World Health Leaders Agree on Action to Combat Antimicrobial Resistance, Warning of Nearly 10 Million Deaths Annually If Left Unchecked
World leaders gathered at a high-level meeting on antimicrobial resistance today committed to concerted action to address the phenomenon, which many warned could lead to significant development backslides and up to 10 million deaths annually by 2050 if left unchecked.
Participants stressed that antimicrobial resistance — the ability of microorganisms to adapt to medications such as antibiotics, rendering them ineffective — posed a number of grave threats to humanity, including a possible resurgence in tuberculosis, malaria and HIV/AIDS deaths and food insecurity due to negative impacts on agriculture.
Acting by acclamation, they agreed to a number of actions outlined in a draft political declaration, to be transmitted to the General Assembly for adoption.
By the terms of that text, Member States committed to develop multisectoral national action plans on antimicrobial resistance in line with the World Health Organization (WHO)’s global action plan on the issue. Endorsing a concerted “One Health” approach — which linked various sectors and actors in defence of human, animal and environmental health — they also agreed to mobilize adequate, predictable and sustained resources to implement those programmes and pledged to raise awareness of the phenomenon around the world.
Acknowledging that resistance to antimicrobial medicines was largely due to the inappropriate use of such drugs in the fields of public health, animal, food, agriculture and aquaculture sectors, Member States called on the WHO and other relevant agencies to finalize a global framework to support the development, control, distribution and appropriate use of new antimicrobial medicines, diagnostic tools, vaccines and other interventions.
Among other things, they also called on the Secretary-General to establish an ad hoc inter-agency coordination group, co-chaired by his Executive Office and the WHO, to provide practical guidance for approaches needed to ensure sustained effective global action to address antimicrobial resistance.
“We are losing our ability to protect both humans and animals from life-threatening infections,” said Secretary-General Ban Ki-moon in opening remarks. Indeed, he warned, if the issue of antimicrobial resistance was not dealt with quickly and comprehensively, it threatened to make the provision of high-quality, universal health coverage more difficult, if not impossible. Cautioning that such trends were undermining hard-won achievements of the Millennium Development Goals, he urged global leaders to turn their commitments into swift, concerted action.
Peter Thompson (Fiji), President of the General Assembly, said antimicrobial resistance had the capacity to kill millions of people each year and could cost trillions of dollars to address, as it threatened access to safe and sustainable food and means of agricultural production. Recalling that one of the principal aims of the Assembly’s seventy-first session was to drive a meaningful push for the achievement of the 17 Sustainable Development Goals, he stressed that “ultimately, the future of humanity may depend on our ability to respond to the great challenges of antimicrobial resistance”.
Emphasizing that the phenomenon was already on the rise, WHO Director-General Margaret Chan said the emergence of bacterial resistance was outpacing the world’s capacity for antibiotic discovery. Last month, an increase in the number of drug-resistant pathogens had forced the WHO to revise its treatment guidelines for chlamydia, syphilis and gonorrhoea. On current trends, a common disease like gonorrhoea might become untreatable, she said, adding that “superbugs” — resistant to nearly all currently available medicines — already haunted hospitals and intensive care units in every region of the world.
José Graziano da Silva, Director-General of the Food and Agriculture Organization of the United Nations (FAO), welcomed the adoption of the political declaration, noting that it provided guidance on how to tackle antimicrobial resistance comprehensively and multisectorally. Describing the current global monitoring system as weak, he said his organization was working closely with partners in that regard and had adopted an action plan to promote best practices and protect consumers.
Monique Eliot, Director-General of the World Organization for Animal Health, said the prevention of antimicrobial resistance and the prudent use of antibiotics in animals was one of her organization’s key responsibilities. It had recently designed a new strategy to fight antimicrobial resistance, protect the effectiveness of antimicrobials used in veterinary medicine, and help maintain the efficacy of the molecules used in human medicine. However, successful outcomes required sustainable change at the national level with long-term political support.
Throughout the day, the meeting heard from a number of Heads of State, as well as health ministers and other high-ranking Government officials. Two breakout panel discussions were also held, tackling the themes “Relevance of addressing antimicrobial resistance for the achievement of the Sustainable Development Goals, in particular the health-related Goals” and “Addressing the multisectoral implications and implementation challenges of antimicrobial resistance in a comprehensive manner”, respectively.
