotic resistance, it is certainly not mirrored by a similar political consensus to act decisively as a global community.

In 2016 the Political Declaration on antimicrobial resistance (AMR) was adopted unanimously. In 2024 the silence procedure for the so-called “modalities resolution” has been broken several times on minor issues, and at the time of writing this piece the resolution had still not been adopted. These resolutions are only intended for setting out procedures – not content – and are therefore not usually controversial or hard to find agreement on.

This is likely a first taste of how the current difficult geopolitical backdrop will impact the coming months of negotiations, and that the process may be shaped just as much – if not more – by global political dimensions as by substance.

2. North-South divide on health equity

The lack of access to lifesaving vaccines in low-and middle-income countries during the COVID-19 pandemic, while high-income countries bought up most of the global vaccine supply, was a stark reminder of just how big global health inequities continue to be. In the wake of the pandemic, addressing health inequity to achieve equitable access to medicines, vaccine and diagnostics (including through financing actions and interventions; establishing mechanisms for sharing of pathogens, benefits and technology; and addressing intellectual property barriers) have been central in several discussion including the pandemic accord negotiations, at the WTO and in negotiations of the UN resolution on Pandemic Preparedness and Response (PPR) last year. The divide in positions on these issues between the Global South and North is deep, and many issues continue to remain unresolved. A recent editorial in the Lancet harshly criticized the global North in the pandemic treaty negotiations and called them “shameful and unjust”.

These dynamics will likely spill over onto the upcoming negotiations of the AMR political declaration. Antimicrobial resistance continues to be seen as largely a high-income country driven issue, despite the global nature of the problem and the clear burden data showing its devastating impact on low-and middle-income countries. It is therefore unlikely that the forthcoming High-Level Meeting will produce the global commitments on the issue that is needed, without high-income countries making some real tangible gestures to bridge the North-South divide on health equity and rebuild a more trustful environment in the coming months. Increased financing for National Action Plans implementation, infection prevention and transformative investments in research and development that ensure equitable and sustainable access to novel antibiotics for all, would be a good place to start.

3. The “One Health approach” is fraught with controversy

Finally, despite One Health being a given way to work and collaborate across sectors to address antibiotic resistance in many national and local contexts, the “One Health approach” turned out to be highly controversial at the global political level.

Many perspectives, misconceptions and misunderstandings circulate about what the concept actually means. At times though it felt as if the opposition to the “One Health approach” at the global political level was more down to the name itself – while at other times it was perhaps used more as a proxy for other issues such as concerns around the potential economic impact on meat and food production, as well as exports.

Regardless of what we call it, it is of course impossible to address antibiotic resistance effectively without tackling its causes, drivers and the systems transformation needed in the human, animal and environmental sectors.

What lies ahead

Against all of the above, it is worth remembering that in 2016 the political declaration text was a real milestone document adopted by all countries. Despite this, the follow-up on the commitments and the subsequent recommendations from the Inter-Agency Coordination Group largely failed.

Getting a truly ambitious political declaration in September 2024, which matches the urgency of the issue, will require a bridge-building narrative that focus on achieving ‘sustainable access to effective antibiotics for all’ as a global collectively goal. But that won’t be enough – showing leadership through solidarity will be needed (in particular from high-income countries) alongside huge amounts of fine tuned diplomatic skill. Fortunately, countries do tend to send their sharpest minds to their UN missions in New York. The delegates at the UNGA High-Level Meeting on AMR have the power to change our common future for the better.