So-called superbugs are estimated to kill 700,000 people each year. Despite this, antimicrobial resistance continues to be thought of as only an emerging global public health threat. There is hope that this could change after a first-ever United Nations high-level meeting on the issue on September 21. Yet progress will depend on establishing a level of cooperation and commitment that has been sorely missing from the UN system in recent years.
The upcoming meeting—only the fourth UN General Assembly gathering to address a public health issue—will bring together heads of state and other high-ranking officials. The aim is to raise awareness, summon political will, mobilize resources, and potentially generate a framework for collective action going forward.
Until recently, antimicrobial resistance has failed to elicit the same level of international action compared to other pathogens such as the Ebola virus. This is despite a recent report by United Kingdom charity the Wellcome Trust estimating that by 2050, drug-resistant strains of bacteria and viruses—the result of overuse of antibiotics on humans and animals—may kill more people than cancer. Certain everyday diseases like Gonorrhea, which infects 78 million people each year, have already become extraordinarily difficult to treat, as multi-drug-resistant strains spread around the world, requiring newer and ever more expensive antibiotics.
Elevating this issue from the World Health Organization to General Assembly discussion recognizes that the threat extends beyond human health to impact indirectly on social and economic progress, the environment, and other areas, as acknowledged by the World Health Assembly.
A Global Threat
Uppsala University health experts have noted that antimicrobial resistance could reverse some of the hard-fought gains made in global development in recent years. This could see huge setbacks in the pursuit of the UN’s 2030 Sustainable Development Goals, including those on health and communicable diseases, food security and sustainable agriculture, and economic growth and employment.
There is also the possibility of more far-reaching consequences. In the US, for instance, the Obama administration’s Global Health Security Agenda recognizes that combating antimicrobial resistance is a key element in the fight for global health security. The UK government, as part of its campaign to prevent an outbreak of virulent superbugs, also recently committed $375 million to build surveillance networks for drug-resistant infections in low- and middle-income countries.
Like climate change, antimicrobial resistance is a slow-burning crisis whose greatest impacts may not be felt for years to come. It is a global, complex, and interconnected challenge for which a coordinated multilateral response is required.
WHO’s Global Action Plan on Antimicrobial Resistance envisions a multisectoral approach of this nature. It calls for a “whole-of-society” strategy with coordination among numerous actors and sectors, including human and veterinary medicine, agriculture, and finance. It calls upon multiple international entities including the UN, WHO, the Food and Agricultural Organization, and the World Organization for Animal Health to support states in implementing national action plans by May 2017.
It remains to be seen whether the WHO strategy can be effectively implemented, especially at a time when the multilateral system is struggling to achieve the transformations necessary to deal with contemporary challenges. Bearing this in mind, there are at least four key strategic challenges for responding to antimicrobial resistance.
First, the UN must address its frequently cited inability to break down silos within and between its principal organs, as well as among its agencies, funds, and programs, in order to pool resources, expertise, and information. This will undoubtedly be needed to fulfill objectives of the WHO Global Action Plan such as introducing “integrated surveillance and reporting of antimicrobial resistance in human and animal health and agricultural…in all countries.”
Second, while there is broad agreement on the need for accountability measures to implement the WHO plan, the path forward is less clear. Devi Sridhar, Professor of Global Public Health at the University of Edinburgh, and her colleagues propose a new high-level body within the UN that can report on progress and coordinate stakeholder action. However, she told me that there is resistance to creating new vertical structures that may add further layers of bureaucracy. David Heymann, Head and Senior Fellow of the Center on Global Health Security at Chatham House, writes that the current WHO strategy could discourage action due to its “overwhelming” list of recommendations. Instead, he believes identifying a few key interventions could point the way forward.
Third, inadequate resources and inflexible financing have consistently hampered international action on global health, and there is little reason to expect that will change here. “Given the challenges WHO has with raising funding for tackling the Zika virus, I don’t think serious money will be put through the agency for antimicrobial resistance in the near future, at least until the next director-general is elected,” Sridhar told me. It is hoped that elevating the issue from Geneva to New York can help, although it’s unclear whether start-up funding will come from donor governments or the NGO sector.
Fourth, the UN has in other areas emphasized reactive rather than preventative responses, relying on short-term military solutions to conflicts rather than long-term political solutions, for example. Similar attitudes being adopted may be detrimental to the campaign against antimicrobial resistance. “[The availability of antibiotics] has led us to overly rely on the curative potential of drugs, at the expense of a prudent focus on prevention,” reports the Wellcome Trust report. Keiji Fukuda, WHO Special Representative for Antimicrobial Resistance, meanwhile, has stated that new antibiotics and technologies cannot substitute for basic public health practices such as infection prevention and good sanitation and hygiene.
The upcoming UN meeting represents a milestone in the fight against antimicrobial resistance. Yet, despite the optimism surrounding the event, participants will need a dose of realism and to be clear-eyed about the potential, and potential limitations, of the multilateral system in addressing this emerging threat.