A number of panellists representing Government, civil society and the pharmaceutical industry underscored the need for more committed investment in antibiotic research and development, pointing out that while some new antibiotics had been developed most were found to be toxic to humans and were, therefore, not usable. Others stressed that antimicrobial resistance posed a particular risk in developing countries, where it was often coupled with weak health systems and a lack of resources and technological capacity.
Opening Remarks
PETER THOMPSON (Fiji), President of the General Assembly, said microbes or “super bugs” had adapted, undermining the effectiveness of many medications. Those challenges went beyond health systems, affecting many aspects of human life and transcending national borders. Antimicrobial resistance had the capacity to kill millions of people each year and could cost trillions of dollars to address, he warned, adding that it could also impact the environment, access to safe and sustainable food and means of agricultural production. A global response was required. Recalling that one of the principal aims of the Assembly’s seventy-first session was to drive a meaningful push for the achievement of the 17 Sustainable Development Goals, he said it was crucial to ensure that antimicrobial resistance did not negatively impact those Goals. The global action plan on anti-microbial resistance, adopted by Member States, had recognized that tackling the challenge lay with prevention and control of infections in humans and animals, as well as improved research and development, increased monitoring and international cooperation. Innovative partnerships and financing initiatives were needed. “Ultimately, the future of humanity may depend on our ability to respond to the great challenges of antimicrobial resistance,” he said.
BAN KI-MOON, Secretary-General of the United Nations, warned that antimicrobial resistance posed a fundamental, long-term threat to human health, sustainable food production and development. The challenge was already a reality in many parts of the world, including both urban and rural areas, hospitals, farms and communities. “We are losing our ability to protect both humans and animals from life-threatening infections,” he stressed, pointing out that resistance to HIV/AIDS medications was on the rise, resistance to tuberculosis and malaria drugs was a great concern and dangerous new genetic mechanisms for the spread of resistance were emerging. Cautioning that such trends were undermining hard-won achievements of the Millennium Development Goals, he said: “If we fail to address this problem quickly and comprehensively, antimicrobial resistance will make providing high-quality, universal health coverage more difficult, if not impossible”. A solution would require the long-term commitment from many actors, he said, calling for the cooperation of multiple sectors and sustained financing. Noting that participants had gathered today because they recognized that antimicrobial resistance posed a fundamental threat to sound economies and social cohesion, he said: “The commitments you make today must be turned into swift, concerted action.”
MARGARET CHAN, Director-General of the World Health Organization (WHO), said that antimicrobial resistance was a global crisis, and the situation was getting worse. Last month, an increase in the number of drug-resistant pathogens forced the WHO to revise its treatment guidelines for chlamydia, syphilis and gonorrhoea. On current trends, a common disease like gonorrhoea might become untreatable, she said, noting that the crisis could be succinctly summarized. The misuse of antimicrobials, including their underuse and overuse was causing those fragile medicines to fail. The emergence of bacterial resistance was outpacing the world’s capacity for antibiotic discovery.
Over the past half century, only two new classes of antibiotics had reached the market, she continued. With few replacement products in the pipeline, the world was heading towards a post-antibiotic era where common infections would kill. Superbugs, resistant to nearly all currently available medicines, had already haunted hospitals and intensive care units in every region of the world. In 2015, the World Health Assembly had approved a global action plan for combatting antimicrobial resistance. “What we must see now is the action,” she said, adding that incentives must be found to recreate the prolific era of antibiotic discovery that had taken place from 1940 to 1960. Consumers had to stop demanding antibiotics when they had a viral infection, and doctors must stop prescribing them. More vaccines were needed to prevent infections in the first place.
JOSÉ GRAZIANO DA SILVA, Director-General of the Food and Agriculture Organization (FAO), welcoming the political declaration, said it provided guidance for the international community on how to tackle antimicrobial resistance comprehensively and multisectorally. As antimicrobial resistance had been threatening human health, it was essential that the international community take responsibility and address that threat in a sustainable way. Describing the global monitoring system as weak, he stressed that the FAO was working closely with partners, including international organizations, regional groups and academia. In addition, the FAO had recently adopted an action plan, promoting best practices that would protect consumers. The plan also stressed that the veterinary and medical sectors had an important role to play.
MONIQUE ELIOT, Director-General of the World Organization for Animal Health, said the prevention of antimicrobial resistance and the prudent use of antibiotics in animals was one of the organization’s key responsibilities and activities. She emphasized the need for sharing good practices as alternative approaches existed. “How can we turn this into action in the field without endangering human and animal lives?” she asked, calling upon the international community to engage in dialogue and cooperation. Her organization had designed a new strategy to fight antimicrobial resistance, protect the effectiveness of antimicrobials used in veterinary medicine, and help maintain the efficacy of the molecules used in human medicine. However, successful outcomes required sustainable change at the national level with long-term political support.
