News and Opinions  –  2016

4 key asks for the High-Level Meeting on AMR

2016-11-25

16 September 2016

On 21st September 2016, Heads of States will convene at the United Nations High-Level Meeting on AMR (antimicrobial resistance) to discuss how countries can collaborate to preserve sustainable global access to effective antibiotics.

This represents an unprecedented opportunity as AMR is only the 4th health topic ever discussed on this global forum after HIV/AIDS (2001), non-communicable diseases (2011) and Ebola (2014). The meeting follows on the adoption by all Member States of the Global Action Plan on AMR, which also calls for UN-engagement.

The meeting will reflect on two important perspectives in the scope of its two panels – one on the relevance of addressing AMR for the achievement of the SDGs and the other on addressing the multisectoral implications and implementation challenges of AMR in a comprehensive manner.

4 key asks from ReAct

For a long time, ReAct has advocated for 4 key asks that we believe are essential:

1. Need for transparent monitoring of antimicrobial access, use, sales, prescriptions, trade, and resistance patterns to inform national and global policies on AMR;

2. Need to overcome the rapidly declining lack of antimicrobial effectiveness, to achieve global access and affordability, and to minimize resistance development for newly developed antimicrobials by open-source global collaborations and new economic models where the recouping of costs for R&D are de-linked both from price and volume sales;

3. Need for significantly improved prescribing practices of antimicrobials in human health care and agriculture innovation through strengthened regulation and innovative stewardship approaches;

4. Need for governance and accountability at the UN level where sufficient funding and human resources are allocated for the global and national actions needed.

UN High-Level Coordinating Mechanism (HLCM) on AMR

In a commentary published in The Lancet by ReAct Europe, the Center for Disease Dynamics, Economics, and Policy (CDDEP) and others, the authors called for a UN High-Level Coordinating Mechanism (HLCM) on AMR. The HLCM would engage in advocacy, monitoring and evaluation, resource mobilization, and multisectoral coordination to support implementation of the Global Action Plan on AMR across countries.

The draft political declaration just made public

The draft political declaration (PDF) that will be adopted at the meeting was just made public. ReAct is very pleased to see that there are provisions to, among other things, create a structure for lasting global leadership. How such structure would be set up is the subject of an intense debate.

Papers outline expectations and targets

Several recent papers have also outlined expectations and targets that need to be met.

  • An editorial in Science called for more specific commitments on global targets, financing, and governance, such as that global targets for antimicrobial consumption across all countries.
  • In another editorial, published in the WHO Bulletin (PDF), authors outline three key areas for global action on AMR; namely the need for phasing out antimicrobial use in food animal production for growth promotion, surveillance and monitoring of drug resistance levels and antimicrobial use, and improved sanitation and access to clean water.
  • In an article published in the Transactions of the Royal Society of Tropical Medicine and Hygiene, authors across universities around the globe as well as the Food and Agricultural Organization describe AMR as both a One Health and One World issue, requiring coordinated action across sectors and countries. The authors call for interdisciplinary research to bridge the gaps in understanding between the biomedical, environmental, animal health and social sciences.
  • Lastly, a recently published Nature comment by ReAct North America, the Royal Swedish Academy of Sciences, CDDEP and others argue that the UN must reframe action on antimicrobial resistance as the defense of a common resource. The authors stress the importance of national commitments to broad and creative participatory education campaigns about resistance and the microbial world itself. Informed decision-making via routine-surveillance initiative on a global scale will also be instrumental. Looking at global governance analogies, authors identify model set up by UNAIDS in 1996 as an example of how to intensify collaboration, leverage resources, involve more parties and reduce barriers in the process of establishing a HLCM.

The declaration however is only the first step in a long journey. To fulfill the key asks, strong political commitment is crucial and sufficient resources need to be made available.