Course: Antibiotic Resistance - The Silent Tsunami  –  Part 4

Global initiatives to fight antibiotic resistance

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Over the last few years, political commitment to address antibiotic resistance has markedly increased. Antibiotic resistance is now widely recognized as a major threat to global health and therefore countries and international actors increasingly recognize the need to work together to find sustainable solutions.

Global policies are often used in advocacy initiatives to remind countries of their global commitment to antimicrobial resistance and to hold governments accountable to track progress towards managing these commitments. With the onset and fast pace of globalization, global governance helps address issues that affect all countries regardless of borders.

The Sustainable Development Goals (SDGs) are one set of global commitments that include 17 goals that affect all countries. Global coordination and collaboration are necessary to fulfill the goals. It will be impossible to achieve these goals without addressing antimicrobial resistance. In 2019 a new indicator was added to the SDG framework specifically addressing resistance (Indicator 3.d.2: Reduce the percentage of bloodstream infections due to selected antimicrobial resistant organisms).

Antimicrobial resistance and antibiotic resistance

Antimicrobial resistance is a wide term that includes resistance in different microorganisms to their respective treatment: Antibiotics for bacterial infections including TB, antivirals for viral infections, antifungals for fungal infections and antiparasitic agents for parasite infections. Global discussions on antimicrobial resistance today are in fact often about antibiotic resistance, as this is the most urgent global risk requiring increased attention and global coordination.

Antimicrobial resistance global governance timeline

Recent global efforts to address antimicrobial resistance began in 1994 with scientific working groups convened by the World Health Organization (WHO). The WHO released the first global strategy on antimicrobial resistance in 2001. Global uptake was slow and fifteen years later, the WHO released the Global Action Plan (GAP) on Antimicrobial Resistance. The GAP marks a transition from encouraging countries to develop national solutions towards a greater harmonization of national and international strategies. Also released in 2015, were Global Action Plans from the Food and Agriculture Organization of the United Nations (FAO) and the World Organisation for Animal Health (WOAH, founded as OIE). Together the three organizations are known as the Tripartite.

In 2016, Heads of States, during the United Nations General Assembly (UNGA), signed a political declaration on antimicrobial resistance committing to a broad multisectoral approach. That is, in agriculture, human and animal health – to strengthen regulation of antimicrobials, improve knowledge and awareness, promote best practices and to foster innovative approaches using new technologies in diagnostics and vaccines. This was only the fourth time in history that a health topic was discussed at the UNGA. Shortly thereafter, the UN Secretary General convened the Interagency Coordination Group (IACG) on Antimicrobial Resistance. The IACG submitted their recommendations to the UN Secretary General in April 2019.

In 2022, the United Nations Environment Programme (UNEP) became an official partner of the Tripartite (WHO, FAO, and WOAH) to form a new Quadripartite Collaboration for One Health. This quadripartite collaboration aimed to encourage countries to develop and implement their National Action Plans on AMR with a One Health approach.

IACG Recommendations

The IACG on Antimicrobial Resistance were tasked with outlining a blueprint of how to tackle resistance. The IACG included stakeholders across the UN, international organizations and individuals with expertise in human, animal and plant health, as well as the food, animal feed, trade, development and environment sectors. On 29 April 2019, the IACG completed its mandate upon submission of its report to the Secretary-General. The report included recommendations around five central themes outlined in the box below:

Themes and main recommendations of the IACG

  1. Accelerating progress in countries: Member states need to accelerate their progress on development and implementation of AMR National Action Plans
  2. Innovating to secure the future: Intensify efforts to support research into the development of new antimicrobials, diagnostics, vaccines, waste management tools, and safe and effective alternatives to antimicrobials across the One Health spectrum with sustained investment and the aim of equitable access.
  3. Collaborating for more effective action: Strengthen the systematic engagement of civil society and the private sector to optimize their contributions to the response to antimicrobial resistance, including working with national governments.
  4. Investing for a sustainable response: Develop innovative approaches to mainstream antimicrobial resistance-related activities and leverage resources from existing funding streams, as well as to mobilize new and additional funding including domestic financing commitments by national governments.
  5. Strengthening accountability and global governance: Create a platform that will raise the profile and urgency of addressing antimicrobial resistance; build and maintain political momentum and public support; enable more comprehensive monitoring of the science and evidence related to antimicrobial resistance; ensure accountability among all stakeholders; and recognize the central role of national governments.

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