Panel I
This morning, the high-level meeting held two breakout panel discussions, which heard from Government representatives, as well as members of civil society and the business community. The first, entitled, “Relevance of addressing antimicrobial resistance for the achievement of the Sustainable Development Goals, in particular the health-related Goals”, was moderated by James Chau, News Broadcaster and WHO Goodwill Ambassador for Sustainable Development Goals and Health. It featured Vytenis Andriukaitis, European Union Commissioner for Health and Food Safety; Veronika Skvortsova, Minister of Health Care of the Russian Federation; Cleopa Mailu, Cabinet Secretary for Health of Kenya; Joanne Liu, International President of Médecins Sans Frontières; Andrew Witty, Chief Executive Officer of GlaxoSmithKline; and Martin Khor, Executive Director of the South Centre.
Mr. CHAU said discussions on antimicrobial resistance should move away from placing blame on any one sector and instead focus on the international community’s historic responsibility to reverse it, which could potentially save millions of lives. Today’s meeting aimed to bring the highest level of political attention to the issue, he said, asking the panellists to focus their responses on the challenge of antimicrobial resistance in the context of the Sustainable Development Goals.
Ms. SKVORTSOVA said antimicrobial resistance was an acute concern for the Russian Federation. The country had taken part in negotiating international action plans to eradicate the phenomenon, as well as today’s Political Declaration. At the national level, it was engaged in an intersectoral approach, including the reduction of antibiotic use in agriculture and veterinary practices. Among other things, it had been working with the medical community to put in place preventive measures for communicable diseases, as well as vaccine plans, and it had adopted a procedure to govern the use of antibiotics and help doctors use electronic software. Investment was needed in health innovations to quickly identify cases of resistance and develop new-generation medicines based not on the killing of organisms but on blocking the spread of infection and preventing the emergence of antimicrobial resistance.
Mr. KHOR, noting that “super-resistance genes” had been discovered, added that the overuse of antibiotics could speed up that natural resistance. Such genes could spread from one pathogen to another and were causing great alarm in the scientific community. “We have not taken the action that we needed in the last 30 years,” he said, stressing that antimicrobial resistance presented a particular crisis for developing countries. In those nations, where people suffered disproportionately from certain diseases, it was projected that approximately 9 million people would die from antimicrobial resistance in the coming decades. Noting that developing nations often lacked the knowledge, finance and technology to tackle the issue, he said a key question going forward would be whether they would have access to new medications being developed.
Mr. MAILU warned that low- and middle-income countries could easily see the erosion of health gains, especially with regard to the control of HIV/AIDS, tuberculosis and malaria. Coupled with low investment in research and development, antimicrobial resistance could lead to a resurgence of mortality rates. Expressing concern about the food security situation of developing countries — as antimicrobial resistance also affected animal health and agriculture — he underscored the urgent need to act now to address those issues.
Mr. ANDRIUKAITIS emphasized that various actors from across a number of sectors needed to work together in a “one health” approach to antimicrobial resistance. Recalling that the use of antibiotics as growth promotors was banned at the European Union level, he warned against the overuse of antibiotics and the use of such drugs without a prescription. Such actions could have tragic consequences. The European Union had put in place a six-year action plan, which was a good model of cooperation between sectors. Calling for that type of cooperation around the globe, he added that awareness campaigns were needed to encourage action on the part of many different actors.
Ms. LIU said her organization’s major concern was that “my medicine cabinet is bare”. Too often, doctors found themselves saving the lives of a mother and child only to later lose the baby to sepsis, or treating war wounds only to see patients die from infection weeks later. “Doctors are running out of options,” she said, stressing that antimicrobial resistance was a medical emergency and should not be portrayed simply as a security threat. Indeed, the issue was a public health failure and, therefore, a public responsibility. In that regard, she called on Governments — who were ultimately responsible for the health of their citizens — to step up and act.
Mr. WITTY said GlaxoSmithKline had been involved in antibiotic research for 70 years, but no new class of antibiotic had been introduced by the industry in a decade. While many such drugs had been discovered, they had ultimately failed because they were toxic to humans. “We need completely new approaches” including strengthening the human response instead of killing the bug, he said. A newly developed molecule, which was now moving into phase III development, had initially proved highly effective against such illnesses as complex gonorrhoea and offered a ray of hope. Nevertheless, all actors needed to work together in a more coordinated way.
