Investing to deliver on the objectives of the Global Action Plan on Antimicrobial Resistance is urgently needed. The return of economic and health investments in managing antimicrobial resistance will be large and are needed across several sectors to minimize the negative impact of antimicrobial resistance. The current lack of a ‘go-to-place’ for funding the implementation of National Action Plans on Antimicrobial Resistance poses high risks in weakening global political momentum and delaying urgent actions. A sustainable financing mechanism for antimicrobial resistance interventions and capacity building should be called for by low- and middle-income country governments and made accessible by international donors and investors.
Since 2018 when this article was written,The Multi-Partner Trust Fund has now been established. But for a sustainable change, further commitment is needed – antibiotic resistance needs to be addressed at all levels and with strong financing.
Sustainable investments are needed across the range of interventions necessary to address antibiotic resistance. This includes investing in developing new antibiotics, diagnostics, vaccines and other health technologies, and more importantly, investing in strengthening health, agriculture, regulatory and financial systems holistically.
A convincing narrative for sustainable investment in antimicrobial resistance
An effective and sustainable antimicrobial resistance response requires strong evidence that clarifies the consequences of antimicrobial resistance which may undermine important global development gains made over the last decade. A convincing narrative need to show how building the antimicrobial resistance components into development programs can become a lever for averting negative impact of antimicrobial resistance and catalyzing public investment returns.
The economic simulation from the World Bank has projected an average 3.8% annual GDP loss globally from 2017 to 2050 under a high antimicrobial resistance impact scenario. Low-income countries will be hit the hardest, by 5% GDP losses. An additional 28.3 million people could be forced into extreme poverty by 2050 as a destructive result from antimicrobial resistance and the vast majority (26.2 million) will live in low-income countries. Livestock production in low-income countries are especially vulnerable to antimicrobial resistance impacts and would decline the most with a possible 11% loss by 2050. The annual costs for health care expenditures may exceed the base-case level by 25% in low-income countries.
The World Bank considers funding antimicrobial resistance an exceptional economic and health investment for countries. It projected a high rate of return of 88% per year, if 75% of negative effects of antimicrobial resistance could be avoided. The recent OECD report also highlights that investing in public health actions to tackle antimicrobial resistance is a good investment that produces additional savings and substantial health gains by investing in building capacity, changing practices, scaling up stewardship programs, awareness and knowledge sharing, improving hand hygiene and water, sanitation and hygiene.
Objective 5 of the Global Action Plan on Antimicrobial Resistance (GAP):
“… develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions”
UNGA Political Declaration on Antimicrobial Resistance:
10(f) “international cooperation and funding to support the development and implementation of national action plans, including surveillance and monitoring, the strengthening of health systems and research and regulatory capacity, without jeopardizing, in particular in the case of low- and middle-income countries, health or posing barriers for access to care”
12(b) “Mobilize adequate, predictable and sustained funding and human and financial resources and investment through national, bilateral and multilateral channels to support the development and implementation of national action plans, research and development on existing and new antimicrobial medicines, diagnostics, vaccines and other technologies and to strengthen related infrastructure, including through engagement with multilateral development banks and traditional and voluntary innovative financing and investment mechanisms, based on priorities and local needs set by governments, and ensuring public return on investment;”
All key elements highlighted in the Global Action Plan objectives and UNGA political declaration should be incorporated into investment priorities and national budgets. However, many low- and middle-income countries still face the challenge of constrained budgets and are often largely reliant on donor funding. The funding needs are not met with adequate resources and capacities, largely due to the lack of understanding and communication of governments and international donors on the urgency and priority in financing for antimicrobial resistance.
While investments in discovery and research & development plays a critical role to guarantee a sustainable pipeline of novel antibiotic compounds, a holistic approach is required to look downstream of research & development to address challenges in regulatory practices, manufacturing, producing enough quantities that can meet environmental standards, purchasing, marketing, devising models for controlled purchasing, distribution and use in particular in countries with weak systems and infrastructure.
To effectively leverage resources and get the healthcare and food producing systems moving in addressing antimicrobial resistance, an overview of what can be done with domestic resources is needed, including the cost of human and technical resources required to implement National Action Plans on AMR, as well as areas where accessing international financing support are necessary. Granular information on current and future programs needs to be reviewed to map funding gaps and identify options of investments that can catalyze more antimicrobial resistance sensitive workstreams across sectors. This could be followed by mobilizing new funding and resources to jumpstart antimicrobial resistance specific work, as well as channelling tangible resources from existing funding streams and integrating with crosscutting programmes including health systems strengthening, water, sanitation and hygiene, infection prevention and control, sustainable agriculture, etc.
Mobilizing more and better financing for antimicrobial resistance
We need forward-looking strategies for investors, governments and their development partners to ensure that we mobilize not just more, but better financing to enable a broader range of interventions to manage antibiotic resistance in a realistic and timely manner. It is especially critical to include these considerations when countries are developing new development priorities, making/revising budgets and submitting funding requests to donors.
We pose some points here for continued efforts in exploring options on sustainable investment in antimicrobial resistance:
- Higher political engagement and clear requests from low- and middle-income countries for antimicrobial resistance needs.
- Transparency in existing project-level details by governments and development partners and using granular information to map components that will benefit work on antimicrobial resistance and monitor funding flows.
- Equip policymakers with practical information they can use to effectively manage the financing for antimicrobial resistance.
- Low- and middle-income country governments should request funding with greater specificity on development cooperation priorities.
- Funders should engage and align with national priorities of ow- and middle-income countries.
- Engage a more diverse set of actors into the discussion of financing options for antimicrobial resistance.
- Mobilize stronger coalitions at all levels to leverage resources and monitor follow-through on commitments.