Is the fight against antimicrobial resistance finally gaining traction?

Antimicrobial resistance is a complicated issue with a public relations problem. Many people don’t know what it means nor fully grasp the ways in which it's rapidly accelerating. And globally, there is a lack of targets and accountability on the issue. It happens when bacteria, viruses, fungi, and parasites no longer react to medicines. It threatens to turn back the clock on advancements made in modern medicine — creating a world where it's commonplace that simple infections become impossible to treat and routine medical procedures become too unsafe to perform. It’s been dubbed a “silent pandemic” that already directly kills nearly 1.3 million people per year. The global health community is warning the world has moved far too slow in responding to AMR and are working to elevate the issue. At the 77th World Health Assembly in Geneva last week, the topic was ever-present with much more discussion than years past. The world’s countries adopted a resolution to accelerate national and global action toward AMR, with a focus on access to prevention, diagnosis, and treatment of infections. These discussions are part of the lead-up to a high-level meeting on the issue at the United Nations General Assembly in September — where it’s expected a political declaration will be adopted that serves as a foundation to guide a more coordinated global response. There is also a ministers meeting on AMR taking place in Saudi Arabia in November. “This is, indeed, a very important year for antimicrobial resistance,” Dr. Hanan Balkhy, the regional director for eastern Mediterranean at WHO, told the World Health Assembly. A political declaration AMR happens from the overuse and inaccurate use of antibiotics, but also due to a lack of prevention efforts that allow infections to spread largely unabated — among other reasons. There’s a need for a new pipeline of antibiotics, broader use of vaccines to prevent infections, more hygienic conditions in places such as health facilities, and increased access to diagnostics to ensure that when people take antibiotics, they take the right ones. And while avoiding the overuse of antibiotics has been a large part of the conversation, in many parts of the world increasing access to affordable, effective antibiotics is still needed to save lives. When people use the right antibiotics in the right ways it helps reduce the spread of AMR. Last week, on the sidelines of WHA, The Lancet launched a series by 40 authors from around the world calling for sustainable access to effective antibiotics — both new and existing — and the importance of infection prevention. "Antibiotics, if used as indicated, can avert many deaths from bacterial infections, and access to second-line antibiotics can even prevent deaths from some drug-resistant infections," the authors wrote. "It's been really important to have very clear metrics of what success looks like and being able to keep track of progress towards those. … What gets measured, gets managed.” --— Jeremy Knox, head of policy for infectious diseases, Wellcome They estimated that 750,000 deaths linked to antimicrobial resistance could be prevented annually through access to available vaccines, water and sanitation, and infection control methods. The meeting in New York in September will be the second time the UNGA has hosted a high-level meeting on AMR, with the last one taking place in 2016. But the previous meeting missed the mark, Ramanan Laxminarayan, president of the One Health Trust, told Devex. It focused on the development of new drugs — which is a high-income country priority — but didn’t emphasize infection prevention or access to effective antibiotics, which is crucial in low- and middle-income countries. In the lead-up to the UNGA meeting, a zero draft of the political declaration is circulating among countries and others for their input. There are three things that need to happen at the U.N. high-level event in September to create a “step change” around the global governance of this issue, said Jeremy Knox, head of policy for infectious diseases at Wellcome, during a Devex event on the sidelines of WHA. This includes the creation of targets on antimicrobial resistance, an independent panel, and accountability measures. “We've seen in other areas of global health and climate change, it's been really important to have very clear metrics of what success looks like and being able to keep track of progress towards those,” Knox said. “What gets measured, gets managed.” The targets would be something akin to the 90-90-90 targets for HIV or the 1.5 degree Celsius target for climate change, he said. “It can kind of be the goal, the target, that can unify efforts and really drive things forward,” Knox said. In the zero draft, there is currently a target of 10% reduction in deaths caused by bacterial antimicrobial resistance and a reduction of at least 30% of antimicrobials used in agri-food systems by 2030. But The Lancet series also calls for an additional target of a 20% reduction in the inappropriate use of human antibiotics to be included. Currently, the draft says that antibiotics that are included in WHO’s access group should comprise at least 80% of overall human antibiotic use globally by 2030. This group of antibiotics "have activity against a wide range of commonly encountered susceptible pathogens while also showing lower resistance potential than antibiotics in the other groups." But that's counterintuitive, Laxminarayan said, as calling for an increase in access to these antibiotics could also result in an increase in consumption. He said the proposed 10-20-30 targets are “impactful, feasible, and measurable.” The draft also calls for the creation of an independent panel that would focus on the growing body of evidence on the issue. This could play a similar role to the Intergovernmental Panel on Climate Change that provides global governance around climate change, Knox said. It could make sense of the growing pipeline of research and guide governments and the global community on what to prioritize, he added. Finally, there’s a need for follow-up mechanisms to ensure that once targets are in place, there are ways to ensure progress is made. Global leaders need to meet on this issue more frequently than at high-level meetings or the World Health Assembly, Knox said. This could include regular events that bring ministers together to “really focus across multiple sectors on what progress is being made and review progress and guide prioritization going forward,” he said.