Asked to address the issue of drug pricing and accessibility, he said not enough new drugs had been discovered to drive research over the last 20 to 30 years. Meanwhile, there had been an explosion in other health research fields, such as oncology. The business sector must create more sustainable methods of development, he said, recalling that it had nevertheless made giant leaps in such areas as vaccinology. “It’s not all doom and gloom,” he said in that regard.
Ms. SKVORTSOVA, responding to a question on whether a holistic “one health” approach was indeed the way forward, said her country was prepared to work with multiple partners to address the issue of antimicrobial resistance at the global level.
Asked whether he was optimistic that a global approach could help people in both the global North and South, Mr. MAILU said that, besides the global approach, countries should be supported to address antimicrobial resistance at the national level. An inter-agency mechanism was needed to help coordinate that effort, ensuring that resources were available and that approaches cut across societies to address the needs of all people. Calling for awareness-raising campaigns to improve the prescribing habits of doctors, he warned that many physicians around the world were still “prescribing in the dark” as they lacked the proper diagnostic tools.
To a question on how to educate practitioners and the general public on antimicrobial resistance, Mr. KHOR said that, while today’s Political Declaration represented an important milestone, some international organizations had not yet stepped up and taken the issue of antimicrobial resistance seriously. For example, a 2001 WHO action plan on the matter had not been implemented due to lack of resources. Forty years of inaction had led to a crisis, he said, likening antimicrobial resistance to climate change. The international community must look at barriers to implementation, in particular among developing countries, which had limited resources. “We need leadership from the North to help the South to help themselves,” he said, calling for a research and development system that would ensure developing countries’ access to new medication.
Ms. LIU, asked about the impact of social and political activism in the case of HIV/AIDS and whether such action was also needed to confront antimicrobial resistance, said the convergence of politics, science, activists and patients had indeed led to affordable, accessible HIV/AIDS drugs. “A political choice is needed,” she said in that regard. However, international agreements did not always yield results, as had been seen recently when a Syrian aid convoy was attacked soon after the Security Council had voted to adopt a resolution to prevent the targeting of hospitals and medical facilities.
Asked for a private-sector perspective on the issue of political will, Mr. WITTY cited several inspiring examples of industry collaboration, including recent progress in addressing tropical diseases. Most people had learned huge lessons from the HIV/AIDS crisis. Today, drug companies did not claim intellectual property rights in the world’s 65 poorest countries, and they took a graduated approach to drug pricing.
Mr. CHAU then asked the panellists what they saw as the most important steps to address antimicrobial resistance going forward.
Mr. MAILU, responding, said Kenya was already implementing a national action plan for antimicrobial resistance. As health minister, he would provide leadership and coordination and ensure that appropriate resources were allocated.
Mr. KHOR said he would reach out to the Governments of developing countries, helping them to craft and implement national action plans. It was also important to reach out to the WHO and other partners who had the experience to help with data and capacity. Most importantly, civil society must be empowered, which would drive political awareness and will.
Mr. ANDRIUKAITIS said people in politics must show leadership to create broad coalitions on public health issues. New laws, guidelines and regulations were needed on the proper use of antibiotics, cooperation, implementation and control.
Ms. SKVORTSOVA, stressing that countries should engage all parts of society, said the Russian Federation was ready to create a global committee on antimicrobial resistance through the United Nations and to provide training and other assistance to developing countries.
Mr. WITTY said he would continue to work and strongly advocate within his industry to promote the responsible use of antibiotics and seek ways to sustain innovation while improving access.
Ms. LIU said doctors needed access to vaccines and medication, as well as political support. Physicians needed to be part of the solution, she stressed.
The representative of Switzerland said a coordinated, one-health approach was critical to reverse the trend of antimicrobial resistance, which challenged the sustainability of current responses to diseases such as tuberculosis and malaria. Preventive measures, alternative treatment for infections and new diagnostics were needed. Switzerland had adopted a new five-year programme in that regard, he said, adding that research and development also needed to be financed at a greater scale.
The representative of the United States said antimicrobial resistance threatened progress in many areas and affected the poor the most. However, it was not too late to reverse the trend. The international community must work together, setting concrete, measurable and ambitious goals. Among other things, rigorous surveillance was needed, as were improved antibiotic use and innovation on infection control, vaccines and diagnostic tools.
