Governance structures on antibiotic resistance including sufficient funding to implement national action plans, are transparent, accountable and responsive to low- and middle-income countries needs; and have a framework in place to actively engage with civil society.
Governance of antibiotic resistance
Why is this important?
Collective action on antibiotic resistance within and across countries and among sectors is today to a large extent absent and the mobilization across the UN system has not moved as fast as it should. Antibiotic resistance transcends the capabilities of the Quadripartite organizations (World Health Organization-WHO, World Organisation for Animal Health-WOAH, Food and Agriculture Organization-FAO and United Nations Environment Program-UNEP) and requires the involvement and policy coherence of other relevant United Nations organizations, the World Bank, and other multilateral and regional agencies as part of globally coordinated action. The progress on the Global Action Plan as well as on developing and implementing National Action Plans has been very slow. Lack of coordination, political commitment and guidance both on national as well as on global level have been identified as key reasons for this.
In 2020, the One Health Global Leaders Group (GLG) was formed. However, it has a limited mandate, acting mainly as an advocate for action, and has little transparency and carries no accountability. Stronger governance mechanisms on several levels are required to secure sustainable access to effective antibiotics for all in need. It should contain global agreements on targets and indicators to reduce inappropriate consumption of antibiotics in human and animal sectors contextualized to the resource settings.
Needed: An independent, transparent, expert-led process
An independent, transparent, expert-led process including representation and voice of civil society, and of low- and middle-income countries, should monitor accountability by identifying shortfalls in performance. Furthermore, there is a clear lack of civil society voices from the low- and middle-income countries that can increase awareness about the challenges faced by the global South in implementing and sustaining interventions mentioned in the action plans on AMR. Taking measure of progress in tackling antibiotic resistance is critical, both to set priorities and milestones. ReAct has participated in key policy processes to put in place such measures. We have brought low- and middle-income countries and civil society perspectives into WHO-NGO dialogues and consultations. We have organized joint position statements supported by members of the Antibiotic Resistance Coalition. Collectively, this work is laying the foundation for ReAct to build up an “ABR Watch” approach.
An intergovernmental agreement has been identified as pivotal to be able to pursue a collective vision and install a sustainable governance for the response to antibiotic resistance.
How can ReAct achieve change?
Engage and support key actors
We will proactively engage political leaders and policy makers to increase their awareness and knowledge on antibiotic resistance, specifically on why supporting NAP interventions are key and the need for immediate response to contain antibiotic resistance.
Initiate policy dialogues
We will initiate policy dialogues publicly and bilaterally with high level decision makers and other key actors to advocate the need for global agreements, and call for stronger and coordinated actions among UN agencies.
Bring together communities, academia and civil society
We will bring together communities, academia, civil society and other relevant actors to analyze and define key components of such agreements.
Analyzing existing data
We will invest in the “ABR Watch” approach by analyzing existing data where available, and making them actionable in the call for greater transparency of governance on different levels, including in NAP work.
What do we want to see?
Global agreements with strong accountability and targets
Intergovernmental global agreements with strong accountability mechanisms in place, including targets for access and conservation, have a stronger root among relevant actors.
Global agencies to track progress and have transparent milestones
The Quadripartite agencies (WHO, FAO, WOAH and UNEP) and other agencies (e.g., UNICEF, UNDP, UNESCO, World Bank) will increasingly adopt measures for tracking progress in tackling antibiotic resistance, make transparent milestones, and be held accountable to these goals.
Independent mechanism for accountability
An independent mechanism for accountability is established to evaluate the policy landscape and identify barriers to efficient and transparent governance structures, including for NAP implementation.
Financing for action on antibiotic resistance
Why is this important?
One essential function of a global governance mechanism is to promote, facilitate, and support national level action. Lack of financing has been acknowledged as a major obstacle for national action and this situation will likely worsen due to the negative impact of the Covid-19 pandemic on health systems and the global economy. While many LMICs have developed NAPs, the tracking Antimicrobial Resistance Country Self-Assessment Survey (TrACSS) found that only one out of five National Action Plans had been adequately financed and implemented. It is conceivable that some expiring NAPs on AMR will undergo renewal without ever having been financed adequately in the first place. Tangible and coordinated funding for national actions therefore needs rapid expansion. To ensure national sustainability and accountability on commitments, domestic resources proportional to the individual country’s capacity must be mobilized.
In December 2018, ReAct and the Dag Hammarskjöld Foundation convened key stakeholders and experts together to discuss the need for sustainable and coordinated global financing for antibiotic resistance, and this gap was also addressed in the recommendations from the UN IACG’s report a few months later.
Needed: Stronger financial commitments to LMICs
While the establishment of the Multi-Partner Trust Fund in 2020 has been a positive first step, the level of tangible support to low- and middle-income countries is far from sufficient. Stronger financial commitments are needed, for example, from the World Bank and through expanding the mandate of the Global Fund to Fight AIDS, Tuberculosis and Malaria, GAVI, and UNITAID to assist countries with planning and implementing National Action Plans including on improving surveillance, pharmaceutical regulation, access to antibiotics, diagnostics, and vaccines. The response to the COVID-19 pandemic may open the door to investments synergistic with tackling antibiotic resistance through improved surveillance, local production of essential medicines, and infection prevention and control measures.
Real change through cross-sectoral actions and investments in countries
In order to achieve real change, countries must make individual and collective commitments for action through a range of cross-sectoral actions and investments. The resources, capacity, and knowledge needed to implement and sustain action differ across countries. Therefore, there is a need for global support in providing funding, normative guidance, and technical assistance. It is important that such catalytic funding is not seen as a “vertical” programme, but as a support for the gradual strengthening that is needed in health, livestock production and environmental systems to mitigate antibiotic resistance and secure access. Meanwhile, countries must be held accountable for the commitments made and progress should be monitored and reviewed at both national and global level. Monitoring for accountability is key to making the case that financing efforts to address antibiotic resistance will return health and economic dividends.
How can ReAct achieve change?
We will advocate for local resource mobilization, building upon the momentum and potential synergy with pandemic preparedness, prevention and response and leveraging on the support given to regional bodies and governments during the COVID-19 pandemic.
We will interact with donors such as the World Bank and the Multi-Partner Trust Fund, and national governments, sharing experiences from ReAct’s NAP implementation support work in countries underlying the needs for support and financing of NAP implementation.
We will investigate how an antibiotic resistance intervention package might be integrated as a cost-effective component of universal health care efforts in low- and middle-income countries settings or advanced through innovative financing approaches.
What do we want to see?
Intergovernmental organizations, ministers of finance, donors and development actors, will prioritize investments for National Action Plans on AMR at the country level in a sustainable and coordinated way.
Financing antibiotic resistance becomes more visible in the global and country financing landscape with an increase of synergistic investments, cost-saving intervention packages and innovative financing approaches.