The rapidly rising antibiotic resistance challenge requires the world’s urgent collective response. The coming years will be instrumental for shaping the future governance of how the global community and individual countries are going to manage the risk of losing effective antibiotics as a global public good. This piece looks at where we stand on the path towards the UN General Assembly 2019 where antimicrobial resistance will be on the agenda.
Last week, on October 1-2 the WHO held Member States consultations on the draft Global Framework for Development & Stewardship to Combat Antimicrobial Resistance in Geneva. In a separate process, the inter-agency coordination group (IACG) on Antimicrobial Resistance (AMR) is developing recommendations on the future coordination of antimicrobial resistance and how to ensure sustained action to address the challenge.
This piece looks at where we stand on the path towards the UN General Assembly 2019 where antimicrobial resistance will be back on the agenda and whether current Member States engagement in these processes will suffice for taking the steps forward needed to secure sustainability in the global response to antimicrobial resistance.
AMR on the cusp of global attention
The global community was late to the table to pick up on the problems of antibiotic resistance. Placing antimicrobial resistance at the high-level meeting of the United Nations General Assembly (UNGA) in 2016 with the resulting political declaration did however momentarily give antimicrobial resistance the global attention that was needed.
Following this an unprecedented opportunity to shape the future global response to antibiotic resistance will now take place in the coming years. The question remains open however whether Member States will maintain the same political momentum that was shown two years ago.
Processes that set the path
The world is progressing on the pathway laid out by political leaders in 2016 when the UNGA called to finalize the Global Framework for Development and Stewardship and to establish the Inter-Agency Coordination Group on AMR.
The primary responsibility for the implementation of National Action Plans lies with Member States. The Global Action Plan on AMR (GAP AMR) adopted in 2015 is there to set the frame and to steer what is needed for the global coordination and normative functions across nations. The global framework for development and stewardship, together with other initiatives to strengthen and coordinate specific areas of the GAP AMR, will guide countries’ activities.
Three years down the road, the Global Framework for Development and Stewardship has identified a range of options for how to address certain challenging parts of the GAP AMR, namely research & development, appropriate use of antibiotics and affordable access to existing and new antibiotics.
The IACG which was tasked by the UNGA Political declaration in 2016 to provide practical guidance for approaches needed to ensure sustained effective global action, and how to improve the future coordination of the work on AMR is in the process of finalzsing its recommendations to the UN Secretary-General. Next year when the Member States convene at the UNGA in September, the Secretary-General will submit a report with recommendations for steps forward based on the recommendations of the IACG for their consideration.
We are therefore at a critical time, and the work done between now and then, including the level of Member States engagement with these processes in the coming 10 months will likely have strong influence for shaping the world’s response to addressing antibiotic resistance in the future.
Lack of Member State engagement
Worryingly the political priority and attention given to AMR by Member States still seems relatively low – and without a doubt below what is needed to adequately respond to this global challenge. Notably low- and middle-income countries participation is low.
When IACG released the six discussion papers for an open consultation this summer, 20 countries out of 194 WHO Member States responded. Only 7 of these responses were from the 135 low- and middle-income countries (LMIC), and none from sub-Saharan Africa or South-East Asia. There was no LMIC response to the discussion paper on the shaping of future governance for antimicrobial resistance.
The participation by Member States in the consultation on the draft Global Framework for Development & Stewardship was similarly low and discussions were limited on the first day of discussions which were open to non-state actors participation. This might be explained by a range of competing big meetings on global health issues held in Geneva on the same dates, and many Member States noted that they had not had enough time to consult on the document at capital level.
Regardless of these contributing factors, the deep and enthusiastic engagement by Member States seems limited to only few high-income countries. As much broader engagement in these processes will be needed to sufficiently reflect the challenges of perspectives of all countries – in particular LMICs. Without this there is also a risk that the recommendations put forward at the UNGA will not receive sufficient support.
The way forward must be driven by all countries
It looks however as if antimicrobial resistance might be placed on the agenda for the WHO Executive Board meeting in January 2019 and likely also on the agenda of the World Health Assembly in May next year. This would be good news and would be a positive opportunity to revisit the issues twice ahead of the UNGA meeting in September. If antimicrobial resistance ends up on the agenda of the World Health Assembly in May 2019, it coincides with the time where the IACG will report back its recommendations to the UN Secretary-General. This will provide an important opportunity to gain further momentum and support for agreeing on sustained action to address antibiotic resistance beyond UNGA 2019.