During the 70th World Health assembly held in Geneva in late May, 60 countries and 11 non-state actors took the floor in what ended up being a 3-hour long debate on antimicrobial resistance. The debate touched on progress in developing national action plans and challenges in their implementation; support and concerns over the joint WHO, OIE and FAO progress document on the Development and Stewardship Framework as well as the newly established ad-hoc UN Inter-Agency Coordination Group. Countries also discussed and adopted a resolution on sepsis and even agreed on a dedicated AMR budget line in the increased overall WHO budget for 2018-19.
ReAct supported the intervention given by Medicus Mundi International together with other members of the Antibiotic Resistance Coalition to the assembly. Together with a group of other organizations, ReAct also co-sponsored a side-event which filled the room at Palais des Nation and explored the role and perspectives of civil society and developing countries in tackling antimicrobial resistance.
National action plans – biggest task still ahead
With 77 countries done and 52 in progress with developing national action plans it was clear from the discussions that many countries now feel overwhelmed by the prospect of actually implementing their plans. Calls for technical and financial support for this next phase from the WHO was repeated over and over again from the floor.
The Republic of Congo noted that the disease and expense burden that AMR places on their health system is a great challenge and the overall lack of resources in the country slow the development of their national action plan. Fiji noted that getting the One Health approach right was particularly difficult for them given the lack of national veterinary and food safety expertise and called on FAO and OIE to provide better guidance.
In responding to the debate at the end the WHO Secretariat announced that a meeting will be held for remaining countries who have yet to get started on their national action plans in the coming weeks to understand the barriers and how the WHO could support countries in overcoming them.
Continued divide on Development and Stewardship Framework
The discussions revealed that the divide on the vision for the framework between developed and developing countries, which first emerged during the negotiations for the UNGA Declaration on AMR in New York, now spills over to the Development and Stewardship Framework. High-income countries on one side expressed support for the scope and the stepwise approach outlined by the WHO Secretariat in the joint WHO, OIE and FAO framework document. Conversely, countries like Brazil, India and Algeria expressed concern about the discussion and the document focusing too much on controlling production facilities and stewardship and too little on improving affordable access to antibiotics in all countries.
Brazil compared the document to the UNGA Declaration and lamented that its strong emphasis on access, affordability and delinkage, as it was defined in the Declaration, was not equally reflected in the document. India argued that the framework instead of being an expert and secretariat driven process should be made an intergovernmental process. Algeria took the floor to urge that the framework should align more closely with the recommendations made in the UN High Level Panel on Access to Medicines on research and development. The United States, as the only country, called into question the WHO’s authority to implement the framework.
One slightly more unifying point however seemed to be the call from many countries on the need to ensure that the framework also addresses how old, but still effective antibiotics, are maintained on the market in all countries.
Sepsis resolution adopted
Delegates also agreed on a resolution on sepsis asking WHO to develop guidance on sepsis prevention and management, and provide country support in building and strengthening their capacities and strategies to reduce sepsis cases.
Calls for more transparent UN Interagency Coordination Group on AMR
Finally the discussions touched on the recently established ad-hoc UN Inter-Agency Coordination Group which had its first convening in the beginning of May. Several countries noted their high expectations on the group delivering clear and concrete outcomes. However, many countries, including Canada and Sweden, also noted their eagerness to get more clarity on the role and scope of work of the group.
Civil society organizations, which delivered interventions to the assembly, called for broader agency inclusion – in particular, the need to include UNDP was noted given their presence at country level and their catalytic role in the process around the UN High Level Panel on Access to Medicines. Following calls on the WHO secretariat from several civil society interventions to amend the terms of reference of the group, the document has since been changed to mention a broader set of stakeholder than just industry to consult on key topics.