As millions across the world take to the streets to demand concrete action on the climate emergency, growing drug-resistant infections that could cost 10 million lives and reduce global gross domestic product by up to 3.8% every year demand a similar international solidarity and action.
Antimicrobial resistance, or AMR, is on the rise worldwide — spreading in humans, animals, and even the environment — and threatens our ability to treat infections and to meet the Sustainable Development Goals. Estimates suggest that AMR currently causes around 700,000 deaths every year, and the World Bank has suggested that this could rise to 10 million deaths every year by 2050 if no action is taken.
Mutant superbugs do grab international attention. The challenge now is to translate multilateral discussions on AMR into the concrete action that is urgently needed, especially at the national and local levels. Global collaboration is critical if we are to safeguard a century of progress in medicine and development and to avoid a doomsday scenario in which common injuries and infections are untreatable because of increasing resistance to available antibiotics.
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Coordination across key sectors and governments is central to developing a successful response, and more countries must prioritize implementing fully financed multisectoral action plans, as world leaders committed to doing so at the 2016 United Nations high-level meeting on AMR.
Drug resistance is fueling inequality, since it is the poorest who are most at risk from its consequences, with millions of people caught in a vicious cycle of being at higher risk of infections while having insufficient access to medicines, diagnostics, and vaccines.
Reason for optimism
But there are signs of hope that suggest the world can collectively tackle the rising threat of AMR, as it did to reduce the use of chlorofluorocarbons, or CFCs, in the 1980s because of the damage being done to the ozone layer. The recently launched Antimicrobial Resistance Multi-Partner Trust Fund — which has benefited from contributions from the Netherlands and Sweden — is critical, and more countries and partners must step up to contribute their share.
There are also successful national models that can be scaled and replicated. In Vietnam, for example, UNDP, the World Health Organization, and the Food and Agricultural Organization are working to bring together groups from government, business, and civil society that work on animal, human, and environmental health to coordinate their responses. Referred to as a One Health approach, this has led to improved surveillance for drug resistance and a more effective response to bird flu, which is a major public health threat in the country.
In Ghana — with the support of the Access and Delivery Partnership, which strengthens systems to increase access to new health technologies — the government has created a successful model for multisectoral engagement to increase policy alignment in the development of national medicines laws and regulations relevant to AMR. Ultimately, these laws ensure that people are getting the drugs and health care that they need to prevent, diagnose, and tackle diseases, such as tuberculosis that is resistant to multiple anti-TB drugs.
Carefully designed intranational meetings have also yielded results. Earlier this year, the Netherlands, in cooperation with WHO, FAO, and the World Organisation for Animal Health, organized the Second Ministerial Conference on Antimicrobial Resistance. The concept of AMR twinning was given a central place to create cooperative bonds between nations that will be beneficial to the implementation of national action plans. The number of countries that showed interest in working together with other countries exceeded expectations.
The next steps in scaling up the global AMR response should include strategies that deliver increased investment and public return on urgently needed innovation for new antibiotics. The U.N. Interagency Coordination Group on Antimicrobial Resistance has called for public, private, and philanthropic donors and other funders to increase investment and innovation in new antimicrobials.
Finally, it is critical that strategies to improve sustainable and affordable access to medicines, vaccines, and diagnostics are at the center of the response. More people continue to die from lack of access to medicines than from drug-resistant infections — with an estimated 5.7 million people per year dying from treatable infections, compared with 700,000 from AMR — so emphasizing the prudent use of antibiotics and promoting innovation in urgently needed new antibiotics must go hand in hand with efforts to ensure affordable and uninterrupted access to existing and future health technologies.
Taking bold and urgent action to implement effective multisectoral AMR plans will make or break the global response to drug-resistant infections. To tackle the grand challenges of our time such as the climate crisis, drug resistance, and inequality, global collaboration is our best — if not our only — shot.