This past week, the UN General Assembly featured a high-level meeting on the growing threat of antimicrobial resistance (AMR)—by far the most high-profile gathering ever on this topic, and just the fourth ever such meeting on a health-related issue following HIV (2001), non-communicable diseases (2011), and Ebola (2014). There, member states adopted a landmark UN resolution recognizing the enormous scope of the problem; committing countries to develop, fund, and implement national multi-sectoral action plans, among other actions; and calling on the Secretary-General to form a new interagency coordination group intended to report back in two years with recommendations and progress on implementation.
AMR’s appearance on the UN agenda is itself a welcome development, suggesting that the global community is starting to wise up to the true extent and urgency of the threat. (At an event the night before, Ramanan Laxminarayan of the Center for Disease Dynamics, Economics, and Policy (CDDEP) mused that such a meeting was more than he could have even hoped for just a few years prior.) Nonetheless, the mood among advocates has been less triumphant than cautiously optimistic; they’ve succeeded in sounding the alarm, but the hard work of containing and extinguishing the fire still lies ahead. And after a day of platitudes and vague commitments from UN member countries, the problem is obvious but the path forward remains unclear.
So what needs to happen to translate the resolution to meaningful action?
First, countries need to get specific about the requisite policy change required to mount a robust global and national response. While the resolution commits countries, in theory, to the broad pillars of AMR containment—R&D, stewardship, surveillance, awareness, and infection prevention—it fails to lay out any concrete funding or policy changes. For example, the resolution states that countries commit to “the optimal use of antimicrobial medicines in humans and animals and appropriate prescriptions by health professionals.” But this broad commitment gives member states plenty of room for evasion; it certainly stops well short of a commitment to ban the use of antibiotics for growth-promotion in agriculture, as the EU and some other wealthy countries have done, or to set “targets/limits to reduce antibiotic use in agriculture,” as recommended by the UK’s AMR Review. The vague resolution, perhaps unsurprisingly, sidesteps this and other potentially contentious issues to reach political consensus—but for this agenda to move forward, countries will need to make more specific commitments about the policy change they’re willing to undertake. (And then, of course, make good on those commitments.) At the very least, countries will need to better define targets for reduction in inappropriate use of antibiotics and adopt a policy agenda that drives toward that goal.
Funding presents another sticking point. The resolution states that countries will “mobilize adequate, predictable and sustained funding . . . through national, bilateral and multilateral channels to support the development and implementation of national action plans, research and development on existing and new antimicrobial medicines, diagnostics, vaccines and other technologies and to strengthen related infrastructure.” The need is substantial; the World Bank, for example, estimates in a new report that $9 billion per year in additional funding is required to implement a robust global action plan for AMR containment. But the UN resolution is silent on the exact price tag, and few countries are stepping up with specific commitments. UK and US leadership have established a few nascent efforts to curb AMR emergence, mostly through new R&D funds/partnerships such as the Fleming Fund, AMR Centre, and CARBX. But the current scale of these initiatives—<$1 billion total by my back of the envelope math—represents a drop in the proverbial bucket and focuses on just one dimension of the problem, the antibiotic pipeline. (Of course it’s possible I’ve missed a new announcement or initiative—if so, let me know!) These are welcome contributions and a good first step, but there’s still quite a ways to go.
Finally, there needs to be an institution with the mandate, funding, capacity, and political buy-in to carry forward this agenda. In the weeks before the meeting, CDDEP research Anna Trett called for a new “international body to coordinate the global response,” but the resolution only commits to ad-hoc interagency coordinating group at the UN. The track record of such groups is mixed at best, so one hopes a more robust institution will follow. Also unclear is how the new AMR resolution and proposed inter-agency coordination group relates to the ongoing global health security agenda; can we get beyond to siloed action to address these deeply interrelated issues?
So three cheers to the UN on recognizing the AMR crisis—but we need and expect more. I’ll be watching to see whether action matches the great rhetoric.