Panel II
The day’s second panel discussion, on “Addressing the multisectoral implications and implementation challenges of antimicrobial resistance in a comprehensive manner”, was moderated by Mr. Chau. It featured Erna Solberg, Prime Minister of Norway; Jorge Lemus, Minister for Health of Argentina; Paulyn Jean Rosell-Ubial, Secretary of the Department of Health of the Philippines; Keith Hansen, Vice-President of Human Development of the World Bank Group; Timothy Evans, Senior Director of Health, Nutrition and Population Global Practice at the World Bank Group; Martha Tellado, President and Chief Executive Officer of Consumer Reports; and David George Velde, Board Member of the World Farmers Organisation and Vice-President of the United States National Farmers’ Union.
Ms. SOLBERG said “if you want to work together, you have to speak with each other”. As a small country, Norway was not using antibiotics in chicken production. Some developing and developed countries still did not have statistics about antibiotics use or they were not transparent, she said, adding: “We cannot hide information from people.” In that regard, scrutiny and surveillance, as well as international discussion, was necessary to address the problem and make progress. With its 5 million citizens, Norway was combatting the overuse of antibiotics, she said, calling for an international ban.
Mr. HANSEN, said that the World Bank had issued a report this week stressing that drug-resistant infections had the potential to cause significant economic damage. The research had shown that antimicrobial resistance could cause low-income countries to lose more than 5 per cent of their gross domestic product (GDP) and push as many as 28 million people, mostly in developing countries, into poverty by 2050. It was a great concern for the world, he said, emphasizing the lack of global coordination and surveillance. As there was still a lack of access to basic life-saving drugs, he called for setting a standard for access. Citing an example from a project that had taken place in East Africa, he said that it would be an exemplary model for transparency.
Mr. VELDE said that farmers did not have direct relations with customers. Rather they produced basic agricultural commodities mostly through processing chains that were then made available to consumers. “Farmers are also human beings,” he said, stressing that they shared health concerns with others. In that regard, it was essential that the international community did not put a disproportionate burden on them. On addressing challenges of antimicrobial resistance in a comprehensive manner, he noted that he had seen an advertisement recently in which poultry producers were using herbs such as thyme and oregano to control animal diseases.
Ms. ROSELL-UBIAL emphasized the need to set international standards. The Department of Health in the Philippines had created a three-year action plan with a view to localizing the global agenda, outlining timelines, targets and costs of each activity. “If we fail to plan, we are planned to fail,” she said. The best way to implement the action plan was to ensure commitment at the highest political level. It was critical to market the idea of a surveillance and feedback system.
Ms. TELLADO said the public health was a shared goal and awareness-raising and transparency about that goal were critical. While Norway had launched best practices to address antimicrobial resistance, campaigns in the United States were focusing instead on preventing animal diseases. It was shocking that half of the world’s antibiotics were given to farm animals. According to the latest Consumer Report, there was a huge gap between progress in reducing antibiotics use in farm animals in the United States and the recognition of global standards for their use. In some cases, information about outbreaks of animal diseases in the United States was not available to the public. Nevertheless, “We are seeing tremendous progress in chicken,” she said, noting that McDonald’s had completely eliminated antibiotics use in chickens served at its restaurants.
Mr. LEMUS said appropriate national legislation governing antibiotics use was essential. “We have a major problem in Argentina,” he said. “We are fighting against irresponsible use of antibiotics.” To address that, the Government had established a commission in the Ministry of Health and the Ministry of Industry. The main problem was to ensure surveillance and sustainable funding. As a major provider of protein, Argentina wanted to monitor meat production closely. “We have more cows than people,” he said.
In the ensuing dialogue, many speakers stressed the need for global awareness campaign and cross-sectoral policy coherence.
Mr. LEMUS, in response, said that addressing antimicrobial resistance must be done at the intersectoral level. The political declaration would provide guidance to all.
Ms. TELLADO, expressing hope about the future, stressed that the Consumer Reports’ campaign thus far had contributed to the discussion.
Mr. EVANS said ensuring coordination at the multisectoral level was not specific to addressing antimicrobial resistance.
Ms. ROSELL-UBIAL said her country would soon host a meeting on climate change. So far, 50 ministers from all around the world had confirmed their participation.
Mr. VELDE said education was essential in various sectors, including food processing, farming, health care and veterinary science. It provided the opportunity to be powerful.
Also speaking today were representatives of the United Kingdom and Finland.